Causes of cardiopulmonary insufficiency. Pulmonary heart failure Treatment of pulmonary heart disease

The phenomena of insufficiency of the respiratory process, both in acute and chronic manifestations, are threatening to health and life.

The normal functioning of the body requires uninterrupted coordinated work of all its systems. An important role of the respiratory system is to ensure gas exchange. Thanks to this process, there is a balanced state between the amount of oxygen that comes in from the outside and the amount of carbon dioxide that is removed.

A failure, a violation of the normal balance, leads to a pathological condition, the so-called respiratory failure, when the maintenance of the necessary arterial gas composition, the ratio of oxygen and carbon dioxide, is disturbed and cannot be provided by the body, or occurs due to additional efforts.

The term "respiratory failure" is a broader concept than the actual pulmonary insufficiency, which is understood as the inadequate functioning of the organs that provide external respiration.

To systematize the pathological condition, types of pulmonary insufficiency, it is customary to classify it based on a number of criteria:

• According to the rate of occurrence and course of the process, pulmonary insufficiency, acute and chronic are distinguished.
• According to the nature of the disturbances in the balanced state of blood gases, hypoxemic pulmonary insufficiency (otherwise parinchymatous, or the first type) is distinguished, in which there is a reduced oxygen content and its partial pressure; and hypercapnic (ventilation, or insufficiency of the second type), which is characterized by an increase in the content of carbon dioxide and its partial pressure
• According to the level of severity of the disease and, accordingly, the patient's condition, it is customary to distinguish three degrees; an indicator such as saturation or oxygen content in arterial blood, expressed as a percentage, is taken into account: in the first degree, this indicator corresponds to values ​​​​from 90 to 94%, in the second - from 75 to 89%, in the third - below the value of 75%
• According to how pronounced the clinical symptoms of the pathology, there are four stages of pulmonary insufficiency, initial, compensated, decompensated, terminal

It is important to classify the type of pulmonary insufficiency for understanding what is happening with the patient, as well as for choosing medical tactics.

Learn more about respiratory failure in this video.

Acute and chronic pulmonary insufficiency

The acute form of pulmonary insufficiency is characterized by:

• The rapid nature of the occurrence, taking from several minutes to hours
• Life-threatening nature of the flow
• A condition in which the provision of immediate assistance, including resuscitation, is vital
• Due to the transience of development, the impossibility of involving compensatory mechanisms (rapid breathing, increasing blood volume, increasing the number of red blood cells, adapting cellular and tissue structures) to correct the pathology, provide the body with oxygen and remove carbon dioxide
• The possibility of developing in healthy individuals who do not suffer from any diseases due to suffocation, foreign objects entering the respiratory organs, pain shock, swelling of the respiratory mucosa, poisoning, with damage to the integrity of the chest, with depression of the respiratory center of the brain
• Development due to various kinds of respiratory disorders or blockage due to diseases such as bronchitis, pneumonia, as well as other painful conditions (, acute heart failure, thrombosis)
• Development as a result of exacerbation of the chronic form of pathology

Cor pulmonale (pulmonary heart failure) is a pathological condition characterized by an increase in the right atrium and right ventricle as a result of increased pressure in the pulmonary (small) circulation. The causes of the development of this condition can occur acutely (acute cor pulmonale) or form gradually (chronic cor pulmonale). The cause of acute disorders can be thromboembolism in the pulmonary artery system, collapse of the lung as a result of the formation of pathological holes in the pleura (pneumothorax), a prolonged asthma attack, and extensive pneumonia. In turn, the cause of thromboembolism in the pulmonary artery system is most often thrombi that “shoot” from the veins of the lower extremities during their varicose expansion. Another reason may be the presence of a permanent form of atrial fibrillation, leading to the formation of intracardiac (in particular, intraatrial) thrombi, which can also be fragmented. Chronic cor pulmonale is most often caused by chronic lung diseases affecting the bronchi, bronchioles and alveoli. For example: obstructive bronchitis, emphysema, bronchial asthma, polycystic lung disease, pneumosclerosis, pneumoconiosis and others. It can also be caused by chronic pulmonary vascular disease. These are allergic, nodular, obliterating, lupus vasculitis, atherosclerosis of the pulmonary arteries, compression of the pulmonary arteries by various neoplasms, tumors and aortic aneurysm. With the development of acute pulmonary heart as a result of the above processes, there is a rapid increase in blood pressure in the pulmonary circulation (pulmonary circulation) with an increase in the load on the right heart and a violation of gas exchange in the lungs. At the same time, the permeability of the pulmonary capillaries may increase, which leads to the development of pulmonary edema. During the formation of chronic pulmonary heart, the same processes occur, but due to the gradual nature of the increase in pressure in the pulmonary circulation, gradual sclerosing changes occur in the vessels of the lung and gradual degenerative changes in the muscle cells of the heart. As a result, on the one hand, there is a violation of ventilation and gas exchange in the lungs, which leads to general hypoxia of the body, and on the other hand, congestive circulatory failure develops in a large circle. In the clinical picture with acute cor pulmonale, people have sudden complaints of shortness of breath, in the chest, increased agitation and cyanosis. A large number of different rales (dry and wet) are heard, the pulse is quickened, a sharp swelling of the cervical veins is very characteristic. The appearance of hemoptysis is a sign of developing pulmonary edema. Thromboembolism of the main trunk of the pulmonary artery, as a rule, ends with the development of shock, pulmonary edema and death within a few minutes. Chronic pulmonary heart in its development goes through two phases - compensated and decompensated. In the compensated phase, the main complaints are during physical exertion, when inhaling frosty air, in a supine position. A characteristic sign is the constant swelling of the cervical veins, pulsation in the upper abdomen (pulsation of the enlarged right ventricle is visible). With decompensation, these signs intensify, pronounced cyanosis, edema appear (initially - of the lower extremities, and then - of the entire lower to the level of the heart with the development of ascites - accumulation of fluid in the abdominal cavity), an increase in the liver is observed, and brain disorders in the form of dizziness attacks are possible , tinnitus, headaches (the result of brain hypoxia). The addition of pulmonary infectious complications, accompanied by a cough with sputum and fever, is very characteristic, which aggravates hypoxia and worsens the patient's condition.

