Acute left ventricular failure

The heart muscle, as you know, performs the function of a kind of pump in our body. If this device for any reason does not cope with its immediate work, there is a place of heart failure. Every year, this pathology only gets younger, and more recently, it leads to a fatal outcome.

Acute congestive heart failure. What it is?

Acute heart failure is a sudden decrease in the contractile function of the heart, which causes its congestion and pulmonary circulation disorders. The disease can appear both against the background of already existing pathologies of the heart, and without previous cardiac ailments. Most often it is diagnosed with myocardial infarction, when cell death occurs due to a sharp deterioration of blood circulation in this area.

Depending on the overload of the main muscle of the human body, two main trends of the disease are distinguished: right ventricular and left ventricular failure. The latter will be discussed in more detail in this article.

Pathogenesis of the disease

One of the main pathogenetic moments of the development of left ventricular failure is the increase in hydrostatic pressure in the capillary and venous sections of the small circulation. In pulmonary interstitium fluid gradually accumulates in excess, which leads to a decrease in the elasticity of the organs. The lungs become more "rigid", there are restrictive disorders. Then, the edematous fluid enters the alveoli, so that they cease to participate in gas exchange.

There is further spread along the pulmonary serosa and bronchial trunks. Infiltration of serous fluid with perivascular and peribronchial spaces is observed, which is reflected in their direct resistance, deterioration of exchange conditions.

In the left atrium, blood from unventilated alveoli is mixed with an oxygenated substance. This leads to a decrease in the total arterial partial pressure of oxygen, the development of hypoxemia. In the initial stage, the latter is circulatory.

Left ventricular failure is usually caused by serious overloads or lesions of the corresponding parts of the heart. Such a disease entails a worsening of blood circulation. It requires not only timely diagnosis, but also competent treatment. When the pathology is combined with right-sided heart failure, the probability of the patient's death increases.

The main causes of the disease

• Cardiomyopathy.
• IHD.
• Myocardial infarction.
• Cardiogenic pulmonary edema.
• Symptomatic arterial hypertension.
• Mitral stenosis.
• Extensive surgical intervention.
• Trauma of the brain.
• Diseases of infectious nature.
• Toxic effects on the myocardium (taking medications, drinking alcohol).

Acute left ventricular failure and myocardial infarction

This disease often develops against a background of myocardial infarction. It is usually caused by a diastolic function and can occur with a normal ejection fraction. An important role in the development of heart failure in this case is given to mitral regurgitation. It is explained by ischemia of the papillary muscle or loss of a significant mass of the myocardium.

Disease in the first hours in patients with myocardial infarction is characterized by a sharp decrease in the volume of circulating blood, changes in cardiac output and minimal sodium retention in the body.

Clinical picture

As you know, almost all diseases of cardiac nature have a common symptom, that is, they express pain in the heart. It can give into the elbow, neck or shoulder blade. This phenomenon is usually observed with a disease such as left ventricular failure. Symptoms are supplemented by fever, dyspnea, sudden pressure surges and a violation of the temperature regime.

The nature and intensity of the signs of pathology directly depend on which part of the heart muscle is damaged. For the left ventricular form, in addition to the main symptoms, fainting, attacks of arrhythmia, dizziness, puffiness of the extremities, and enlargement of the cervical veins are characteristic.

Gradually, all signs of left ventricular failure increase, appearing now not only in the stage of activity, but also at rest. If you do not respond to this problem in a timely manner, death can not be ruled out.

Forms of the disease

Pathology can occur in several types.

• With a stagnant type of hemodynamics. It manifests in the form of cardiac asthma (attacks of suffocation) and pulmonary edema.
• With a hypokinetic type of hemodynamics:

1. Arrhythmic shock. Develops as a response to heart failure.
2. Reflex shock. Appears as a reaction to pain.
3. True cardiogenic shock. It occurs with significant lesions (over 50% of the mass of the left ventricular myocardium).

• A sharp deterioration in the already diagnosed heart failure (the muscle does not provide the need for organ systems in adequate blood supply).

Diagnostics

Many pathologies of cardiac nature are characterized by rapid progression, and acute left ventricular failure in this matter is no exception. The doctor should be examined first if he is suspected of this diagnosis. However, physical research is not enough to evaluate the overall clinical picture. Therefore, the patient is prescribed a number of diagnostic procedures, including ECG, ultrasound of the heart, x-ray of the sternum, radioisotope ventriculography and PET.

Based on the results, the doctor can confirm the diagnosis and appoint a competent treatment.

