Cardiovascular failure is an acute condition of the body, which is caused by the processes of impaired cardiac function in the form of pumping blood and regulating its vascular influx to the heart itself. As a rule, there is an acute form of cardiovascular failure and heart failure left and right half of the heart.
The concept of "heart failure" includes such states, which are characterized by violations of the stages of the cardiac cycle, which as a result becomes the cause of the decrease in strokes and the volume of the heart. In addition, CB can not provide all the necessary tissue requirements. In similar situations, OSS is formed as a consequence of pulmonary embolism, complete atrioventricular blockade, myocardial infarction. Chronic form of cardiovascular failure is observed with a slow progression of the underlying disease.
The concept of "vascular insufficiency" is explained by insufficient blood circulation in peripheral vessels, which is characterized by low blood pressure and impaired blood supply to tissues and / or organs. This condition can develop due to the sudden appearance in a reduced amount of primary filling of peripheral blood vessels, and is manifested by syncope, collapse, and sometimes shock.
Cardiovascular failure of the cause
This disease - a special nosological form, which reflects the defeat of the heart of an organic nature. This causes disruption of the work of the whole organism, as the inferior work of the heart and blood vessels causes the development of ischemia, and this causes a partial loss of their functions.
Most often, cardiovascular failure is found among people of advanced age, as well as those who suffer from heart defects for a long time. This is considered the leading cause of the development of the disease, since it too quickly causes decompensation in the work of SS. But the main factors contributing to the formation of cardiovascular insufficiency, include increased functional load, due to violations of hemodynamics.
In most cases, the causes of this pathological condition in the elderly population are long-term arterial hypertension, various valve flaws, IHD , cardiac pathologies of infectious etiology and genetic predisposition. As a rule, all these diseases are characterized by their developmental causes, but these factors of nosological nature are the factors that cause cardiovascular insufficiency.
For example, the emergence of this pathology against the background of arterial hypertension is due to narrowing of the peripheral vessels, increased contractility of the heart, hypertrophy of the cardiac muscle of the LV in connection with increased heart activity, decompensation of hypertrophied myocardium, development of IHD, the appearance of the first signs of atherosclerosis, LV dilatation. Thus, all the causes leading to coronary artery disease, hypertension, atherosclerosis will always refer to provoking factors of cardiovascular insufficiency.
The emergence of syncope, as a form of cardiovascular insufficiency, can be facilitated by a rapid rise, for example, in young women with asthenic constitution; fright and prolonged stay in a stuffy room. A predisposing factor of this condition can be the transferred infectious pathology, various types of anemia and overwork.
But the development of collapse can be affected by severe forms of various diseases, such as sepsis, peritonitis, acute pancreatitis , pneumonia. Poisoning with fungi, chemicals and drugs can also be accompanied by a sharp drop in blood pressure. Also, collapse is observed after injuries by electricity and when the body overheats.
Cardiovascular failure symptoms
The clinic of cardiovascular insufficiency consists of its forms of pathological process: OCH (cause - myocardial infarction ) and CHF. As a rule, these forms are divided into left ventricular cardiovascular insufficiency, right ventricular and total. All of them are characterized by their signs and differ from each other at all stages of the formation of pathological disorders in the heart. In addition, the disease is called cardiovascular failure because in the damaging process is not only the myocardium, but also the vessels.
Symptomatology of the disease is divided into clinical manifestations of acute CH, chronic CH and on the lack of right and left ventricles, as well as the total form of insufficiency.
In acute cardiovascular failure, there is pain, which is anginal and lasts more than twenty minutes. The reason that contributes to the development of DOS is a heart attack. It is characterized by general symptoms of impaired circulation in the left ventricle. As a rule, pain in the heart is noted, and behind the sternum there is a heaviness, a pulse of weak filling, difficulty breathing, cyanosis of the lips, on the face and extremities. A terrible symptom is a cough due to swelling of the lungs.
For the clinic of chronic cardiovascular insufficiency, dyspnea, weakness, drowsiness, depression of pressure, asthma attacks of the cardiac type, edema by the BCC, dizziness with nausea and vomiting, fainting for a short period are typical.