Diagnostics

To diagnose this disease, an electrocardiogram is prescribed, which reveals signs of overload of the right heart. An echocardiogram allows you to assess the size of the cavities of the heart and indirectly calculate the pressure in the pulmonary artery system. In addition, studies are carried out to assess the condition of the lungs and identify the cause of the development of cor pulmonale. This is the lungs (and if necessary - their computed tomography), Doppler study of the veins of the lower extremities.

Treatment

Since acute cor pulmonale is a life-threatening condition that leads to the development of shock and often to death, it is necessary to carry out the entire complex of resuscitation measures aimed at maintaining the contractility of the heart and gas exchange in the lungs. In the event of thromboembolism of the main trunk of the pulmonary artery, only an emergency operation to remove the thrombotic embolus or thrombolysis through a catheter inserted into the trunk of the pulmonary artery within the first six hours after the development of the embolism can save the patient's life. Treatment of chronic cor pulmonale is also challenging. First of all, it is necessary to effectively treat the pulmonary pathology that caused the development of cor pulmonale, timely and adequate fight against infectious exacerbations. In this case, the correct selection of a combination of drugs that expand the bronchi, cause sputum discharge and others is important. As for antibiotics, they should be prescribed in these patients, taking into account the results of studies on the sensitivity of bacteria to them. Cardiac therapy for cor pulmonale is extremely specific for each specific case and can only be prescribed by a cardiologist. But more often than others, diuretics are used (to remove excess fluid from the body), nitrates (they dilate blood vessels and reduce pressure in the pulmonary artery system), calcium antagonists (well reduce pressure in the pulmonary artery system), but not in the stage of circulatory decompensation. ACE inhibitors have gained particular popularity in the treatment of congestive heart failure. This is due to the fact that they effectively expand the peripheral vessels, unloading the heart, and their main side effect - cause - in this case plays a positive role, as it contributes to better sputum discharge.

Prevention

The most important factors in the prevention of the development of acute pulmonary heart is the appointment of indirect anticoagulants (warfarin under constant monitoring of the INR) to patients suffering from a permanent form of atrial fibrillation and varicose veins of the lower extremities. The presence of blood clots in the veins of the lower extremities is an indication for the installation of a cava filter - a special "trap" that does not allow detached blood clots to pass into the right heart and then into the pulmonary artery system. The main prevention of the development of chronic pulmonary heart is the correct treatment of patients suffering from chronic pulmonary pathologies.

Under the definition of pulmonary insufficiency, it is customary to understand the inability of the respiratory system to supply arterial blood with oxygen in sufficient quantities. In more detail, pulmonary insufficiency can be described as a pathological process in which the partial tension of CO2 is greater than 45 mm Hg. st, and the oxygen pressure is less than 80 mm Hg. Art.

Pulmonary insufficiency usually develops when there is a violation of the work or function of the organs and systems that provide breathing. These include the following: chest, upper respiratory tract, alveoli, lower respiratory tract, central nervous system (which regulates the coordination of the respiratory system), peripheral nervous system, pulmonary muscles. A wide variety of diseases can lead to pulmonary insufficiency, ranging from the common cold to acute bronchitis.

Classification of pulmonary insufficiency.

According to the mechanism of occurrence, respiratory failure is divided into hypoxic, in which there is not enough oxygen in the tissues of the body; and hypercaptic - a large amount of carbon dioxide accumulates in the tissues.
The etiology of hypoxic pulmonary insufficiency is most often a violation of the functioning of the blood in our lungs. These disorders are observed when the blood exchanges gases with the alveoli, which do not exchange gases well with the environment. During shunting, venous blood does not have time to be saturated with oxygen and in this composition directly enters the arteries.
The etiology of hypoxemic pulmonary insufficiency is in the presence of the following diseases:

• Pulmonary edema;
• pneumoconiosis;
• Acute respiratory distress syndrome;
• Chronic obstructive pulmonary disease, a frequent manifestation of which is pulmonary emphysema and chronic bronchitis;
• Pulmonary alveolitis;
• Pneumonia;
• Pulmonary hypertension;
• Pulmonary fibrosis;
• Obesity;
• Pneumothorax;
• Bronchial asthma;
• Sarcoidosis;
• pulmonary embolism;
• Kyphoscoliosis;
• Brochnoectatic disease.

Pulmonary insufficiency. Symptoms and signs.

It should be noted that in some of these diseases, mixed forms of pulmonary insufficiency are observed. Hypoxia or hypercapnia, for example, may occur in chronic obstructive pulmonary disease. In hypoxia or hypercapnia, the pumping function of the lungs is usually impaired.
A manifestation of pulmonary insufficiency is considered to be complaints of shortness of breath or suffocation. Both a decrease in the oxygen content in the blood and the accumulation of carbon dioxide can lead to disruption of the central nervous system. These disorders are usually manifested by general agitation, memory impairment, insomnia, poor sleep, confusion, loss in space. The accumulation of CO2 causes pain in the head, and in some cases even loss of consciousness or even a coma. If suddenly the number of breaths is less than 12 per minute, then you should think about a possible cessation of breathing. Sometimes there is paradoxical breathing, which consists in the multidirectional movement of the chest and abdominal wall. In lung diseases, wheezing and wheezing are noted on auscultation.
According to the rate of formation, pulmonary insufficiency is divided into acute and chronic. Acute pulmonary insufficiency develops over several days. And chronic - can develop up to several years.

Diagnosis of lung disease.

