Stroke chronic hypertension heart failure. The drug in acute heart failure and stroke Stroke as one of the causes of death

Atrial fibrillation is one of the forms of arrhythmia caused by the occurrence of a pathological focus of impulse circulation in the sinus node or in the atrial tissue, characterized by the occurrence of non-rhythmic, rapid and chaotic contraction of the atrial myocardium, and manifested by a feeling of frequent and irregular heartbeat.

Forms of atrial fibrillation; paroxysmal, persistent

In the general concept of atrial fibrillation, fibrillation (flicker) and atrial flutter are distinguished. In the first type, atrial contractions are "small-wave", with a pulse of about 500 per minute, providing a rapid contraction of the ventricles. In the second type, atrial contractions are about 300-400 per minute, "large-wave", but also causing the ventricles to contract more often. Both in the first and in the second type, ventricular contractions can reach more than 200 per minute, but with atrial flutter, the rhythm can be regular - this is the so-called rhythmic, or regular form of atrial flutter.

In addition, atrial fibrillation and flutter can occur simultaneously in one patient over a certain period of time, for example, with paroxysm of atrial fibrillation - atrial flutter. Often during atrial flutter, the ventricular rate can remain within the normal range, and then a more accurate analysis of the cardiogram is required for a correct diagnosis.

In addition to such a division of atrial fibrillation, according to the principle of the course of this disease, the following forms are distinguished:

• Paroxysmal, characterized by the occurrence of interruptions in the work of the heart and recorded by ECG during the first 24-48 hours (up to seven days), which can be stopped on their own or with the help of medications,
• Persistent, characterized by rhythm disturbances such as atrial fibrillation or flutter for more than seven days, but capable of spontaneous or drug-induced rhythm recovery,
• Long-term persistence, existing for more than one year, but able to restore the rhythm with the introduction of drugs or electrocardioversion (restoration of sinus rhythm with a defibrillator),
• Permanent - a form that is characterized by the absence of the possibility of restoring sinus rhythm, which exists for years.

Depending on the frequency of ventricular contractions, brady-, normo- and tachysystolic variants of atrial fibrillation are distinguished. Accordingly, in the first case, the frequency of ventricular contractions is less than 55-60 per minute, in the second - 60-90 per minute and in the third - 90 or more per minute.

Statistical data

According to studies conducted in Russia and abroad, atrial fibrillation occurs in 5% of the population over the age of 60 and in 10% of the population over 80 years of age. At the same time, women suffer from atrial fibrillation 1.5 times more often than men. The danger of arrhythmia is that patients with paroxysmal or permanent forms are 5 times more likely to have strokes and other thromboembolic complications.

In patients with heart defects, atrial fibrillation occurs in more than 60% of all cases, and in patients with coronary heart disease - in almost 10% of cases.

What happens with atrial fibrillation?

Pathogenetic changes in this rhythm disturbance are due to the following processes. In normal myocardial tissue, the electrical impulse moves unidirectionally - from the sinus node towards the atrioventricular junction. If there are any blocks in the path of the impulse (inflammation, necrosis, etc.), the impulse cannot bypass this obstacle and is forced to move in the opposite direction, again causing excitation of the myocardial regions that have just contracted. Thus, a pathological focus of constant circulation of impulses is created.

Constant stimulation of certain areas of the atrial tissue leads to the fact that these areas spread excitation to the remaining atrial myocardium, and its fibers contract separately, chaotically and irregularly, but often.

In the future, the impulses are conducted through the atrioventricular connection, but due to its relatively small "throughput" capacity, only a part of the impulses reaches the ventricles, which begin to contract at different frequencies and also irregularly.

Video: atrial fibrillation - medical animation

What causes atrial fibrillation?

In the vast majority of cases, atrial fibrillation occurs as a result of organic damage to the myocardium. Diseases of this type include primarily heart defects. As a result of stenosis or insufficiency of valves over time, the patient develops cardiomyopathy - a change in the structure and morphology of the myocardium. Cardiomyopathy causes part of the normal muscle fibers in the heart to be replaced by hypertrophied (thickened) fibers that lose their ability to conduct impulses normally. Areas of hypertrophied tissue are pathological foci of impulses in the atria when it comes to stenosis and / or insufficiency of the mitral and tricuspid valves.

The next disease, which ranks second in the incidence of atrial fibrillation, is coronary heart disease, including acute and past myocardial infarction. The path of development of arrhythmia is similar to defects, only areas of normal muscle tissue are replaced by necrotic rather than hypertrophied fibers.

Also a significant cause of arrhythmia is cardiosclerosis - the growth of connective (scar) tissue instead of ordinary muscle cells. Cardiosclerosis can form within a few months or years after heart attacks or myocarditis (inflammatory changes in the heart tissue of a viral or bacterial nature). Often, atrial fibrillation occurs in the acute period of myocardial infarction or in acute myocarditis.

In some patients, atrial fibrillation occurs in the absence of organic heart damage due to diseases of the endocrine system. The most common cause in this case is thyroid disease, accompanied by an increased release of its hormones into the blood. This condition is called hyperthyroidism, occurring with nodular or autoimmune goiter. In addition, the constant stimulating effect of thyroid hormones on the heart leads to the formation of dyshormonal cardiomyopathy, which in itself can lead to impaired conduction through the atria.

In addition to the main reasons, it is possible to identify risk factors that increase the likelihood of developing atrial fibrillation in a particular patient. These include age over 50 years, female gender, obesity, hypertension, endocrine pathology, including diabetes mellitus, and a history of heart disease.

The factors provoking the occurrence of atrial fibrillation paroxysm in individuals with a history of arrhythmia already present include conditions that cause changes in the autonomic regulation of cardiac activity.

For example, with the predominant influence of the vagus nerve (vagal, parasympathetic influences), an arrhythmia attack may begin after a heavy meal, when turning the body, at night or during daytime rest, etc. With the influence of sympathetic nerves on the heart, the onset or worsening of the course of arrhythmia occurs as a result of stress, fear, strong emotions or physical exertion - that is, all those conditions that are accompanied by increased secretion of adrenaline and norepinephrine into the blood.

Symptoms of atrial fibrillation

Symptoms of atrial fibrillation may vary in individual patients. Moreover, the clinical manifestations are largely determined by the form and variant of atrial fibrillation.