The symptomatology of LVF is based on a characteristic symptom in the form of dyspnea, which is observed mainly after physical exertion or emotional stress. In addition, the above listed characteristics are added to it. In the case of dyspnea in a calm state, cardiovascular failure is characterized by the terminal stage.
For PZHN, edema formation in the BCC is typical. Most edema appears on the legs, and then there is swelling of the abdominal cavity. At the same time, soreness is revealed in hepatomegaly as a result of stagnation in the liver and in the portal vein. It is these signs that contribute to the development of ascites, therefore, because of the increased blood pressure, the liquid penetrates into the cavity of the peritoneum and begins to accumulate there. Hence the name of the pathological process "stagnant CH".
Total cardiovascular insufficiency has all the signs of PLV and PZHN. This can be explained by the fact that dyspnea is added to the edema syndrome, as well as signs characterized by pulmonary edema, weakness and dizziness.
Basically, cardiovascular insufficiency is characterized by three degrees of the course of the pathological process.
At the first degree there is rapid fatigue, frequent heartbeat and sleep disturbance. Also, there are first signs of difficulty breathing and frequent heart rate after some physical movements.
At the second degree of cardiovascular insufficiency, symptoms of the first degree are joined by irritability, unpleasant sensations in the heart, dyspnea becomes stronger and arises even at the moment of conversation.
At the third degree, the intensity of all previous symptoms becomes even stronger, and also objective signs are noted. As a rule, swollen by the evening of the legs, hepatomegaly develops, urine output decreases, traces of protein, urates are found in it, and nocturia is noted with a characteristic diuresis at night. Further edema spreads throughout the body, hydrothorax, ascites and hydropericardia are observed, blood stasis in the vessels of the lungs with characteristic wet rales, a cough with bloody sputum, in some cases. Diuresis also sharply decreases, causing a suburhemic condition, the liver causes soreness and falls down the abdomen, the skin has a subicteric color, meteorism is formed, and constipation alternates with diarrhea.
In the physical examination of the heart, the enlarged borders of its cavities are diagnosed, but the noise is weakened. Also, extrasystole and arrhythmia of cilantial nature, lung infarction in the form of hemoptysis, a slight increase in temperature, a muffled percussion sound over the lungs and a transient noise of pleural friction are also noted. Patients with such symptoms are in bed in a semi-sitting position (orthopnea).
Cardiovascular failure in children
This condition in childhood is characterized by impaired blood circulation by two factors: a decrease in the ability of the heart muscle to contract (heart failure) and a decrease in the stress of peripheral vessels. It is the latter condition that represents cardiovascular failure. It is more common in more healthy children in isolated form with asympatheticotonia, and also as the primary true predominance of the parasympathetic nature of the vegetative part of the central nervous system. However, the manifestations of cardiovascular insufficiency may have a secondary character and develop as a consequence of various infections, pathological processes of the endocrine system, diseases of non-infectious etiology with chronic course.
The leading clinical signs of cardiovascular failure in children include: blanching with possible dizziness and vaso-vagal fainting. For signs of heart failure characterized by shortness of breath, tachycardia, hepatomegaly, peripheral edema, congestion, while the heart is widened with loud heart tones and the contractile function of the myocardium is impaired. Thus, the combination of both forms of circulatory insufficiency determines a characteristic condition, such as cardiovascular insufficiency.
This condition in children is due to violations of hemodynamics inside the heart and periphery as a result of a decrease in the ability of the heart muscle to contract. In this case, the heart is unable to transfer the flow of blood from the veins into a normal cardiac output. This fact is the basis of all clinical symptoms of heart failure, which in children is expressed in two forms: acute and chronic. Children's OSN develops as a consequence of heart attack, valvular defects, rupture of LV walls, and also complicates CHF.
To the causes of development in children of cardiovascular insufficiency are cardiac malformations with congenital etiology (newborn children), myocarditis with early and late manifestation (infancy), valve defects of acquired character, acute form of myocarditis.
