Acute heart failure: symptoms before death and first aid

Annually, diseases of the cardiovascular system lead to the death of more than 17 million people around the world. Only in 10% of cases such pathologies are congenital. The vast majority of disease states occur against the background of stress and the wrong lifestyle of modern man. In this article we will understand what is acute heart failure.

Symptoms before death and complications, which lead to pathology, methods of diagnosis and treatment of the disease, types and forms of the disease - information on all these issues will be reflected in the materials of our review. In addition, the article mentions rules of behavior that can be useful to any of us. The ability to act correctly in a critical situation provides, in most cases, the preservation of life to a person. In accordance with this, everyone should know what is the first help in acute heart failure.

The concept of heart failure

Heart failure (CH) is a pathology in which the heart stops supplying the body's tissues with the necessary amount of blood. It is a consequence of the impaired ability of the heart muscle (myocardium) to contract. CH leads, as a rule, to severe clinical manifestations, including pulmonary edema, heart attack, cardiogenic shock.

Both men and women are affected, but the latter suffer more often. Mortality from pathology is high enough. The danger to human life is any of the manifestations caused by a disease such as acute heart failure. Symptoms before death, called in medicine sudden, are very diverse. They depend on what form of the disease takes place. By the nature of the origin of heart failure distinguish:

• Myocardial heart failure is a pathology that is the result of direct damage to the heart muscle due to a disturbance in energy metabolism. This type of heart failure leads to a violation of the function of contraction and relaxation of the heart.
• Transient heart failure is a pathology that develops as a result of a heavy burden on the heart. This type in a number of cases develops against the background of heart defects.
• Combined heart failure is a form of pathology that combines the causes of the two above.

Classes of heart failure

To date, there are various criteria by which the disease is divided into species or forms. Medicine knows several classification systems (Russian, European, American), but the most popular is the system proposed by US cardiologists. In accordance with this technique, four classes of disease are distinguished:

• 1 class, in which the patient has dyspnea with active movement, for example, climbing the stairs to a level above the third floor.
• 2 class, in which dyspnea appears even with a slight load - when lifting to the first or second floor. At the same time there is a decrease in physical activity of a person.
• Grade 3, in which heart failure is noticeable with minor stress, for example, walking, but at rest, the symptoms of pathology disappear.
• 4 class, in which the symptoms of the disease manifest even in a state of rest, and a slight physical strain leads to serious disruption in the work of the heart and the entire vascular system as a whole.

Classification of CH

Pathology can be classified by several features. Depending on the clinical picture of the disease, medicine knows acute and chronic heart failure.

Acute heart failure (OCH) is a disorder in which the symptoms of the pathology manifest quickly (within a few hours). As a rule, against the background of other diseases of the vascular system, acute cardiac insufficiency arises.

Infarction, myocarditis and other diseases can become a trigger mechanism of disease states, because with these pathologies the cells of the heart muscle die due to local circulatory disorders. OCH can also be a consequence of rupture of the walls of the left ventricle, acute failure of the valves (aortic and mitral). In a number of cases, pathology develops without previous disturbances.

OCH is a rather insidious disease, because it can cause painful conditions of other body systems. Complications of acute heart failure often affect not only the heart, but also the respiratory system, causing pulmonary edema, cardiac asthma, cardiogenic shock.

Chronic heart failure is a disorder in which pathology is formed gradually, for weeks, months or even years. It occurs against the background of heart disease, arterial hypertension or prolonged anemia.

Types of DOS by type of hemodynamics

Depending on the type of hemodynamics, characteristic for the site of localization of pathology, there are following forms of acute heart failure:

• OCH with congestive hemodynamics.
• OCH with hypokinetic type of hemodynamics.

Hemodynamics is the flow of blood through the vessels, which is due to the excellent pressure in various areas of the circulatory system. It is known that blood moves from a site with a higher pressure to a region with a lower one.

The pressure directly depends on the viscosity of the blood, and also on the resistance of the walls of blood vessels to the blood flow. OCH with congestive hemodynamics can affect the right or left ventricle of the heart. In accordance with this distinguish:

• Acute right ventricular failure, in which venous congestion is observed in a large circle of blood flow, ie, affects virtually all organs and tissues.
• Acute left ventricular failure, in which venous congestion occurs in a small circle of blood flow. Pathology causes disruption of gas exchange in the lungs and leads to the development of pulmonary edema or cardiac asthma. Thus, against the background of such violations, there is an acute pulmonary-cardiac insufficiency.

OCH with hypokinetic type of hemodynamics

The acute course of heart failure with a hypokinetic type of hemodynamics is a pathology caused by cardiogenic shock - a sharp decrease in the ability of the myocardium to contract, which leads to a violation of the blood supply of all tissues of the body.