So, for example, the clinic of paroxysmal atrial fibrillation is bright and characteristic. The patient, against the background of complete health or minor precursors (shortness of breath when walking, pain in the region of the heart), experiences sudden unpleasant symptoms - a sharp feeling of rapid heartbeat, a feeling of lack of air, an asthma attack, a sensation of a coma in the chest and throat, inability to inhale or exhale. At the same time, according to the description of the patients themselves, the heart trembles like a "hare's tail", ready to jump out of the chest, etc. In addition to this most characteristic symptom, some patients experience vegetative manifestations - excessive sweating, a feeling of internal trembling throughout the body, redness or blanching of the skin of the face, nausea, feeling light-headed. This symptom complex in simple language is called "disruption" of the rhythm.
But the formidable signs that should alert relatives and the doctor examining the patient are a sharp jump in blood pressure upwards (more than 150 mm Hg) or, conversely, a significant decrease in pressure (less than 90 mm Hg), since against the background of high pressure there is a high risk stroke, and low blood pressure is a sign of acute heart failure or arrhythmogenic shock.

Clinical manifestations are brighter, the greater the heart rate. Although there are exceptions when the patient tolerates a frequency of 120-150 per minute more than satisfactorily, and, conversely, a patient with a bradysystolic variant experiences interruptions in the heart and dizziness more pronounced than with normo- and tachysystole.

With an uncompensated constant form of atrial fibrillation or flutter, the heart rate is usually 80-120 per minute. Patients get used to such a rhythm, and practically do not feel interruptions in the work of the heart, only during physical exertion. But here, due to the development of chronic heart failure, complaints of shortness of breath during physical exertion, and often with minimal household activity and at rest, come to the fore.

Diagnostics

The algorithm for diagnosing atrial fibrillation consists of the following points:

1. Examination and questioning of the patient. So, even in the process of collecting complaints and anamnesis, it is possible to establish that the patient has some kind of rhythm disturbance. Counting the pulse per minute and determining its irregularity may prompt the doctor to think about atrial fibrillation.
2. ECG diagnostics is a simple, affordable and informative method for confirming atrial fibrillation. The cardiogram is already performed when an ambulance is called or when the patient first contacts the clinic with interruptions.

The criteria for atrial fibrillation are:

1. After the ECG, indications for hospitalization in a hospital are determined (see below). In case of hospitalization, further examination is carried out in the department of cardiology, therapy or arrhythmology, in case of refusal of hospitalization, the patient is sent for additional examination to the polyclinic at the place of residence.
2. Of the additional diagnostic methods, the most frequently prescribed and informative is the daily monitoring of the ECG and blood pressure. This method allows you to register even short runs of arrhythmias that are not “caught” on a standard cardiogram, and also helps to assess the quality of the treatment.
3. Ultrasound of the heart, or echo-CS (echo-cardioscopy). It is the "gold standard" in the imaging diagnosis of heart disease, as it allows you to detect
   significant violations of myocardial contractility, its structural disorders and to evaluate the ejection fraction of the left ventricle, which is a decisive criterion for evaluating the effectiveness of therapy for heart failure with a constant form of atrial fibrillation.
4. Transesophageal electrophysiological study (TEFI) is a method based on artificial stimulation of the myocardium and provoking flicker, which can be immediately recorded on the ECG. It is carried out in order to register an arrhythmia, which clinically worries the patient with subjective sensations, but was not registered on the ECG (including with the help of Holter monitoring).
5. X-ray of the chest organs is used to examine patients with a paroxysmal form (suspicion of pulmonary embolism) and with a permanent form (to assess venous congestion in the lungs due to chronic heart failure).
6. General and biochemical blood tests, the study of the level of thyroid hormones in the blood, ultrasound of the thyroid gland - helps in the differential diagnosis of cardiomyopathy.

In principle, for the diagnosis of atrial fibrillation, characteristic complaints (interruptions in the heart, chest pain, dyspnea), anamnesis (occurred acutely or exist for a long time), and an ECG with signs of atrial fibrillation or flutter are sufficient. However, the cause of such a rhythm disturbance should be clarified only in the process of a thorough examination of the patient.

Tactics for the treatment of atrial fibrillation

Therapy for paroxysmal and constant forms of atrial fibrillation differs. The purpose of care in the first form is to provide emergency care and to conduct rhythm-restoring therapy. In the second form, the priority is the appointment of rhythm-reducing therapy with the constant use of medications. The persistent form can be subject to both rhythm-restoring therapy, and, in case of failure of the latter, to the transfer of the persistent form to a permanent one using rhythm-reducing drugs.

Treatment of paroxysmal atrial fibrillation

The relief of paroxysm of flickering or fluttering is carried out already at the prehospital stage - by ambulance or in the clinic.

Of the main drugs for an arrhythmia attack, the following are used intravenously:

• Polarizing mixture - potassium chloride solution 4% + glucose 5% 400 ml + insulin 5 units. In patients with diabetes, physical therapy is used instead of a glucose-insulin mixture. solution (sodium chloride 0.9%) 200 or 400 ml.
• Panangin or asparkam solution 10 ml intravenously.
• A solution of novocainamide 10% 5 or 10 ml in saline. With a tendency to hypotension (low pressure), it should be administered simultaneously with mezaton to prevent drug-induced hypotension, collapse and loss of consciousness.
• Cordarone at a dosage of 5 mg/kg of body weight is administered in a 5% glucose solution intravenously slowly or drip. Should be used in isolation from other antiarrhythmic drugs.
• Strofantin 0.025% 1 ml in 10 ml of saline solution intravenously slowly or in 200 ml of saline solution intravenously drip. It can be used only in the absence of glycoside intoxication (chronic overdose of digoxin, corglycon, strophanthin, etc.).

After the administration of the drugs, after 20-30 minutes, the patient is retaken the ECG and, in the absence of sinus rhythm, he must be taken to the emergency department of the hospital to resolve the issue of hospitalization. Restoration of the rhythm at the level of the emergency department is not carried out, the patient is hospitalized in the department, where the started treatment continues.