The diagnosis of acute or chronic pulmonary insufficiency can be made on the basis of the history of the disease and the clinical manifestation of the disease. It should be noted that complaints and clinical symptoms are different in pulmonary insufficiency. Usually they depend on the disease that caused the development of pulmonary insufficiency. Symptoms, treatment are determined by the attending physician, according to the method of diagnostic observation, a course of therapy is prescribed. The key principle in the diagnosis of pulmonary insufficiency is the study of the gas composition of arterial blood.

Forecasts for patients with pulmonary insufficiency.

Mortality depends on the cause of the onset of the disease. The development of acute pulmonary insufficiency accounts for about a third of all cases. With progressive diseases, the appearance of pulmonary insufficiency can be an unfavorable sign. Without appropriate medical therapy, the average life expectancy with pulmonary insufficiency is about a year. If you apply special methods of breathing support, then this period increases. Mortality from pulmonary insufficiency in other diseases varies widely, but is considered one of the main factors that generally reduce the life expectancy of patients.

Pulmonary insufficiency. Treatment and therapy.

Treatment of pulmonary insufficiency consists in the combined treatment of both the disease itself and the disease that caused it.
Treatment of acute pulmonary insufficiency is the appointment of oxygen therapy. If breathing remains weak for a long time, then non-invasive ventilation of the lungs is prescribed. If further improvements are not observed, then invasive ventilation is used in hospitals, since it is simply impossible to carry out artificial ventilation of the lungs at home. In this case, the underlying disease, such as pneumonia, should be intensively treated. Inflammation of the lungs is treated with antibiotics. Ventilation of the lungs should be carried out until spontaneous breathing is stabilized.
Treatment of chronic pulmonary insufficiency is to treat the very cause of the disease. Also, oxygen therapy and non-invasive ventilation of the lungs will not interfere, in some severe cases it is desirable to resort to artificial ventilation of the lungs. In the case of the formation of a large amount of sputum in the lungs and respiratory tract, the use of broncho-pulmonary drainage is required.

Cardiopulmonary failure is a pathology that provokes disorders in the respiratory and cardiovascular systems. Appears due to the development of hypertension in the pulmonary circulation. This phenomenon provokes the release of blood into the pulmonary artery, due to which myocardial hypertrophy occurs.

In the case of destruction of the heart muscle, its contractility decreases, which affects the total amount of pumped blood.

Failures in the work of the heart lead to the following pathologies:

1. Hypoxia of various organs due to a reduced amount of oxygen obtained from the blood.
2. Congestion in the lungs, which does not allow the patient to use their full volume when breathing.
3. Pathologies associated with stagnation of fluid in the lungs, which are combined with heart failure. The syndrome includes several dangerous disorders.

The following symptoms appear:

1. Dizziness that starts for no apparent reason, even at rest.
2. Shortness of breath with little exertion.
3. Decrease in working capacity, inability to perform habitual actions that did not seem difficult before the onset of pathology.
4. Paleness of the skin in the region of the nasolabial triangle and fingers of the upper extremities.

The reasons

Acute cardiopulmonary insufficiency is considered a dangerous disease in which prompt medical intervention is required to prescribe treatment. Reasons for this condition:

1. Asthma during exacerbation.
2. Persistent spasms, pulmonary thrombosis.
3. Pneumonia.
4. Stagnation in the chest due to the accumulation of a significant amount of fluid, air.
5. Injury in the sternum.

Factors affecting the occurrence of the disease from the cardiovascular system:

1. Vasculitis in the lungs.
2. Formations of a tumor nature in the mediastinum.
3. The development of aneurysms, which, with an increase in the pathological process, compress the parts of the heart located on the right side.

The causes of the disease from the bronchi:

1. Pneumonia treatment.
2. Chronic infectious processes in the lungs: bronchitis, tuberculosis.
3. Emphysema in the lungs.
4. Bronchitis with asthmatic component.

Symptoms

Sometimes cardiopulmonary insufficiency appears without predisposing factors, while a clear clinical picture is noticeable. If the disease is acute, first aid must be provided immediately. Usually the patient is transferred to the intensive care unit. The disease is manifested by the following symptoms:

1. Thrombosis of the pulmonary artery.
2. Pneumonia.
3. Exacerbation of asthma.
4. Mitral valve dysfunction.
5. Failure of a previously transplanted prosthetic valve.
6. In the case of the development of many adverse factors, signs of severe circulatory failure are possible.

The following symptoms appear:

1. Breathing is accelerated, it is impossible to take a deep breath.
2. A sharp drop in pressure. If timely assistance is not provided, there is a risk of collapse.
3. Dyspnea.
4. Decreased limb temperature.
5. Blueish skin tone.
6. Profuse sweating.
7. Pain syndrome in the chest.

Signs of chronic cardiopulmonary insufficiency appear as a result of hypertension in the pulmonary circulation. This process gradually intensifies, development occurs over a long amount of time. Patients live without the manifestation of negative symptoms for several months, years.

Periodically, patients notice the following symptoms:

1. Shortness of breath, which is aggravated by sports.
2. With physical activity, fatigue occurs within a few hours after the start of the work shift, stay at an important event.
3. The frequent appearance of a bluish tint of the skin in the area of ​​\u200b\u200bthe fingertips, the nasolabial triangle.
4. Rapid heart rate.
5. If pulmonary heart failure is accompanied by decompensation, negative manifestations gradually increase, leading to dangerous processes in the organs. You can notice the following signs of the disease:
6. Shortness of breath does not leave a person even at rest. It is possible to increase the attack if the patient moves to a horizontal position.
7. The pain syndrome increases as a result of the progression of ischemia.
8. Distention of the veins of the neck.
9. Decrease in pressure, development of tachycardia.
10. Blueish skin tone.
11. Enlarged liver, discomfort in the right hypochondrium.
12. Edema does not subside with the use of standard drugs, folk remedies.

In case of aggravation of the condition, inhibition of the functions of the brain and kidneys is possible. The person becomes sluggish, apathetic, manifestations of increased drowsiness are noticeable. The condition is dangerous due to a decrease in diuresis, other disorders in the organs that are difficult to restore when using medications. Hypoxia increases the amount of hemoglobin and red blood cells in the blood.