Cardiovascular failure in children is classified into left ventricular lesion and right ventricular. However, very often one can find total (simultaneous violation) of CH. In addition, the disease involves three stages of defeat. At the first the latent form of a pathology is noted and is revealed only at performance of physical actions. At the second - stagnation in the ICC and (or) in the CCB, characterized by symptoms at rest. In the second stage (A) hemodynamics is disturbed quite weakly, in any of the CC, and in the second stage (B), a deep disturbance of the hemodynamic processes occurs involving both circles (MKK and CCB). The third stage of cardiovascular insufficiency in children is manifested by dystrophic changes in many organs, while causing severe violations of hemodynamics, changes in metabolism and irreversible pathologies in tissues and organs.
The general clinic of cardiovascular insufficiency in children consists of the appearance of dyspnea, first with physical exertion, and then it appears at absolute rest and increases with the change of the child's body or conversation. Breathing begins to hamper, if there are concomitant pathologies of the heart, then even in a horizontal position. Thus, such children with this anomaly create a position like orthopnea, they are much quieter and easier in this state. In addition, children with this diagnosis are susceptible to rapid fatigue, they are very weak and they are disturbed by sleep. Then cough, cyanosis , and even fainting and collapse are possible.
Cardiovascular failure treatment
To effectively treat such a pathology as cardiovascular insufficiency, it is necessary to strictly adhere to a special diet with salt restriction, and sometimes even its exclusion and taking of medications strictly according to the scheme prescribed by the attending physician. First of all, the diet should contain a low amount of Na and high - K. In addition, it is recommended to use mainly fruits, vegetables and milk. The food should be taken five times with the restriction of salt, and liquids should not drink more than a liter. As a rule, a significant amount of potassium is found in a banana, dried apricots, izume and baked potatoes.
For medicamental treatment of cardiovascular failure, drugs are used that help strengthen the contraction of the heart muscle and reduce the load in the heart. Thus, they reduce venous return and reduce the resistance to bleeding. To enhance the contractile function of the myocardium, cardiac glycosides are prescribed. For this, intravenous Strophantine or Korglikon is used, either as a jet or as a drip.
After the symptoms of cardiovascular insufficiency are reduced, tablet treatment of the disease using Digitoxin, Isolanide, Digoxin with individual dosage administration is used.
In addition, ACE inhibitors (Prestarium, Fazinopril, Captopril, Enalopril, Lizinopril) blocking the angiotensin enzyme are used. If these drugs are intolerant, Isosorbide, Dinitrate and Hydralazine are prescribed. Sometimes Nitroglycerin or its analogues of prolonged action are used.
To eliminate hyperhidrosis outside cells, increased renal excretion of sodium is used by the appointment of diuretics. In this case diuretics of different mechanisms of action are used, and sometimes they are even combined to obtain a quick effect. Usually, Furosemide is prescribed, but in order to maintain potassium in the body use Verashpiron, Amyloride, as well as diuretics of the thiazide group - Oxodoline, Arifon, Hypothiazide, Klopamid. For correction of potassium in the body, a solution of KCl, Panangin and "Sanasol" is used.
A radical and significant solution to the issue, which is based on cardiovascular failure, is a surgical operation for heart transplant. Today, the number of patients who underwent such an operation is estimated at several thousand throughout the world. Heart transplantation is used when there are no other options for preserving life for the patient. However, there are contraindications to this operation. In such a group of patients people fall: after seventy years; suffering irreversible disorders in the work of the lungs, kidneys and liver; with severe diseases of the cerebral and peripheral arteries; with active infection; tumors of uncertain prognosis and pathologies of a mental nature.
Cardiovascular failure first aid
Carrying out a set of measures that are first aid, are aimed at restorative processes, as well as to save a person's life during attacks of cardiovascular insufficiency. It is this assistance that can be of a nature, both mutual assistance and self-help, if there is no one nearby or the patient's condition allows him to conduct these activities before the doctors arrive. The life of the patient depends on how quickly and correctly the first first aid is provided in case of cardiovascular insufficiency.
To begin with, it is important to assess the patient's condition and determine what happened to him, and then begin to provide the necessary assistance.