Acute left ventricular failure: emergency care

During an attack, it is very important for the patient to provide qualified assistance in a timely manner before the arrival of a team of doctors. First of all, it should be put on the bed (it is strictly forbidden to lie down), to ensure the influx of air, to start oxygen therapy.

The patient should be given "Nitroglycerin" under the tongue, injected 1% "Morphine" subcutaneously. With the development of severe pulmonary edema due to a decrease in blood pressure, Prednisolone is administered intravenously (3-5 ml).

In the absence of the necessary medications, the patient should apply harnesses to the hips and shoulders to severely limit the volume of circulating blood. Also, intravenously, you can enter a special mixture. To do this, in a 10 ml syringe, you should collect 3 ml of 96% ethyl alcohol, and then add water for injection. It is important that the entire volume is filled. This solution has a defoaming effect. The patient should call the cardiac medical team. After the elimination of pulmonary edema, all patients diagnosed with "acute left ventricular heart failure" must be hospitalized without fail. Transportation is usually carried out on stretchers in the sitting position.

Basic principles of treatment

Such a pathology threatens the patient's life and always requires urgent therapy.

• If the cause of the disease is a change in the heart rate, to stabilize the hemodynamics and the patient's condition, it is necessary to restore the heart rate.
• If the cause is an earlier occurred myocardial infarction, in order to fight the disease, it is necessary to normalize the coronary blood flow as soon as possible. In conditions of prehospital care, this is possible through systemic thrombolysis, i.e. intravenous administration of special preparations for the dissolution of blood clots.
• If left ventricular failure is the result of previously developed intracardiac hemodynamic disorders due to myocardial ruptures or injuries, immediate hospitalization is indicated.

Medication Therapy

Treatment of the disease, in general, implies an integrated approach (complete rest, lack of serious physical exertion, adherence to a therapeutic diet). However, these are more preventive measures, which sometimes can not even stop the pain syndrome accompanying the disease with acute left ventricular failure. Treatment with medicines just in this case comes to the rescue.

Listed below are the main objectives of drug therapy:

1. Normalization of myocardial contractility.
2. Elimination of symptoms of sinus tachycardia.
3. Prevention of blood clots and clogging of blood vessels.
4. Normalization of the process of removing fluid from the body.
5. Remission prolongation.

First of all, all patients without exception are prescribed oxygen therapy. To combat excess fluid in the body, it is recommended to take diuretics (Furosemide, Uregit) and a sharp restriction of the drinking regime. To reduce the vascular resistance and simultaneously improve blood circulation, prescribe vasodilator drugs and disaggregants ("Tiklid", "Plavix"). To enhance the contractility of the myocardium, cardiac glycosides and cardiotonics are prescribed.

All the medicines the doctor prescribes individually for each patient. Therefore, it is important to understand that surface independent therapy can only aggravate the clinical picture and not bring the desired result.

When is surgery necessary?

If drug therapy does not alleviate the patient's condition, left ventricular heart failure only intensifies in its manifestations, surgical intervention is recommended. Currently, in medical practice, two types of operations are used: cardiomyoplasty and the implantation of a special device for improving blood circulation. Both options are life-threatening, so they are used only in extreme cases. Moreover, the postoperative effect is noticeable only 3-4 months after a long recovery period. Before going on such an operation, it is worth consulting with a doctor and compare all its advantages and possible disadvantages.

Complications

If the patient is diagnosed with "left ventricular failure", he neglects his own health and postpones treatment, there is a high probability of an early death.

Preventive measures

In the presence of diseases of the cardiovascular system of a chronic nature, a regular observation is observed at the cardiologist and a clear adherence to all of his prescriptions. It is extremely important to minimize the influence of negative factors on the work of the whole organism. These include pernicious habits (smoking, drinking alcohol and drugs), psycho-emotional overload and frequent stress, as well as overweight.

As a preventive measure of such a disease as acute left ventricular failure, the causes of which are often concealed in hypodynamia, a dosed physical exercise is recommended. It can be swimming, walking in the fresh air, skiing, classes in the gym or yoga. It is necessary to constantly monitor blood pressure. Particular attention should be given to nutrition. The diet should be as balanced as possible, with a high fiber content. It is better to give up fatty and fried foods, as well as overly sharp foods.

Such simple preventive measures allow not only to prevent the development of such pathological pathology, but also to improve the quality of life in general.

Conclusion

In this article, we talked about what constitutes a disease called left ventricular failure. The reasons for the development of this pathology can be very different, starting with myocardial infarction and ending with the toxic effect on the body of medications. Timely diagnosis and competent treatment allow to minimize the risk of complications, the most dangerous of which is a lethal outcome. Be healthy!