Treatment

If cardiopulmonary insufficiency appeared in an acute form, the patient moves to the intensive care unit. They use the technology of maintaining artificial respiration by introducing an oxygen mixture through a mask or using a nasal catheter. Thanks to this event, the vital functions of important organs are supported.

Treatment of cardiopulmonary failure includes intravenous administration of the following substances:

1. Thrombolysis is required to reduce the symptoms of pulmonary embolism. After its implementation, there is a dissolution of the thrombus, normalization of blood flow.
2. Atropine acts as a muscle relaxant, relaxes the muscles of the bronchi. As a result, it is possible to breathe independently.
3. Papaverine is necessary for excessively strong vascular tone. The action of this substance is to expand the vascular walls, normalize pressure.
4. Anticoagulants prevent thrombosis, protect the heart from the risks associated with blood diseases.
5. Eufillin restores the normal functioning of the myocardium, reduces the severity of respiratory disorders.

First aid for pulmonary edema

If the pathological process is growing minute by minute, it is necessary not only to call an ambulance, but also to carry out important activities on your own:

1. Move the patient to a sitting position.
2. Make sure the room is well ventilated.
3. To reduce the pressure, you need a nitroglycerin tablet. It must be dissolved under the tongue to provide an almost instant effect. Before deciding on the use of the drug, you should make sure that at the moment the patient does not have low blood pressure. Also, you can not use medications on their own if the patient is unconscious.
4. If the process proceeds in a mild or moderately severe form, a diuretic can be given. So the swelling is quickly removed, due to which there is a disposal of excess fluid.
5. In the event of an excessive increase in pressure, it is necessary to ensure the removal of blood from the lungs in order to avoid its accumulation. To do this, at home, you can take a basin, pour heated water. Ask the patient to lower their legs into it.
6. Soak gauze in alcohol, give to the patient. Inhaled vapors will help to slightly reduce negative symptoms.

In order not to harm a person, it is advisable, when calling the ambulance team, to consult with a specialist about what measures can be taken under specific patient conditions.

Effects

In the case of relief of the acute stage of cardiopulmonary insufficiency, with the onset of remission of the chronic form of the disease, the risk of developing complications remains:

1. Infection. If the patient has pulmonary edema, their inflammation, bronchitis, is possible. With a decrease in the functions of the immune system, the treatment of these diseases is complicated.
2. Chronic hypoxia of organs. Oxygen starvation manifests itself in vital organs, in particular, the brain and heart. It is necessary to start taking medications in a timely manner in order to prevent irreversible violations.
3. Ischemic tissue damage with insufficiently rapid removal of symptoms of hypoxia.
4. Atherosclerosis of the lungs. The formation of a site whose functioning is impaired due to fluid exposure.

The disease has a pronounced symptomatology, which rarely goes unnoticed.

Severity

The chronic form of the disease is characterized by a slow and subtle increase in symptoms. Based on this, four degrees of severity of the disease are distinguished:

Diagnostics

To diagnose cardiopulmonary insufficiency and prescribe effective therapy, it is necessary to conduct a comprehensive examination.

The disease can be determined by instrumental diagnostic methods:

Treatment

The main directions of treatment of cardiopulmonary insufficiency include:

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Cardiopulmonary failure: what is it?

In the case of destruction of the heart muscle, its contractility decreases, which affects the total amount of pumped blood.

Failures in the work of the heart lead to the following pathologies:

1. Hypoxia of various organs due to a reduced amount of oxygen obtained from the blood.
2. Congestion in the lungs, which does not allow the patient to use their full volume when breathing.
3. Pathologies associated with stagnation of fluid in the lungs, which are combined with heart failure. The syndrome includes several dangerous disorders.

The following symptoms appear:

1. Dizziness that starts for no apparent reason, even at rest.
2. Shortness of breath with little exertion.
3. Decrease in working capacity, inability to perform habitual actions that did not seem difficult before the onset of pathology.
4. Paleness of the skin in the region of the nasolabial triangle and fingers of the upper extremities.

The reasons

Acute cardiopulmonary insufficiency is considered a dangerous disease in which prompt medical intervention is required to prescribe treatment. Reasons for this condition:

1. Asthma during exacerbation.
2. Persistent spasms, pulmonary thrombosis.
3. Pneumonia.
4. Stagnation in the chest due to the accumulation of a significant amount of fluid, air.
5. Injury in the sternum.

Factors affecting the occurrence of the disease from the cardiovascular system:

1. Vasculitis in the lungs.
2. Formations of a tumor nature in the mediastinum.
3. The development of aneurysms, which, with an increase in the pathological process, compress the parts of the heart located on the right side.

The causes of the disease from the bronchi:

1. Pneumonia treatment.
2. Chronic infectious processes in the lungs: bronchitis, tuberculosis.
3. Emphysema in the lungs.
4. Bronchitis with asthmatic component.

Symptoms

Sometimes cardiopulmonary insufficiency appears without predisposing factors, while a clear clinical picture is noticeable. If the disease is acute, first aid must be provided immediately. Usually the patient is transferred to the intensive care unit. The disease is manifested by the following symptoms:

1. Thrombosis of the pulmonary artery.
2. Pneumonia.
3. Exacerbation of asthma.
4. Mitral valve dysfunction.
5. Failure of a previously transplanted prosthetic valve.
6. In the case of the development of many adverse factors, signs of severe circulatory failure are possible.

The following symptoms appear:

1. Breathing is accelerated, it is impossible to take a deep breath.
2. A sharp drop in pressure. If timely assistance is not provided, there is a risk of collapse.
3. Dyspnea.
4. Decreased limb temperature.
5. Blueish skin tone.
6. Profuse sweating.
7. Pain syndrome in the chest.

Signs of chronic cardiopulmonary insufficiency appear as a result of hypertension in the pulmonary circulation. This process gradually intensifies, development occurs over a long amount of time. Patients live without the manifestation of negative symptoms for several months, years.