Indications for hospitalization:

1. The first identified paroxysmal form of arrhythmia,
2. Protracted paroxysm (from three to seven days), since there is a high probability of developing thromboembolic complications,
3. Paroxysm not stopped at the prehospital stage,
4. Paroxysm with developing complications (acute heart failure, pulmonary edema, pulmonary embolism, heart attack or stroke),
5. Decompensation of heart failure with a constant form of flicker.

Treatment of persistent form of atrial fibrillation

In the case of persistent flickering, the clinician should seek to restore sinus rhythm with medication and/or cardioversion. This is explained by the fact that with restored sinus rhythm, the risk of developing thromboembolic complications is much lower than with a permanent form, and chronic heart failure progresses less. In the case of successful restoration of sinus rhythm, the patient must constantly take antiarrhythmic drugs, such as amiodarone, cordarone or propafenone (propanorm, ritmonorm).

Thus, the tactics for the persistent form is as follows - the patient is observed in the clinic with atrial fibrillation for more than seven days, for example, after discharge from the hospital with failed relief of the paroxysm and with the ineffectiveness of the pills taken by the patient. If the doctor decides to try to restore sinus rhythm, he again refers the patient to a hospital for planned hospitalization for the purpose of medical rhythm restoration or for cardioversion. If the patient has contraindications (past heart attacks and strokes, blood clots in the heart cavity according to the results of echocardioscopy, untreated hyperthyroidism, severe chronic heart failure, arrhythmia prescription for more than two years), the persistent form is transferred to a permanent form with other groups of drugs.

Treatment of a permanent form of atrial fibrillation

With this form, the patient is prescribed tablet preparations that slow down the heart rate. The main ones here are a group of beta-blockers and cardiac glycosides, for example, Concor 5 mg x 1 time per day, Coronal 5 mg x 1 time per day, Egilok 25 mg x 2 times a day, Betalok ZOK 25-50 mg x 1 time per day and others. From cardiac glycosides, digoxin 0.025 mg is used, 1/2 tablet x 2 times a day - 5 days, a break - 2 days (Sat, Sun).

It is mandatory to prescribe anticoagulants and antiplatelet agents, for example, cardiomagnyl 100 mg at lunch, or clopidogrel 75 mg at lunch, or warfarin 2.5-5 mg x 1 time per day (necessarily under the control of INR - a parameter of the blood coagulation system, usually 2.0-2.5 is recommended). These drugs prevent increased blood clots and reduce the risk of heart attacks and strokes.

Chronic heart failure should be treated with diuretics (indapamide 1.5 mg in the morning, veroshpiron 25 mg in the morning) and ACE inhibitors (prestarium 5 mg in the morning, enalapril 5 mg x 2 times a day, lisinopril 5 mg in the morning), which have an organoprotective effect on blood vessels and the heart.

When is cardioversion indicated?

Cardioversion is the restoration of the original heart rhythm in a patient with atrial fibrillation using drugs (see above) or an electric current passed through the chest and affecting the electrical activity of the heart.

Electrical cardioversion is performed on an emergency or elective basis using a defibrillator. This type of assistance should be provided only in the intensive care unit with the use of anesthesia.

The indication for emergency cardioversion is a paroxysm of atrial fibrillation not more than two days old with the development of arrhythmogenic shock.

The indication for planned cardioversion is a paroxysm more than two days old, not stopped by medication, in the absence of blood clots in the atrial cavity, confirmed by transesophageal ultrasound of the heart. If a thrombus in the heart is detected, the patient at the outpatient stage takes warfarin for a month, during which, in most cases, the thrombus dissolves, and then after repeated ultrasound of the heart in the absence of a thrombus, he is again sent to the hospital to decide on cardioversion.

Thus, planned cardioversion is carried out mainly when the doctor strives to restore sinus rhythm in the persistent form of atrial fibrillation.

Technically, cardioversion is performed by applying defibrillator electrodes to the anterior chest wall after the patient has been placed under intravenous anesthesia. After that, the defibrillator delivers a shock, which affects the rhythm of the heart. The success rate is very high, accounting for more than 90% of successful restoration of sinus rhythm. However, cardioversion is not suitable for all patient groups, in many cases (for example, in the elderly) AF will quickly develop again.

Thromboembolic complications after cardioversion are about 5% among patients who did not take anticoagulants and antiplatelet agents, as well as about 1% among patients receiving such drugs from the onset of arrhythmia.

When is surgery indicated?

Surgical treatment for atrial fibrillation can have several goals. So, for example, with heart defects as the main cause of arrhythmia, surgical correction of the defect as an independent operation in a larger percentage of cases prevents further recurrences of atrial fibrillation.

For other heart diseases, radiofrequency or laser ablation of the heart is justified in the following cases:

• Ineffectiveness of antiarrhythmic therapy with frequent paroxysms of atrial fibrillation,
• Permanent form of flickering with rapid progression of heart failure,
• Intolerance to antiarrhythmic drugs.

Radiofrequency ablation consists in the fact that the areas of the atria involved in the pathological circulation of the impulse are exposed to an electrode with a radio sensor at the end. The electrode is inserted into the patient under general anesthesia through the femoral artery under X-ray television control. The operation is safe and less traumatic, takes a short period of time and is not a source of discomfort for the patient. RFA can be performed according to quotas from the Ministry of Health of the Russian Federation or at the patient's own expense.

Is it possible to treat with folk remedies?

Some patients may ignore the recommendations of their doctor and begin to be treated on their own, using traditional medicine methods. As an independent therapy, taking herbs and decoctions, of course, is not recommended. But as an auxiliary method, in addition to the main drug therapy, the patient can take decoctions of soothing plants that have a beneficial effect on the nervous and cardiovascular systems. For example, decoctions and infusions of valerian, hawthorn, clover, chamomile, mint and lemon balm are often used. In any case, the patient should notify the treating doctor about taking such herbs.

Are complications of atrial fibrillation possible?

The most common complications are pulmonary embolism (PE), acute heart attack and acute stroke, as well as arrhythmogenic shock and acute heart failure (pulmonary edema).

The most significant complication is stroke. An ischemic-type stroke caused by a thrombus shooting into the cerebral vessels (for example, when a paroxysm stops) occurs in 5% of patients in the first five years after the onset of atrial fibrillation.