Distinguish:

• Arrhythmic shock, which is the result of a disturbed rhythm of the heart.
• Reflex shock is a reaction to pain.
• True cardiogenic shock is a pathological condition that occurs when the left ventricular tissue is damaged, and the lesion is at least 50%. Violations, as a rule, are more likely to affect people over 60; People who underwent a repeated infarction; Patients with arterial hypertension and diabetes mellitus.

It is important to note that cardiogenic shock is characterized by pain syndrome, a sharp decrease in blood pressure to minimum values (up to 0), a threadlike pulse, pale skin. Pathology can later go into pulmonary edema or end with kidney failure.

Factors contributing to the emergence of DOS

The development of heart failure with acute course in a patient may be preceded by previously arisen diseases of the vascular system. Such states include:

• Heart diseases caused by damage to the heart muscle, leading to a sharp decline in the ability of the myocardium to contract;
• Chronic heart failure, in which the normal supply of blood to organs and tissues is disrupted;
• Damage to the integrity of the heart valves and chambers;
• Accumulation of fluid in the pericardial bag, which leads to a violation of the right rhythm of heartbeats due to the pressure exerted on the heart cavity (this pathology is called a cardiac tamponade);
• Thickening of the walls of the heart - myocardial hypertrophy;
• Hypertensive crisis - marked deviation of blood pressure from normal.

Non-carded reasons

In addition to heart problems, the pathology associated with increased pressure in a small circle of blood circulation may be involved in the development of disease states. Diseases leading to the diagnosis of "acute heart failure":

• Stroke - a violation of the blood circulation of the brain, which provokes damage to its tissues and a general breakdown of brain functions;

• Thromboembolism of the pulmonary artery (this disease occurs due to clogging of the pulmonary artery, as well as its outgrowths by blood clots (thrombi), most often thrombi arise in large veins of the pelvis and lower limbs);
• Lung diseases - inflammation of the bronchi (bronchitis), inflammation of the lung tissue (pneumonia);
• Violation of the rhythm of heartbeats (acceleration or deceleration) - tachyarrhythmia, bradyarrhythmia;
• Infections caused by various pathogens.

There are also factors that lead to the development of HF, but are not a manifestation of diseases of any body systems. These include:

• Operative intervention;
• Trauma and brain damage;
• Toxic attacks on the heart muscle - alcohol, aggressive medicamentous effects;
• Apparatus of artificial circulation, the use of which leads to certain consequences;
• Electric trauma - the effect on the body of electric current;
• Psychoemotional or physical stress.

Diagnosis of acute heart failure

Diagnosis of heart failure is primarily aimed at establishing the causes that led to the development of pathology. Before conducting laboratory studies and manipulations with the use of medical equipment, the doctor determines, by talking with the patient, the presence or absence in his life of certain factors contributing to the development of such pathology as acute heart failure. Symptoms before death (sudden) occurring within 24 hours may be poorly manifested, and the task of a specialist is not to waste time, but, having taken into account all the patient's complaints, to establish a correct diagnosis as soon as possible.

The main methods of research used in the diagnosis of OSS include:

• Electrocardiogram;
• Echocardiogram;

• Chest X-ray;
• General and advanced blood test;
• Sometimes a cardiovisor is used for the diagnosis of OSN, a device whose principle of operation does not differ from an electrocardiograph.

Criteria for diagnosis

The main and most pronounced sign of the acute course of heart failure can be called sinus tachycardia - the form of supraventricular tachyarrhythmia, for which the accelerated sinus rhythm is characteristic - the frequency of heart contractions in an adult person exceeds 100 per minute. Graphic representation of cardiac activity illustrates the widened border of the organ to the left or to the right. In addition, a third tone appears on the top or above the xiphoid process .

Acute congestive right ventricular failure is manifested by several symptoms:

• Cervical veins and veins of the liver swell and swell;
• High venous pressure;

• Enlargement of the liver, icterus of the integument;
• Swelling of the extremities;
• Cyanotic fingers, face (ears, chin, nose tip);
• The patient experiences severe pain in the hypochondrium on the right;
• ECG of the heart fixes sharp overloads of the right ventricle and atrium, which is expressed by high pointed teeth.

Signs of right ventricular failure are clearly revealed by X-ray examination and electrocardiogram. The final stage of this type of heart pathology leads to exhaustion of the body, a decrease in the level of protein in the blood and a violation of the salt balance in the human body.

Signs of left ventricular failure and cardiogenic shock

In turn, the presence of acute left ventricular failure with congestive hemodynamics is indicated by a number of the following features:

• Shortness of breath, sometimes choking;
• Paroxysmal dry cough, sometimes with foamy sputum, which is released from the mouth or nose;
• The presence of wet wheezes, which are tapped over the entire surface of the chest.