Periodically, patients notice the following symptoms:

1. Shortness of breath, which is aggravated by sports.
2. With physical activity, fatigue occurs within a few hours after the start of the work shift, stay at an important event.
3. The frequent appearance of a bluish tint of the skin in the area of ​​\u200b\u200bthe fingertips, the nasolabial triangle.


4. Rapid heart rate.
5. If pulmonary heart failure is accompanied by decompensation, negative manifestations gradually increase, leading to dangerous processes in the organs. You can notice the following signs of the disease:
6. Shortness of breath does not leave a person even at rest. It is possible to increase the attack if the patient moves to a horizontal position.
7. The pain syndrome increases as a result of the progression of ischemia.
8. Distention of the veins of the neck.
9. Decrease in pressure, development of tachycardia.
10. Blueish skin tone.
11. Enlarged liver, discomfort in the right hypochondrium.
12. Edema does not subside with the use of standard drugs, folk remedies.

In case of aggravation of the condition, inhibition of the functions of the brain and kidneys is possible. The person becomes sluggish, apathetic, manifestations of increased drowsiness are noticeable. The condition is dangerous due to a decrease in diuresis, other disorders in the organs that are difficult to restore when using medications. Hypoxia increases the amount of hemoglobin and red blood cells in the blood.

Treatment

If cardiopulmonary insufficiency appeared in an acute form, the patient moves to the intensive care unit. They use the technology of maintaining artificial respiration by introducing an oxygen mixture through a mask or using a nasal catheter. Thanks to this event, the vital functions of important organs are supported.

Treatment of cardiopulmonary failure includes intravenous administration of the following substances:

1. Thrombolysis is required to reduce the symptoms of pulmonary embolism. After its implementation, there is a dissolution of the thrombus, normalization of blood flow.
2. Atropine acts as a muscle relaxant, relaxes the muscles of the bronchi. As a result, it is possible to breathe independently.
3. Papaverine is necessary for excessively strong vascular tone. The action of this substance is to expand the vascular walls, normalize pressure.
4. Anticoagulants prevent thrombosis, protect the heart from the risks associated with blood diseases.
5. Eufillin restores the normal functioning of the myocardium, reduces the severity of respiratory disorders.

First aid for pulmonary edema

If the pathological process is growing minute by minute, it is necessary not only to call an ambulance, but also to carry out important activities on your own:

1. Move the patient to a sitting position.
2. Make sure the room is well ventilated.
3. To reduce the pressure, you need a nitroglycerin tablet. It must be dissolved under the tongue to provide an almost instant effect. Before deciding on the use of the drug, you should make sure that at the moment the patient does not have low blood pressure. Also, you can not use medications on their own if the patient is unconscious.
4. If the process proceeds in a mild or moderately severe form, a diuretic can be given. So the swelling is quickly removed, due to which there is a disposal of excess fluid.
5. In the event of an excessive increase in pressure, it is necessary to ensure the removal of blood from the lungs in order to avoid its accumulation. To do this, at home, you can take a basin, pour heated water. Ask the patient to lower their legs into it.
6. Soak gauze in alcohol, give to the patient. Inhaled vapors will help to slightly reduce negative symptoms.

In order not to harm a person, it is advisable, when calling the ambulance team, to consult with a specialist about what measures can be taken under specific patient conditions.

Effects

In the case of relief of the acute stage of cardiopulmonary insufficiency, with the onset of remission of the chronic form of the disease, the risk of developing complications remains:

1. Infection. If the patient has pulmonary edema, their inflammation, bronchitis, is possible. With a decrease in the functions of the immune system, the treatment of these diseases is complicated.
2. Chronic hypoxia of organs. Oxygen starvation manifests itself in vital organs, in particular, the brain and heart. It is necessary to start taking medications in a timely manner in order to prevent irreversible violations.
3. Ischemic tissue damage with insufficiently rapid removal of symptoms of hypoxia.
4. Atherosclerosis of the lungs. The formation of a site whose functioning is impaired due to fluid exposure.

To cure cardiopulmonary insufficiency, it is necessary to diagnose this disease in a timely manner. Constant monitoring of the patient, conducting regular courses of therapy will help to avoid dangerous complications, reduce the likelihood of irreversible disorders, which positively affects the prognosis and increases life expectancy.

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Why does the heart weaken?

With a variety of cardiac pathologies, too much blood may flow to the heart, it may be weak or difficult to pump blood against increased pressure in the vessels (see also causes of pain in the heart). In any of these cases, the underlying disease can be complicated by heart failure, the main causes of which are worth talking about.

Myocardial causes

They are associated with direct weakness of the heart muscle as a result of:

• inflammation (myocarditis)
• necrosis (acute myocardial infarction)
• expansion of the cavities of the heart (dilated myocardiopathy)
• muscle wasting (myocardial dystrophy)
• myocardial malnutrition (ischemic disease, atherosclerosis of the coronary vessels, diabetes mellitus).

Among the reasons:

• compression of the heart by an inflammatory effusion in the heart sac (pericarditis)
• blood (with injuries or ruptures of the heart)
• fibrillation due to electric shock
• atrial fibrillation
• paroxysmal tachycardia
• ventricular fibrillation
• overdose of cardiac glycosides, calcium antagonists, adrenoblockers
• alcoholic myocardiopathy

Volume overload also leads to symptoms of heart failure.

It is based on the deterioration of blood flow conditions with an increase in venous return to the heart with heart valve insufficiency, defects in the septa of the heart, hypervolemia, polycythemia, or resistance to blood flow to cardiac output in arterial hypertension, congenital and acquired (rheumatic) heart defects with stenosis of valves and large vessels, constrictive myocardiopathy. Another overload can be with pulmonary embolism, pneumonia, obstructive pulmonary disease and bronchial asthma.

Combined variants develop with weakness of the heart muscle and an increase in the load on the heart, for example, with complex heart defects (Fallot's tetrad).