Prevention of thromboembolic complications (stroke and PE) is the constant intake of anticoagulants and antiplatelet agents. However, even here there are some nuances. So, for example, with an increased risk of bleeding, the patient is likely to bleed into the brain with the development of a hemorrhagic stroke. The risk of developing such a condition is more than 1% in patients in the first year from the start of anticoagulant therapy. Prevention of increased bleeding is regular monitoring of INR (at least once a month) with timely adjustment of the dose of the anticoagulant.

Video: how a stroke occurs due to atrial fibrillation

Forecast

The prognosis for life with atrial fibrillation is determined primarily by the causes of the disease. So, for example, in survivors of acute myocardial infarction and significant cardiosclerosis, the short-term prognosis for life can be favorable, and unfavorable for health in the medium term, since in a short period of time the patient develops chronic heart failure, which worsens the quality of life and reduces it. duration.

However, with regular use of drugs prescribed by a doctor, the prognosis for life and health undoubtedly improves. And patients with a permanent form of MA registered at a young age, with proper compensation, live with it even up to 20-40 years.

Video: atrial fibrillation - expert opinion

Video: atrial fibrillation in the Live Healthy program

Causes, classification and treatment of heart failure

Heart failure is a syndrome characterized by an acute or chronic disruption of the heart. The muscle loses its functionality: it stops pumping the amount of blood that the body needs, which stagnates as a result, and the organs do not receive the necessary amount of oxygen. In men, the pathology occurs at an earlier age than in women, and more often leads to death.

There are several classifications of heart failure (HF):

• According to the rate of development: acute HF; chronic HF.
• By localization of the lesion: left ventricular heart failure; develops due to a decrease in the volume of blood ejected into the systemic circulation and stagnation of blood in the pulmonary circulation. This condition often occurs after a myocardial infarction or as a result of narrowing of the aorta; right ventricular heart failure occurs due to a decrease in the amount of blood ejected into the venous circulation and stagnation of blood in the systemic circulation. A common cause of this form of insufficiency is pulmonary hypertension; mixed heart failure occurs due to overload of both ventricles.
• By origin: overload heart failure occurs from too high a load on the heart due to malformations of its development or diseases associated with a violation of the normal blood flow; myocardial heart failure develops as a result of direct damage to the myocardium and leads to a violation of the heart rhythm; mixed heart failure occurs with simultaneous high load and damage to the muscle wall.

Acute HF

Acute heart failure (AHF) is a form of the disease characterized by a sudden decrease in the number of heartbeats. The time of its development is from several minutes to several hours. There are several forms of acute insufficiency.

• AHF with blood stasis:
  • Acute right ventricular failure is a decrease in the dynamics of venous blood in the systemic circulation. Symptoms of chronic insufficiency of this form are represented by an increase in venous pressure, swelling of the veins, tachycardia, pain in the liver, aggravated by palpation. Edema of the legs appears when the patient lies for a long time.
  • Acute left ventricular failure - stagnation of venous blood in the pulmonary circulation. Signs of heart failure of this form - suffocation, paroxysmal shortness of breath, orthopnea (breathing disorder in the supine position), dry and then wet cough, foamy sputum. She is also accompanied by pallor of the skin, increased sweating, panic and fear of death. The form of the disease is represented by: pulmonary edema, in which extravascular fluid accumulates in their tissues; cardiac asthma - an attack of shortness of breath, turning into suffocation.
• AHF with slowing blood flow - cardiogenic shock, in which there is a decrease in blood pressure and blood supply to all organs is disturbed. At the same time, compensatory tachycardia, coldness and pallor of the skin, the appearance of a marble pattern, profuse cold sweat, decreased diuresis, mental agitation or lethargy are manifested.
  • True cardiogenic shock occurs if the volume of tissue damage is more than 40% of the mass of the myocardium of the left ventricle. This type of cardiogenic shock is characterized by resistance to therapy, congestive left ventricular failure, and a high mortality rate. It often develops in people over 60 years of age, with repeated and anterolateral infarcts, diabetes mellitus, arterial hypertension.
  • Arrhythmic shock occurs due to a drop in the minute volume of blood circulation. Hemodynamics recovers quite quickly after shock relief.
  • Reflex shock (pain collapse) is manifested by pain that has arisen as a reaction to an increase in the tone of the vagus nerve. The condition disappears after taking medications, primarily painkillers.
• Exacerbation of chronic heart failure.

AHF is equally common in men and women. Acute heart failure often occurs in children.

The reasons

There are several groups of factors due to which AHF develops:

• From the side of heart disease:
  • acute myocardial infarction;
  • myocarditis;
  • the consequences of surgery and the use of an artificial heart;
  • exacerbation of chronic heart failure;
  • myocardial hypertrophy;
  • cardiac tamponade;
  • hypertensive crisis;
  • damage to the valves or cavities of the heart;
  • tachy and bradyarrhythmias.
• From the side of the lungs:
  • pulmonary embolism;
  • pneumonia, acute bronchitis.
• Other reasons:
  • stroke;
  • brain injury;
  • infections or intoxication of the myocardium;
  • electrical trauma, consequences of electropulse therapy.

Acute heart failure in children occurs as a result of:

• flu;
• pneumonia;
• heart defects;
• intestinal infections and toxicosis;
• rheumatic, diphtheria or typhoid myocarditis;
• prolonged anemia;
• acute nephritis;
• poisoning;
• acute hypoxia;
• deficiency of potassium and vitamins of group B.

Diagnostics

To determine the presence and form of AHF, the following types of diagnostics are used:

• Physical examination. Distinctive signs of acute left ventricular failure are moist rales, bubbling breathing. In the right ventricular form of insufficiency, swelling of the liver and cervical veins, an increase in the jugular veins on inspiration are observed. Cardiogenic shock is accompanied by a drop in systolic blood pressure below 90 and pulse - below 25 mm Hg. Art.
• A urinalysis shows the level of protein, red and white blood cells.
• A complete blood count determines the level of leukocytes and the erythrocyte sedimentation rate (ESR).
• A biochemical blood test that measures the levels of cholesterol, glucose and triglycerides.
• Electrocardiography (ECG) shows left ventricular overload and impaired blood flow to the myocardium.
• Radiography, through which the borders of the heart and the condition of the vessels of the lungs are assessed.
• Coronary angiography shows the condition and localization of the coronary arteries.
• Magnetic resonance imaging (MRI) and multislice computed tomography (MSCT) demonstrate the exact condition of the walls, chambers, valves and blood vessels of the heart.
• Analysis for the level of ventricular natriuretic peptide, which increases depending on the level of insufficiency.

