Internal illnesses. Heart failure (most important)

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Internal illnesses. Heart failure (most important)

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25. HEART FAILURE

A pathological condition in which the cardiovascular system is unable to provide organs and tissues with the necessary amount of blood both at rest and during exercise.

Etiology. Infectious-inflammatory and toxic lesions of the myocardium, myocardial blood supply disorders, metabolic disorders, overload of the heart with pressure, volume, heart defects such as valvular insufficiency, a combination of heart overload and myocardial damage, cardiac arrhythmia.

Pathogenesis. In the initial period of heart failure, the functioning of cardiac and extracardiac compensation mechanisms is noted.

Clinic. The initial stage of heart failure is characterized by the appearance of shortness of breath during exercise, dry cough at night, and nocturia. Auscultation is heard gallop rhythm, IV tone.

Chronic left ventricular heart failure develops with aortic defects, mitral insufficiency, arterial hypertension, coronary artery disease, and diseases affecting the left ventricle. Shortness of breath, cyanosis, and cough appear. Congestive bronchitis with sputum production and hemoptysis develops. In the lungs there is hard breathing, in the lower parts there are moist small and medium-bubble rales, expansion of the heart to the left, tachycardia, accent of the second tone over the pulmonary artery.

Chronic right ventricular heart failure develops with mitral defects, emphysema, pneumosclerosis, tricuspid valve insufficiency, congenital defects. There is stagnation of blood in the veins of the systemic circulation, shortness of breath, palpitations, swelling of the legs, pain and heaviness in the right hypochondrium, small diuresis.

Expressed acrocyanosis, swelling of the cervical veins, cardiac impulse, epigastric pulsation, expansion of the heart to the right.

Plesha's symptom and venous pulse, ascites, hydrothorax are noted.

Diagnostic research. The colloid-osmotic state of the blood, the electrolyte balance of sodium, potassium, calcium, etc.

The ECG reveals signs of overload of the left or right atrium, etc.

EchoCG study determines an increase in cavities, a decrease in myocardial contractility.

X-ray examination establishes the expansion of the cavities of the heart, central and peripheral venous congestion.

Treatment. Table number 10 is assigned with the restriction of liquid and table salt.

To improve myocardial contractile function, cardiac glycosides, β-adrenergic receptor stimulators, and ACE inhibitors are prescribed.

Normalization of myocardial metabolism is carried out with potassium, ATP, B vitamins, amino acids, anabolic hormones.

To improve peripheral circulation, caffeine, cordiamine, and peripheral vasodilators are used.

The elimination of stagnation in the small circle is carried out by bloodletting, the use of fast-acting diuretics - uregit, mannitol.

To increase the tone of the cardiovascular system, exercise therapy, massage, carbon dioxide and hydrogen sulfide baths are prescribed.

Forecast. In stages I and IIA - relatively favorable, in stage IB - serious, in stage III - unfavorable.

Author: Myshkina A.K.

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