How fast the problem develops

Depending on how quickly the symptoms of heart failure increase, they speak of its acute or chronic variants.

• Acute heart failure develops over several hours or even minutes. It is preceded by various cardiac catastrophes: acute myocardial infarction, pulmonary embolism. In this case, the left or right ventricle of the heart may be involved in the pathological process.
• Chronic heart failure is the result of long-term illnesses. It progresses gradually and worsens from minimal manifestations to severe multiple organ failure. It can develop along one of the circles of blood circulation.

Acute left ventricular failure

Acute left ventricular failure is a situation that can develop in two ways (cardiac asthma or pulmonary edema). Both of them are characterized by congestion in the vessels of the small (pulmonary) circle.

Their basis is disturbed coronary blood flow, which remains more or less adequate only at the moment of relaxation of the heart muscle (diastole).

At the time of contraction (systole), blood does not completely enter the aorta, stagnating in the left ventricle. Pressure builds up in the left side of the heart, and the right side overflows with blood, causing pulmonary congestion.

cardiac asthma

Cardiac asthma is essentially cardiopulmonary insufficiency. Its symptoms may gradually increase:

• Pathology is manifested in the early stages of shortness of breath. Occurs initially with physical activity, tolerance to which gradually decreases. Shortness of breath is inspiratory in nature and, unlike bronchial asthma, it is difficult to inhale. With further development of the process, shortness of breath appears at rest, forcing patients to sleep on higher pillows.
• Then shortness of breath is replaced by episodes of suffocation, which often accompany a night's sleep. In this case, the patient has to sit up in bed, take a forced position with his legs lowered from the bed and leaning on his hands to enable the auxiliary respiratory muscles to work.
• Often attacks are combined with fear of death, palpitations and sweating.
• Cough in heart failure - with scanty, difficult to separate sputum. If you look at a person's face at the time of the attack, you can see the blue of the nasolabial triangle against the background of pale or grayish skin. There are also frequent respiratory movements of the chest, cyanosis of the fingers. The bullet is often irregular and weak, blood pressure is reduced.

Comparative characteristics of suffocation in cardiac and bronchial asthma

Pulmonary edema

Pulmonary edema is a significant effusion of the liquid part of the blood into the lung tissue. Depending on where this fluid enters, pulmonary edema is divided into interstitial and alveolar. In the first case, the effusion occupies the entire lung tissue, in the second case, it is mainly the alveoli, which are clogged with bloody sputum. Pulmonary edema develops at any time of the day or night, as an attack of sudden suffocation. The patient's condition rapidly progressively worsens:

• increasing shortness of breath, shortness of breath,
• cyanosis of the extremities and face,
• palpitations, cold sweat
• disturbances of consciousness from motor and speech excitement up to fainting.
• hoarse, gurgling breathing can be heard in the distance.
• with alveolar edema, a large amount of pink foam is released.
• if edema develops against the background of a decrease in cardiac output (with myocardial infarction, myocarditis), then there is a risk of developing cardiogenic shock.

Acute right ventricular failure

This is an acute cor pulmonale, which leads to congestion in the systemic circulation. The most likely causes of its occurrence:

• thromboembolism of a large branch of the pulmonary artery
• pneumothorax
• lung atelectasis
• asthmatic status

It can also aggravate myocardial infarction or acute myocarditis. Increased pressure in the pulmonary circulation increases the workload on the right ventricle and reduces blood flow to the left side of the heart, which reduces cardiac output. As a result, coronary blood flow suffers and pulmonary ventilation decreases.

With such acute heart failure, the symptoms are as follows:

• The patient begins to be disturbed by shortness of breath and a feeling of lack of air.
• His neck veins swell, which is more noticeable on inspiration.
• The face and fingers become blue.
• Further, a pulsation in the epigastrium joins, an increase in the liver and heaviness in the right hypochondrium.
• Pastosity develops, and then swelling of the legs, face and anterior abdominal wall.

How is chronic heart failure classified?

In all cases, when heart failure (symptoms and organ disorders) develops slowly, they speak of its chronic form. As symptoms increase, this option is divided into stages. So, according to Vasilenko-Strazhesko there are three of them.

• initial stage
  • I - at rest there are no manifestations of pathology.
  • IA - preclinical stage, detected only by functional tests.
  • IB - symptoms of heart failure manifest themselves with physical exertion and completely resolve at rest.

• Stage two
  • II is characterized by the presence of signs of pathology at rest.
  • IIA - stagnation in a large or small circle with moderate manifestations at rest.
  • IIB- violations are detected in both circles of blood circulation.

• Stage three
  • III - dystrophic changes in organs and tissues against the background of circulatory disorders in both circles.
  • IIIA - Organ disorders are treatable.
  • IIIB- Dystrophic changes are irreversible.

The modern classification of chronic heart failure takes into account exercise tolerance and the prospects of therapy. For this, functional classes are used, which can change with successful therapy.

• Class I - this is the absence of restrictions with the usual physical activity. Increased load may be accompanied by minimal manifestations of shortness of breath.
• Class II implies a slight limitation of physical activity: there are no symptoms at rest, and habitual exercise may be accompanied by shortness of breath or palpitations.
• Class III is the onset of symptoms at minimal exertion and their absence at rest.
• IV functional class does not allow to withstand even a minimal load, there are symptoms at rest.

Symptoms of chronic heart failure

This variant of heart failure is often the outcome of many chronic heart diseases. It proceeds according to the right or left ventricular type, and may be total. The mechanisms of its development are similar to acute forms, but extended in time, due to which oxygen starvation and degeneration of organs and tissues come first.