There are a number of characteristic symptoms of cardiogenic shock, namely:

• Arterial pressure in the patient falls to values of 90-80 mm Hg. Art. And even less. If a person suffers from arterial hypertension, then a sign of shock will be a decrease of 30 mm Hg. Art. From the daily individual level.
• Reduction of pulse pressure - less than 25-20 mm Hg. Art.
• Suspicion of a cardiogenic shock should cause pale skin and its coldness. These manifestations indicate a violation of blood microcirculation in the tissues of the body.

With a person who has identified the above manifestations of pathology, you should conduct a series of activities before the arrival of specialists. First aid for acute heart failure (stroke, heart attack, etc.) should be aimed at:

• Organize access to fresh air;
• Ensure the patient's horizontal position (unless he has signs of left ventricular failure);
• To carry out anesthetic actions.

Treatment of acute heart failure

Treatment of heart failure is a complex therapy, aimed primarily at:

• Eliminate the overload of the heart muscle - this measure is achieved using drugs that reduce blood pressure and heart rate;
• To curtail the symptoms of pathology (therapeutic measures will depend on manifestations of painful manifestations).

If DOS developed due to myocardial infarction, it is necessary to restore the flow of the coronary artery as soon as possible. As a rule, an infarcted condition causes thrombosis of the artery feeding the heart. Elimination of the thrombus helps to completely restore the patency of the blood vessel and stabilize the patient's condition.

The most popular technique in this case is thrombolysis, but the procedure should be performed as soon as possible after the onset of the infarction, while the thrombus is still "fresh." The first medical aid for acute heart failure involves the use of drugs (thrombolytic agents), whose action is aimed at dissolving blood clots. Medications are administered intravenously, the rate of their entry into the body is strictly regulated.

Treatment of acute insufficiency (right ventricular) with stagnant hemodynamics presupposes the elimination of the causes that caused it - asthmatic status, thrombi in the pulmonary artery, etc. Therapy begins with the appointment of the patient "Nitroglycerin" or "Furosemide", with the combination of pathology with cardiogenic shock, inotropic facilities. Together with the above measures, oxygen inhalation through the catheter is performed.

Psychomotor agitation is eliminated by narcotic analgesics, for example, "Morphine", which reduces the work of the respiratory muscles and reduces the burden on the heart.

Elimination of symptoms of left ventricular failure

Stagnation of blood in a small circle often leads to severe consequences, for example, pulmonary edema. With such violations, patients are prescribed the administration of "Nitroglycerin" intravenously.

If acute left ventricular failure with congestive hemodynamics is combined with cardiogenic shock, administration of "Dobutamine" or "Noradrenaline" is given intravenously. There are often cases when these drugs are combined in a complex way.

Foaming is stopped with the help of foam breaking agents.

If the hemodynamics is stabilized, but signs of pulmonary edema persist, the patient is assigned glucocorticoids. In this case, first aid for acute heart failure will help reduce the permeability of membranes.

Therapy with cardiogenic shock begins with an increase in cardiac output, in the absence of manifestations of congestive heart failure, it includes the introduction of plasma substitutes. This procedure is performed only under the control of heart rate, blood pressure and respiration. If a large loss of fluid occurred before the onset of acute heart disease, a solution of sodium chloride is used.

Elimination of the symptoms of pathology, of course, in the first is due to the use of medicines, but if the measures taken do not lead to the proper effect, you can use the right way - to perform hemodynamic relief by applying tourniquets to the veins of the extremities.

In cases where conservative medicine is powerless, resort to surgical treatment. This way eliminates the problems associated with blockage of the arteries, the replacement of heart valves. Stabilize the heart rhythm helps install a pacemaker or defibrillator.

Prevention

The best way to prevent the development of pathology is to observe simple rules, namely, to lead a healthy lifestyle, quit smoking and give up excessive alcohol consumption, and conduct periodic monitoring of existing chronic diseases. However, in cases when the disease still made itself felt, in a daily life it is necessary to adhere to a certain regime.

Patients with acute heart failure should closely monitor their weight. Excess kilograms provoke an increase in blood sugar and the formation of cholesterol plaques on the vessels, and this causes high blood pressure. An important condition for maintaining a physical condition is normal: adherence to a special diet in the diet. It is necessary to strictly regulate the intake of salt in the body, the excess of which badly affects health - it causes fluid retention, edema develops, the load on the heart increases.

It is useful to exercise, exercise muscles and joints, but exercise should not cause body overload. The complex of exercises must be agreed with the doctor. It is important to often be outdoors, get enough sleep, avoid stress and mental stress.

Summarizing all of the above, it can be noted that acute heart failure is a pathology that often leads to a fatal outcome. The ailment, as a rule, develops against the background of other painful conditions of the cardiovascular system and leads to the emergence of various complications, including stroke, cardiogenic shock, pulmonary edema, etc.

There are signs on which acute heart failure is diagnosed. Symptoms before death can be implicitly manifested, so an important task of specialists is to take into account all patient complaints and conduct an immediate screening.