During an unconscious condition in a patient with cardiovascular insufficiency, consciousness may be clouded or completely lost, he may experience twisting of the head and ringing in the ears, and then nausea and increased peristalsis. Objectively: pale skin, cold extremities, dilated pupils, reaction to light alive, pulse with weak filling, pressure is reduced, and breathing is superficial (duration - 10-30 seconds or two minutes, depending on the cause).
The tactic of helping with cardiovascular failure consists of: first, the patient must be placed on his back and lower his head slightly; secondly, unfasten the gate and provide air access; thirdly, to bring a fan-like cotton wool with ammonia to the nose and then sprinkle his face with cold water.
If there is a collapse, which is characterized by a drop in vascular tone, signs of hypoxia in the brain, depression of many important functions in the body and a drop in blood pressure, it is also necessary to provide first aid. At the same time, the victim looks weak, his head turns dizzy, he becomes chill, and the temperature drops to 35 degrees, his features are pointed, his limbs are cold, his skin and mucous pale with a grayish tint, cold perspiration is noted on his forehead and temples, the patient is indifferent to everything, tremor of fingers, superficial breathing, no choking, weak pulse, threadlike, low blood pressure, tachycardia.
In this case, it is necessary to eliminate the etiologic factor of development of this type of circulatory insufficiency in the vessels (intoxications, acute blood loss, myocardial infarction, acute somatic diseases, endocrine and nervous pathology). Then the patient should be laid horizontally with the raised end; Remove crushing clothing for fresh air; warm the patient with warmers, hot tea or rub the limbs with diluted ethyl alcohol or camphor. If possible, immediately enter Caffeine or Cordiamine subcutaneously, and in severe cases - intravenously, Corligon or Strophantine with Glucose solution, Adrenaline or Ephedrine subcutaneously.
In case of shock, urgent hospitalization is necessary in order to save the life of the victim. Shock - this particular reaction of the body to the actions of an extreme stimulus, is characterized by a sharp suppression of all vital functions of the body. In the initial period of shock, the patient's chills, excitement, anxiety, pallor, cyanoticity on the lips and nail phalanx, tachycardia, mild dyspnea, BP are normal or elevated. As the shock deepens, the pressure begins to fall catastrophically, the temperature decreases, tachycardia increases, sometimes there are cadaveric blemishes, vomiting and diarrhea (often bloody), anuria, hemorrhage into mucous membranes and internal organs. In the provision of medical care in the shock of an infectious-toxic character, intravenously administered Prednisolone, Trisol and Contrikal.
Cardiovascular failure is also characterized by such attacks as cardiac asthma and pulmonary edema.
In cardiac asthma, when suffocation is characterized by difficulty breathing and accompanied by fear of death, the patient is forced to sit, while lowering his legs down. His skin is cyanotic at that moment and is covered with a cold sweat. At the beginning of the attack, there is a dry cough or cough with poor sputum. Breathing at the same time is sharply increased, with a prolonged bout bubbling, audible at a distance of BH 30-50 per minute, the pulse is increased and the blood pressure is increased.
The measures of emergency power in cardiac asthma include: physician's call and pressure measurement. Then the patient is seated, lowering his legs down. Give the tabletted Nitroglycerin under the tongue (if the systole is not less than one hundred, then repeat the procedure after fifteen minutes). Then they begin to apply venous tourniquets to three limbs (below the inguinal folds by fifteen centimeters, below the joint on the shoulder by ten), and after fifteen minutes one tourniquet is removed and later it is used for no more than an hour. If possible, put banks or warm foot baths. Then, oxygen is applied with defoamers through the nasal catheter using an alcohol solution of Angiomfosilane.
In case of pulmonary edema, the doctor is also called up, the blood pressure is measured, the sitting position is placed with the legs down, and then the tourniquets are placed on three limbs, Nitroglycerin is given, warm foot baths and oxygen therapy are used, and then they begin to provide medical assistance with the introduction of the necessary preparations.
All other actions to provide medical care in case of signs of cardiovascular insufficiency should be performed in a hospital of a specialized institution.