Insufficiency of the right heart chambers

leads to disturbances in the pulmonary circulation and is manifested by pulmonary symptoms. In the first place among the complaints of patients is:

• shortness of breath that progresses and reduces quality of life
• there is a need to sleep with a raised head, periodically occupy the position of orthopnea (sit with support on hands).
• gradually coughing joins the shortness of breath with the separation of a small amount of clear sputum.
• as heart failure progresses, episodes of suffocation may occur.
• patients are characterized by a grayish-cyanotic skin color, cyanosis in the area of ​​the nasolabial triangle, hands and feet. The fingers take the form of drumsticks. Nails become excessively convex and thickened.

Left ventricular weakness leads to changes in the great circle

• Patients are concerned about palpitations (paroxysmal tachycardia, atrial fibrillation, extrasystoles), weakness and fatigue.
• There is an edematous syndrome. Gradually, edema in heart failure increases, spreading to the legs, anterior abdominal wall, lower back and genitals. Massive edema is called anasarca.
• First, it is the pastosity of the feet and legs and hidden edema, which is detected during weighing.
• Violations of blood flow in the kidneys cause a decrease in the amount of urine separated up to anuria.
• An increase in the liver manifests prolonged congestive heart failure. Its symptoms are heaviness and pain in the right hypochondrium due to the tension of the edematous liver of its capsule.
• Problems with cerebral circulation lead to sleep disturbances, memory disorders, and even mental and mental disorders.

Comparative features of cardiac and renal edema

Treatment for heart failure

Therapy of heart failure is carried out in two directions. Acute forms require emergency care. Chronic variants undergo planned treatment with correction of decompensations and long-term administration of maintenance dosages of drugs.

First aid

Emergency care includes the pre-hospital stage, carried out by an ambulance or doctor on an outpatient appointment and inpatient treatment.

• The relief of acute left ventricular failure in the form of pulmonary edema begins with giving the patient a position with a raised headboard. Oxygen inhalations with alcohol vapors are carried out. Lasix and isosorbide dinitrate on 5% glucose are administered intravenously. With oxygen starvation of the patient's tissues, they are transferred to artificial ventilation of the lungs (the trachea is intubated, after introducing atropine sulfate, dormicum, relanium and ketamine).
• Symptoms of acute right ventricular failure on the background of pulmonary embolism include oxygen therapy, the introduction of rheopolyglucin and heparin (with stable blood pressure). In case of hypotension, dopamine or adrenaline is administered. If clinical death occurs, cardiopulmonary resuscitation is performed.

Treatment of chronic heart failure

Chronic heart failure requires an integrated approach. Treatment includes not only drugs, but involves a diet with a decrease in fluid (up to 2.5 liters per day) and salt (up to 1 g per day). Therapy is carried out using the following groups of drugs.

• Diuretic

They reduce venous return to the heart and allow you to cope with edema. Preference is given to saluretics (furosemide, lasix, torasemide, indapamide) and potassium-sparing (triampur, spironolactone, veroshpiron). Aldosterone antagonists (veroshpiron) are the drug of choice in the treatment of refractory edema.

• ACE inhibitors

They reduce pulmonary preload and congestion, improve renal blood flow, and remodel the heart muscle to increase cardiac output:

- Captopril (Capoten), enalapril (Enap), perindopril (Prestarium), lisinopril (Diroton), fosinopril (Monopril), ramipril (Tritace) are used. This is the main group to which chronic heart failure lends itself. Treatment is carried out with minimal maintenance dosages.

- Medium and long-acting cardiac glycosides: digoxin (tsedoxin) and digitoxin (digofton). Cardiac glycosides are most preferred when there is heart failure against the background of atrial fibrillation. Treatment of III and IV functional classes also requires their appointment. The drugs increase the force of contractions of the mytocardium, reduce the frequency of contractions, and reduce the size of the enlarged heart.

• Beta-blocker tori

reduce tachycardia and myocardial oxygen demand. After two weeks of drug adaptation, cardiac output increases. Metoprolol succinate (betaloc ZOK), bisoprolol (concor), nebivolol (nebilet).

Treatment of heart failure is carried out for a long time under the supervision of a cardiologist and a therapist. If all the recommendations of specialists are followed, it is possible to compensate for the pathology, maintain the quality of life and prevent the development of decompensations.

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Acute cardiopulmonary failure

Doctors call this condition acute left ventricular failure, because it is left ventricular dysfunction that most often leads to stagnation of blood in the lungs.

Deficiency is associated with a sharp change in the activity of the heart muscle, due to an infectious disease or an electrical discharge that hit the heart muscle, thrombosis of the coronary (supplying the heart itself with blood) arteries, muscle rupture and other vascular accidents.

It manifests itself as cardiogenic shock, suffocation (cardiac asthma), pulmonary edema. The patient takes a forced position - sitting with the emphasis of the hands, in order to somehow ensure the flow of air.

The mechanism of pulmonary edema in heart failure: due to the extremely high blood pressure in the lungs, fluid effusion from the vessels into the intercellular space begins, which disrupts normal gas exchange in the lung tissues. As a result, suffocation occurs. Acute cardiopulmonary failure can develop almost instantly; within a few minutes.

Symptoms of acute heart failure

The patient begins shortness of breath, gradually turning into a painful suffocation. The patient assumes a forced position

Due to the effusion of fluid in the lungs, sputum may be coughed up, which does not bring the patient any relief. In severe cases, pink, frothy sputum is separated from the mouth and nose.

Edema and pallor may appear quite quickly. The patient becomes very scared (and not unreasonably).

Acute cardiopulmonary failure may not have specific acoustic manifestations. Sometimes with the help of a phonendoscope, small bubbling rales can be heard in the lower parts of the lungs (edema). With expanded edema, moist rales appear over the entire surface of the lungs.

Symptoms of acute heart failure in the photo

The pressure in acute heart failure may be elevated, may be reduced - this is not a diagnostic criterion. Due to severe stress in this condition, an increase in the heart rate is observed. If the patient has had episodes of arrhythmia in the past, it may happen again.

First aid for acute cardiopulmonary failure

We immediately call an ambulance. If the patient cannot figure out for himself how it is easier for him to breathe, we seat him on a chair (posture “on a horse”) with his legs down. elbows should rest on the back of the chair.