Treatment

Therapy for AHF is prescribed by a doctor depending on the form of pathology. The main goal is to normalize the heart rhythm.

1. If the cause of failure is myocardial infarction, thrombolytic drugs and inhalation of humidified oxygen through a nasal catheter are used.
2. Tachycardia and tachyarrhythmia are treated with antiarrhythmic drugs.
3. Painkillers are used to relieve pain.
4. With congestive AHF, the patient is given nitroglycerin, 1-2 tablets under the tongue. With unexpressed symptoms, the person is raised his head, with pulmonary edema, he is brought to a sitting position.
5. A diuretic drug (Furosemide) is administered intravenously, which causes hemodynamic unloading of the myocardium.
6. Severe psychomotor agitation, or tachypnea, is an indication for treatment with narcotic analgesics. They reduce respiratory activity and workload on the heart. Contraindications - cerebral edema, chronic cor pulmonale, poisoning with substances that depress respiration, Cheyne-Stokes respiration, acute airway obstruction.
7. In case of left ventricular congestive failure in combination with cardiogenic shock, non-glycoside inotropic drugs (Dopamine, Norepinephrine, Dobutamine) are administered by means of a dropper.
8. Left ventricular failure in combination with myocardial infarction or pulmonary edema against the background of a hypertensive crisis is a reason for treatment with nitroglycerin or Isosorbide dinitrate drip. If arterial hypertension, hypovolemia, pulmonary artery obstruction, cerebrovascular accident, cardiac tamponade are present, another tactic of therapy is chosen.
9. Persistent pulmonary edema requires treatment with glucocorticoids, which reduce membrane permeability.
10. If pulmonary edema is accompanied by the release of foam, treatment methods such as inhalation of oxygen vapors of alcohol, silicone solution, Antifomsilan through a mask or nasal catheter are used.
11. In case of microcirculation disorders, especially with persistent pulmonary edema, heparin sodium is administered intravenously, and then drip is introduced.
12. In cardiogenic shock without signs of congestive insufficiency, the patient is given a horizontal position and an anesthetic is prescribed. Plasma substitutes are administered intravenously. If the patient was dehydrated before the onset of shock, isotonic sodium chloride solution is administered.
13. If cardiogenic shock is combined with congestive insufficiency, dopamine is the drug of choice. With contraindications (thyrotoxicosis, tachycardia, hypersensitivity) or insufficiency of the treatment, Dobutamine or Norepinephrine is used.
14. The lack of effectiveness of the measures taken is an indication for the use of intra-aortic balloon counterpulsation (IABP). With its help, hemodynamics are stabilized until surgical intervention is performed.

Acute heart failure requires an ambulance call. After the initial correction of hemodynamic disorders, the patient is hospitalized in the cardiac intensive care unit. People with cardiogenic shock, if possible, are hospitalized in medical facilities where cardiac surgery departments operate. Usually, without medical attention, AHF is fatal.

Chronic HF

Chronic heart failure (CHF) is a pathology in which the heart gradually ceases to perform its functions of pumping blood and, thus, supply organs and tissues with oxygen and nutrients. This is due to the weakening of the muscle wall caused by various untreated cardiac diseases. Usually, the onset of chronic insufficiency occurs without clear symptoms and is detected in the early stages only during research.

Due to the fact that early diagnosis of CHF in Russia is poorly developed, medicine considers the disease to be one of the most severe and difficult to predict. During the first 5 years, the initial asymptomatic stage may develop into the most severe one.

To differentiate the severity of chronic insufficiency, the New York Heart Association developed a classification according to which 4 functional classes (FC) of patients are distinguished:

• 1 FC - no symptoms. The patient does not experience discomfort during physical activity. Weakness, shortness of breath, palpitations, chest pains are absent.
• FC 2 - mild symptoms. At rest, the patient feels well, but ordinary physical activity causes shortness of breath, chest pain, palpitations, or weakness.
• 3 FC - severe symptoms. The patient feels comfortable only at rest, even slight physical activity leads to the appearance of signs of heart failure.
• 4 FC - permanent symptoms that appear even at rest and intensify as the load increases.

In addition to this, there are other classifications. According to the severity of the course, chronic insufficiency is:

• Initial (stage 1). There are no obvious symptoms, there are no circulatory disorders, echocardiography (EchoCG) shows a latent structural deterioration of the left ventricle.
• Clinically expressed (stage 2 A). In one of the circles of blood circulation, hemodynamic disturbances are observed.
• Severe (stage 2 B). Pronounced violation of the movement of blood in both large and small circles of blood circulation, structural pathologies of the heart and blood vessels.
• Final (stage 3). Pronounced pathologies of hemodynamics and severe, often irreversible damage to the heart, blood vessels, lungs, kidneys, and brain.

Depending on the zone of primary lesion, there are:

• right ventricular heart failure, in which blood stasis is observed in the vessels of the lungs (pulmonary circulation);
• left ventricular heart failure, in which blood stasis is observed in the systemic circulation;
• biventricular heart failure, with stagnation of blood in both circles.

According to the classification, built on the nature of the violation of cardiac activity, there are:

• systolic heart failure associated with the period of ventricular contraction;
• diastolic heart rate, depending on the period of relaxation of the ventricles;
• mixed CH.

Symptoms

At the initial stage, the disease proceeds without obvious signs. Over time, symptoms appear:

• Edema appears due to blood retention in the venous bed.
• Shortness of breath develops due to the fact that the organs, due to disorders in the pulmonary circulation, receive an insufficient amount of oxygen.
• Fatigue even after normal physical exertion - walking at a moderate pace, house cleaning, climbing stairs.
• Cardiopalmus.
• Cough, dry at the beginning of the disease and with sputum as it worsens. Over time, streaks of blood may appear in the sputum.
• Orthopnea.

