Referred to as "heart failure, heart failure, heart failure) refers to as a result of the contraction function of the heart and (or) diastolic function obstacle, blood vein change can not be fully out of the heart, lead to venous blood pooling system, arterial blood perfusion system is insufficient, causing cardiovascular disorders, such disorders concentrated expression of pulmonary congestion, vena cava blood clot. Heart failure is not an independent disease, but a terminal stage in the development of heart disease. The vast majority of heart failure begins with left heart failure, which first manifests as pulmonary congestion.
The cause of
1. Basic etiology
Almost all cardiovascular diseases will eventually lead to heart failure, myocardial infarction, cardiomyopathy, hemodynamic overload, inflammation and any other causes of myocardial injury, can cause changes in myocardial structure and function, resulting in ventricular pumping and/or low filling function.
2. Inducing factors
On the basis of basic heart disease, some factors can induce the occurrence of heart failure. Common causes of heart failure are:
(1) infection such as respiratory tract infection, rheumatic activity, etc.
(2) severe arrhythmias, especially tachyarrhythmias such as atrial fibrillation and paroxysmal tachycardia.
(3) increased cardiac load pregnancy, childbirth, too much too fast infusion, excessive intake of sodium salt and so on lead to increased cardiac load.
(4) drug effects such as digitalis poisoning or inappropriate withdrawal of digitalis.
(5) improper activities and emotional excessive physical activities and emotional excitement.
(6) other diseases such as pulmonary embolism, anemia and insufficiency of papillary muscles.
According to the severity of heart failure, clinical heart failure can be divided into acute heart failure and chronic heart failure. According to the location of heart failure can be divided into left heart, right heart and heart failure. There are systolic or diastolic heart failure.
Acute heart failure
Means for acute myocardial damage or heart load, causing acute cardiac output plunged, pulmonary pressure, peripheral circulation resistance increased, causing pulmonary congestion and appear acute congestion and edema of the lungs and can have a partner organization, source of organ hypoperfusion and shock of clinical syndrome, with acute left heart failure is the most common. Acute heart failure can be exacerbated on the basis of existing chronic heart failure, or it can occur abruptly on a heart that is functioning normally or in a compensatory phase. Before the onset of most patients with organic cardiovascular disease, often seen in acute myocarditis, extensive myocardial infarction, ventricular outflow tract obstruction, pulmonary artery trunk or large branch infarction. It may manifest as systolic or diastolic heart failure. Acute heart failure is often life-threatening and requires emergency treatment.
Chronic heart failure
A persistent state of heart failure that can be stable, progressive, or decompensated. Chronic heart failure (CHF) is a complex clinical syndrome characterized by dyspnea, edema, and fatigue. Generally, compensatory cardiac enlargement or hypertrophy and other compensatory mechanisms are involved, often accompanied by organ congestive pathological changes caused by increased venous pressure, and atrial and ventricular mural thrombosis and venous thrombosis can be found. The main causes of chronic heart failure in adults are coronary heart disease, hypertension, valvular disease and dilated cardiomyopathy.
Clinical manifestations of
Acute heart failure
(1) early signs of reduced left cardiac function include fatigue, significantly reduced exercise endurance, and 15 to 20 beats/min increase in heart rate in normal cardiac function patients, followed by exertional dyspnea, paroxysmal dyspnea at night, and pillow sleep, etc.; Examination revealed enlargement of the left ventricle, early or middle diastolic galloping rhythm, and moist rales, dry rales, and wheezing at the base of both lungs.
(2) acute pulmonary edema is an acute disease with rapid development to critical condition. Sudden severe dyspnea, sitting breathing, wheezing, restlessness and fear, breathing frequency up to 30 ~ 50 times/min; Cough frequently and cough up large amounts of pink foamy sputum; Heart rate is fast, the tip of the heart can often smell and galloping rhythm; Both lungs were filled with rumbling and wheezing.
(3) cardiogenic shock 1) hypotension lasts for more than 30 minutes, and the systolic blood pressure drops below 90mmHg, or the systolic blood pressure of patients with original hypertension decreases 60mmHg. 2) tissue hypoperfusion. (1) cold, pale, cyanotic skin with purple streaks; Tachycardia >110 times/min; (3) significantly reduced urine volume (<20ml/h), even without urine; (4) conscious disorders, often agitated, agitated anxiety, fear and near-death feeling; Systolic blood pressure is below 70mmHg, can appear restrain a symptom, develop to consciousness fainter even coma gradually. 3) hemodynamic disorder PCWP 18mmHg, cardiac output index (CI) 36.7ml/s·m (2.2l /min·m). 4) metabolic acidosis and hypoxemia
Chronic heart failure
(1) symptoms and signs of left heart failure most patients with left heart failure seek medical treatment for dyspnea or fatigue due to decreased exercise endurance, and these symptoms may occur during rest or exercise. The same patient may have multiple diseases.
Dyspnea is the most important symptom of left heart failure, which can be manifested as exertional dyspnea, sitting breathing, paroxysmal nocturnal dyspnea and other forms. Decreased exercise endurance and fatigue are the manifestations of insufficient blood supply to skeletal muscle. Chen-shi breathing may occur in patients with severe heart failure, indicating a poor prognosis. In addition to the original signs of heart disease, physical examination also found that the left ventricle increased, alternating pulse strength, auscultation can be heard and lung rales.
(2) the signs and symptoms of right heart failure is mainly caused by chronic persistent blood each viscera function change, can appear in patients with abdominal or leg edema, and the primary or only symptoms and treatment, exercise tolerance damage occur gradually, may not noticed by the patient, unless carefully ask ability changes in daily life. On examination, in addition to the original signs of heart disease, enlargement of the heart, jugular vein filling, large and tender liver, cyanosis, drooping edema, and pleural effusion may be found.
(3) symptoms and signs of diastolic heart failure diastolic heart failure refers to the situation that the ventricular systolic function is normal (LVEF>40% ~ 50%), and the decreased ventricular relaxation and compliance leads to decreased ventricular filling volume and increased filling pressure, leading to pulmonary circulation and systemic congestion. Initial symptoms are not obvious, with the development of the disease can appear sports endurance decline, shortness of breath, pulmonary edema.