Pulmonary edema is one of the most dangerous conditions in medicine, no folk methods, the power of self-hypnosis and reflexology can save you from it.

Regardless of your assumptions about the nature of the condition, a nitroglycerin tablet should be placed under the tongue of the patient.

If the leading mechanism of insufficiency is myocardial infarction, then timely prescribed nitroglycerin significantly reduces the area of ​​tissue damage, i.e. reduces the risk of rupture (transmural infarction) of the heart muscle and improves overall prognosis.

We open the windows in the room - the air must be saturated with oxygen. If there is oxygen in the room (in the tank), let the patient breathe.

It is enough to effectively apply a tight tourniquet on both legs - this will significantly unload the heart, because. reduce the volume of circulating fluid. This manipulation can save the life of the patient, however, with prolonged burning, the patient dies from intoxication after decompression of the legs.

If you are afraid that the patient will not make it to the arrival of the ambulance (foamy sputum from the mouth, the patient turns blue) - you can burn the lower limbs.

Treatment of acute left ventricular heart failure in a hospital

Such patients are taken either to the infarction department, or to the intensive care unit at the cardiological dispensary or department. If the process is accompanied by arrhythmia - to the cardiological hospital where there are arrhythmologists.

In the hospital, pulmonary edema will be removed with hormonal drugs, the patient is given narcotic analgesics. If the problem was in thrombosis of the coronary arteries, thrombolytics are prescribed: Actelize, Metalise, Streptokinase, Urokinase, etc.

Thrombolytics are quite expensive, but they can save the patient in the first hours after thrombosis. In fact, when a blood clot splits, the situation is resolved without serious consequences for the patient. Do not save at this stage - if the clinic has run out of a tender thrombolytic - buy it.

In addition, doctors prescribe drugs that reduce the activity of the respiratory center, sedatives and stimulants of metabolism in the heart muscle (metabolic therapy).

If a patient has heart failure accompanied by arrhythmia (atrial fibrillation, atrial fibrillation), antithrombotic therapy is prescribed.

Cardiac arrhythmia caused by left ventricular heart failure is itself a factor provoking thrombosis. To prevent this common complication, Xarelto, Clexane and other fractionated heparins are prescribed.

After providing emergency care, the patient is transferred to a regular ward, prescribed drugs that lower blood pressure (ACE inhibitors, diuretics) and drugs to normalize the heart rhythm.

Chronic cardiopulmonary insufficiency

It is denoted by the abbreviation CHF - this is a very common pathology associated with gradual decompensation (overload) of the left ventricle. It is this part of the heart that is responsible for the blood supply to the entire body, i.e. produces systolic ejection of blood.

As a rule, the cause of heart failure in this case is associated with a gradual narrowing of the lumen of the coronary arteries due to atherosclerosis. The heart is gradually “cut off” from nutrition, as a result of which the heart muscle first increases and then collapses, which leads to insufficiency.

The second consequence of atherosclerosis is high blood pressure, which aggravates the process of destruction of the vascular system.

Causes of CHF in the photo

Another common cause of CHF is excessive exercise and an increase in overall body weight. Both bodybuilders and people who are simply inclined to be overweight increase the overall resistance in the vascular bed (more mass - more blood vessels). Simply put, there are more pipes, but the motor is the same. For a while, the heart works at high speeds - the muscle tries to give out normal pressure. Then - the destruction of the heart muscle occurs and insufficiency occurs.

It is believed that stress and smoking are also factors provoking CHF, since constant vasoconstriction enhances the effect of atherosclerotic changes.

Factors provoking the development of CHF

Alcohol is not a direct risk factor for CHF, however, the toxic effect of ethyl alcohol on the heart muscle is periodically observed, and alcoholic myocarditis is sometimes the cause of the development of an acute form of heart failure. Moderate alcohol consumption is indeed a factor in the prevention of atherosclerosis (and, consequently, CHF), however, due to the lack of moderation among the population in this matter, this topic is not considered by doctors.

Heart failure symptoms and CHF classes

Traditionally, the severity of CHF is determined by analyzing the distance that a person can overcome without shortness of breath and other symptoms. The classic test is climbing stairs.

• 1st class CHF. It is considered the mildest form of the disease - when climbing to the 3rd floor and above, shortness of breath appears. Otherwise, the person feels normal, activity is normal;
• The 2nd class is already quite easy to detect even in the countryside - when climbing to the first floor, shortness of breath begins, as well as when walking fast. Morning swelling appears. The heart is enlarged, which becomes noticeable even on a chest x-ray;
• 3rd class - a serious condition in which shortness of breath occurs with any physical exertion;
• Grade 4 - shortness of breath at rest, the condition is constantly worsening (up to death).

The chronic form is characterized by blue fingers and toes (cyanosis), hemoptysis, dry rales, swelling of the extremities (1st-2nd class - only in the morning).

The diagnosis is made by a cardiologist. As a rule, an examination, an ECG and a plain radiograph are sufficient for this.

Treatment of chronic cardiopulmonary insufficiency

Psychological phenomenon - no one wants to be treated for a long time (consciousness rejects an incurable disease). As a rule, patients take drugs only 2-3 months after visiting a cardiologist. This is the main reason for the relatively rapid death from heart failure.
Treatment of chronic heart failure is prescribed for life. Cancellation of doctor's appointments quickly enough leads to the transition to the next functional class of CHF.

Pressure-reducing drugs are prescribed - sartans (Losartan), ACE inhibitors (enalapril, lisinopril), diuretics (hydrochlorothiazide, etc.). In addition to diuretics, patients are advised to strictly limit fluid intake. Beta-blockers (carvedilol, metaprolol, etc.) are recommended for heart rate control.

For the prevention of thrombosis, patients must be prescribed acetylsalicylic acid (aspirin). Sometimes it is combined with warfarin and other anticoagulants and antiplatelet agents.

Signs of heart failure