Symptoms of heart failure in women who are expecting a baby and are predisposed to developing CHF appear at 26–28 weeks of gestation, in childbirth and in the early postpartum period. This is due to a physiological increase in blood volume and dramatic hemodynamic changes. Pregnancy with CHF is associated with an increased risk for the woman and the fetus, so a patient suffering from cardiac diseases is hospitalized:

• at 8–10 weeks;
• at 28–30 weeks;
• 3 weeks before delivery.

In addition, it is worth remembering that a normal healthy pregnancy can be accompanied by symptoms similar to those of CHF: shortness of breath, palpitations and heart rhythm disturbances.

The reasons

The causes of chronic heart failure are structural changes in the myocardium resulting from:

1. Diseases of the circulatory system. Arterial hypertension is the most common cause of CHF in women; Ischemic disease is the most common cause of CHF in men. And also after myocardial infarction; cardiosclerosis; pericarditis; cardiopathy and cardiomyopathy; aortic aneurysms; mitral valve insufficiency; atrial fibrillation; heart block; atherosclerosis; septic endocarditis; chest trauma; taking certain medications.
2. Endocrine diseases: diabetes mellitus; hyper- or hypothyroidism; adrenal disease.
3. Metabolic disorders: obesity; beriberi and mineral deficiency; cachexia; amyloidosis.
4. Other pathologies: sarcoidosis; HIV; renal failure; alcoholism.

Diagnostics

The diagnosis of "chronic heart failure" is made on the basis of data from several studies.

1. ECG and 24-hour ECG monitoring allow you to determine the quality of the heart throughout the day and in different physiological states.
2. Treadmill test - assessment of the work of the heart under stress.
3. EchoCG demonstrates the volume of the heart chambers, the thickness of the myocardium, the state of the blood vessels.
4. Cardiac catheterization shows the level of pressure in the heart cavities and determines the localization of vascular blockage.

Treatment

With CHF, long-term therapy is prescribed, which requires not only medication, but also lifestyle changes.

• in the initial stages of heart failure, vasodilators and alpha-blockers are prescribed, which have a vasodilating and antispasmodic effect;
• cardiac glycosides reduce tachycardia, normalize the patency of impulses and reduce myocardial excitation;
• diuretics are taken to relieve swelling;
• drugs are prescribed that correct metabolic disorders: calcium antagonists, anabolic steroids, multivitamin complexes.

It is necessary to abandon bad habits: the rate of development of the disease and the quality of life of the patient depend on this. Nutrition for heart failure must meet several requirements:

• Caloric restriction: energy value is calculated by the attending physician, taking into account the need to reduce or gain weight.
• Restriction of table salt to 3 g and water to 1.2 liters per day.
• Usefulness of food: the menu is based on protein and vegetable products, fiber. The amount of fatty, salty, pickled and too hot food should be reduced.

Such a diet for heart failure helps to improve the patient's condition and speed up the rehabilitation process.

Physical activity is also selected individually. For people with chronic heart failure, swimming, walking, cycling, and gymnastics are more often recommended. The intensity of the load depends on the stage of the disease.

Any insufficiency of cardiac activity, contrary to the prevailing stereotype, is by no means a sentence. A patient with this diagnosis can lead a quality life provided:

• timely diagnosis;
• symptomatic treatment and therapy of concomitant diseases;
• supportive spa treatment;
• adequate physical activity;
• following a diet for heart failure;
• giving up bad habits.

Acute heart failure in children has a more favorable prognosis than in adults, due to the greater compensatory abilities of the child's body.

And a stroke should be provided to the patient by surrounding people in a timely manner if a critical situation arises. There is a very high mortality rate from these terrible diseases in the world.

The mechanism of development of heart pathology

Heart failure is not considered an independent disease. This is a syndrome that is the result of a number of long-term developing ailments: severe pathology of the heart valves, problems with coronary vessels, rheumatic heart disease, impaired tone of the arteries, veins, capillaries with uncompensated arterial hypertension.

There comes a moment when, due to poor pumping of blood, the heart cannot cope with its pumping function (full pumping, blood supply to all body systems). There is an imbalance between the body's need for oxygen and its delivery. First, the fall in cardiac output occurs during exercise. Gradually, these pathological phenomena intensify. Eventually, the heart begins to work hard at rest.

Heart failure is a complication of other diseases. Its appearance may be preceded by a previous myocardial infarction, because each such pathological case is the death of a separate section of the heart muscle. At a certain point in a heart attack, the remaining viable sections of the myocardium cannot cope with the load. There is a sufficient number of patients who have a mild degree of this pathology, but they are not diagnosed. Therefore, they can suddenly feel a sharp deterioration in their condition.

Back to index

Symptoms of acute heart failure

The main manifestations of cardiac dysfunction are:

1. The most striking signs of this syndrome are wheezing, nocturnal cough, increasing shortness of breath during movement, physical exertion, climbing stairs. Cyanosis appears: the skin turns blue, blood pressure rises. Patients feel constant fatigue.
2. In heart failure, first dense peripheral swelling of the legs quickly develops, and then the lower abdomen and other parts of the body swell.

People who have noticed such clinical signs in themselves should immediately consult a doctor and tell about their problem. As directed by a specialist, they will undergo diagnostics. When heart failure occurs in a patient, a cardiographic study is very effective, according to the results of which a cardiologist can determine the presence or absence of structural disorders of the heart muscle. If there is a disease, the necessary treatment will be prescribed according to the scheme in order to normalize myocardial metabolism and cardiac output through the selection of rational therapy.

Heart disease is highly treatable if diagnosed early. In this case, the patient is easier to treat, the disease can be compensated. If he receives the right treatment, the patient's cardiovascular system can function successfully for many years. If the course of the disease is delayed, as the patient does not go to the doctor and is not treated, the situation is aggravated. The patient's body suffers from a lack of oxygen, there is a gradual death of body tissues. If the patient does not receive immediate treatment, he may lose his life.

Back to index

How is emergency care carried out in the event of acute heart failure?

With this pathology, the full functioning of the heart, the functions of the circulatory system can be impaired for several hours and even minutes. Sometimes signs of pathology develop gradually. There is moderate pain and discomfort. People don't understand what's going on. They wait too long before seeking medical help. Only urgent measures in this situation can save the patient's life. Immediately after the onset of clinical symptoms of heart failure, an ambulance team should be called. Doctors will take the necessary measures and offer the patient mandatory hospitalization.

While waiting for specialists, it is necessary to provide first aid to the patient:

1. Since panic can be harmful, the patient should be tried to calm down so that anxiety and fear disappear from him.
2. Fresh air must be provided, so the windows must be opened.
3. The patient should be freed from clothing that restricts his breathing. The collar of the shirt must be unbuttoned and the tie must be untied.
4. With a horizontal position of the body, as a result of the accumulation of blood in the lungs and the lack of air, the patient's shortness of breath increases. Therefore, the patient should be in an intermediate position between the lying and sitting posture (i.e., half-sitting). This helps to unload the heart, reduce shortness of breath and swelling.
5. Then, in order to reduce the total volume of blood circulating in the body, you need to clamp the veins. To do this, a venous tourniquet is applied for several minutes on both hands above the elbow and on the hips.
6. 1 tablet of nitroglycerin under the tongue every 10 minutes is given to stop an attack. But you can not give more than 3 tablets.
7. Blood pressure should be under constant control.
8. This pathology significantly reduces the well-being of a patient with a cardiovascular disease. Often, the patient's chances of saving a life depend on the people who are nearby at a critical moment.
9. If it has happened, the surrounding people should do before the arrival of the medical team in order to return the patient to life.

Back to index

Indirect cardiac massage

Since its implementation is ineffective on a soft bed, the patient should lie on a hard shield, floor or ground. Hands are placed on the central part of the chest. She squeezes hard several times. As a result, the volume of the chest decreases, blood is squeezed out of the heart into the lungs and the systemic circulation. This allows you to restore the pumping work of the heart and normal blood circulation.

stroke chronic hypertension heart failure

The most common and severe complications of hypertension are:

As mentioned earlier, hypertension is accompanied by constant tension of the vascular wall, which leads to its thickening, impaired elasticity, and poor nutrition of surrounding tissues. In the thickened wall, lipid particles are much easier to linger, which leads to a narrowing of the lumen of the vessel, a slowdown in blood flow, an increase in its viscosity, and thrombosis. A sharp increase in pressure causes malnutrition of the heart muscle, leading to necrosis of the damaged area, which is manifested by pain in the region of the heart. A prolonged pain attack is the main symptom of myocardial infarction.

A painful attack has a number of characteristic features (Table 23).

It is extremely important to provide first aid for myocardial infarction as soon as possible. The more timely assistance is provided, the faster the recovery process will go and fewer complications are expected.

First aid for myocardial infarction is that if pain occurs:

Take nitroglycerin, which relieves pain well for a few seconds or minutes;

Call an ambulance;

Try not to make sudden movements until the attack stops, stay in bed until the doctor arrives;

Try to calm down, because the attack stops within a few seconds after taking nitroglycerin and the danger will be left behind, so that the disease is subject to you, but if you cannot curb your emotions, the attack will last longer;

Do not tolerate pain: if it does not stop with one pill, you need to take another one;

After taking a nitroglycerin tablet, try to restore breathing: take a deep breath (as far as possible), hold your breath and then exhale slowly, repeat this exercise several times;

Try to relax after taking nitroglycerin: relieve muscle tension, rub the numb fingers of the left hand or the entire hand.

Relatives should put mustard plasters on the calves and on the heart area for the patient, help take warm foot or hand baths with a water temperature of 30–40 ° C for 10-15 minutes, do not leave the patient, cheer and calm him down.

Acute heart failure and cardiogenic shock

Acute heart failure and cardiogenic shock can serve as a terrible complication of myocardial infarction. Relatives of the patient should know the rules of conduct in the event of such complications.

Acute heart failure develops abruptly, suddenly against the background of an acute process in the myocardium, while shortness of breath increases, bubbling breathing, palpitations, foamy sputum, cyanosis of the lips, nose tip, coldness of the hands and feet appear.

The rules of conduct are:

Cover the patient with heating pads;

Give the patient a half-sitting (reclining) position;

To raise blood pressure, press on a point located on the left hand in a triangle between the first phalanges of the thumb and forefinger, in the middle of the phalanx of the thumb;

Massage the fingers, apply sharp pressure with a fingernail in the area of ​​\u200b\u200bthe fingertips;

Do not leave the patient, try to calm him down.

An even more formidable complication that can occur after acute heart failure is cardiogenic shock.

Cardiogenic shock is manifested by symptoms such as:

Sudden severe weakness;

Paleness of the skin;

Cold clammy sweat;

Weak fast pulse;

drop in blood pressure;

Cardiac arrest (the most formidable manifestation of shock), the disappearance of the pulse in large vessels (there are only single breaths, and soon breathing stops), the skin is pale or ash-gray, dilated pupils.

In case of cardiac arrest, the patient needs emergency care, everyone should be able to provide it (you need to master the skills of indirect heart massage and artificial respiration techniques) in order to save the life of the patient, which may be your relative. Very little time is allotted for this - only 3-4 minutes.

It is required to immediately carry out artificial respiration and indirect heart massage, the key to success is the correct technique for conducting:

Lay the patient on a hard surface;

Put a roller of clothes under the shoulder blades so that the head tilts back a little;

The position of the hands put the palm of one hand on the lower third of the chest, put the second on the first;

Carry out several energetic jerky pressures, while the sternum should move vertically by 3–4 cm;

Alternate massage with artificial respiration according to the “mouth to mouth” or “mouth to nose” method, in which the one who provides assistance exhales air from his lungs into the patient’s mouth or nose;

For 1 exhalation, there should be 4–5 pressures on the sternum, if one person provides assistance, then for 3 exhalations there are 10–15 pressures on the sternum.

If the massage is successful, the skin will begin to take on its usual color, the pupils will narrow, the pulse will be palpable, and breathing will recover.

Brain disorders include cerebral stroke and mental disorders.

brain stroke. In connection with damage to the cerebral vessels in long-term hypertension and a violation of their elasticity, it is possible to develop a cerebral stroke - an acute circulatory disorder (Table 24).

Your tactic is to call a doctor, an ambulance, it is not recommended to take any other actions. If the patient is on the floor, carefully transfer him to the bed and turn his head to one side, as vomiting is possible and the patient may choke on vomit.

In acute cerebrovascular accident, there may develop mental disorders:

Visual and auditory hallucinations;

Try to limit the movement of the patient;

Do not argue or enter into conflicts with the patient;

Try to take the patient by the hands and massage the hands and fingers.

The main mistake is that relatives call the psychiatric ambulance team, losing time to provide targeted assistance (lowering blood pressure), although the administration of appropriate drugs by the doctors of the psychiatric ambulance team can reduce blood pressure, which is the main cause of mental disorders.

We hope that the above information will help you and your relatives in preventing unwanted complications from the cerebral vessels.

Chronic heart failure

Heart failure is a condition in which the pumping function of the heart does not provide enough blood to the organs and tissues of the body. In chronic heart disease, it increases in size, it contracts poorly and pumps blood worse. Chronic heart failure occurs gradually against the background of a chronic disease and develops over the years. Chronic heart failure is characterized by a number of signs, the presence of each of which indicates a varying degree of severity of heart failure. For the patient and his relatives, it is necessary to know the main signs (Table 25) in order to consult a doctor in time, make changes in treatment and lifestyle (nutrition, drinking regimen, etc.)

For a better understanding of the symptoms, let's briefly review each of them.

Weakness, fatigue and limitation of physical activity. The reason for weakness and fatigue is that the body as a whole does not receive enough blood and oxygen, even after a good night's sleep, patients may feel tired. Loads that were well tolerated before now cause a feeling of fatigue, a person wants to sit or lie down, he needs additional rest.

1. In case of increasing weakness and fatigue, immediately consult a doctor.

3. Spend more time outdoors, sleep in a well-ventilated area.

4. Create for yourself an optimal mode of work and rest.

Dyspnea- quickening and intensification of breathing, which do not correspond to the state and conditions in which the person is at the moment.

In the beginning, shortness of breath may occur only with heavy exertion. Then it appears at small loads. As heart failure progresses, shortness of breath occurs when dressing, showering, and even at rest. With an increase in shortness of breath, you should immediately consult a doctor!

heartbeat- increased and rapid contractions of the heart, a feeling that the heart "jumps out of the chest", the pulse becomes frequent, weak filling, it is sometimes difficult to calculate, it may become irregular.

First aid rules for palpitations:

Try to calm down and relax;

Start by restoring breathing: take a deep breath, hold your breath, then slowly exhale - repeat this exercise several times;

If the heartbeat does not go away, close your eyes, lightly press on the eyeballs or take as deep a breath as possible and tighten your abs a little.

The main thing is to remember that the situation is manageable, excessive fuss and tension will drag out the symptoms, and will not help to overcome them.

The main symptom of congestion in the lungs is dry cough, most often at night.

If you have this symptom, you should immediately consult a doctor for advice and advice. Only a doctor can assess the severity of shortness of breath and make the necessary decision.

Edema- accumulation of fluid in typical places, especially in the ankles, on the back of the feet. Edema appears in the evening, disappears overnight. With a more pronounced process, they become permanent. The severity of edema is assessed by an increase in body weight. An increase in body weight of 1 kg per day in patients with heart failure corresponds to a delay of 1 liter of fluid, so it is important to weigh yourself every day and follow the rules below:

Weigh yourself on the same scale every morning before meals after the morning toilet;

Keep a self-control diary (Table 26).

If you have gained 1.0-1.5 kg in 1 day or 1.5-2.0 kg in 5 days, you should immediately consult a doctor.

Lethargy, lethargy. The patient constantly wants to sleep, he is lethargic, has ceased to be interested in others, his movements are slow, etc. These signs are very serious, since there is fluid retention in the brain cells, which entails irreparable consequences, so you should immediately consult a doctor.

Stroke and heart failure

Heart failure is the most severe pathological condition of the human body. It lies in the fact that the heart, for one reason or another, is not able to perform its function of pumping blood completely.

Because of this, the entire body, each of its cells, each organ experiences a very strong oxygen starvation. But the most serious complication of heart failure is a stroke, which is caused by a severe violation of blood circulation in the brain.

Acute heart failure develops very, very quickly, almost instantly. It refers to terminal states and can easily lead to the death of the patient. And therefore, stroke and heart failure are the diseases whose symptoms everyone should know.

What can lead to the fact that the heart will start to work incorrectly and not work with all its strength? In the first place among such causes is, of course, myocardial infarction - a very common disease that most often occurs in men. This is followed by a violation of the coronary blood flow and compression of the heart by other organs. Compression of the heart or tamponade very often occurs with pulmonary edema or tumors that are located in the chest. At the same time, the heart simply does not have enough space for normal work, and it begins to give severe failures. Often, heart failure occurs with infectious lesions of the pericardium or myocardium, when bacteria and microbes literally destroy the walls of this organ.

An attack of heart failure develops in a few minutes. Such a state is always sudden and unexpected both for the patient himself and for his relatives. At the same time, the patient feels that he simply has nothing to breathe and everything is squeezed in his chest. The skin of a person begins to turn blue sharply and quickly due to a lack of oxygen supplied to it. The person loses consciousness. But the worst thing is that very often all these symptoms are accompanied by complications such as pulmonary edema, myocardial infarction and hypertensive crisis. And, of course, a stroke. Stroke and heart failure are two diseases that in most cases occur in parallel.

A stroke is a sudden interruption of blood flow to the veins and arteries of the brain. There are 3 varieties of this serious disease.

The first variety is the ischemic type or cerebral infarction. This condition most often develops after the age of 60. For the development of this condition, there must be some prerequisites - heart defects, diabetes mellitus, or the same heart failure. Most often, cerebral infarction develops at night.

The second type is a hemorrhagic stroke or cerebral hemorrhage. This pathology very often manifests itself in people aged 45 to 60 years. The cause of this condition is usually high blood pressure or hypertensive crisis. This condition develops very suddenly and more often in the daytime after a strong emotional or physical stress.

And finally, the third type of stroke is subarachnoid hemorrhage. It occurs at the age of 30 - 60 years. Here, the leading factor is most often smoking, a one-time consumption of a huge amount of alcohol, high blood pressure, excess body weight or chronic alcoholism.

A sudden onset of a stroke may well end in the death of a person, which is why you should definitely call an ambulance immediately. Only professional medical workers will be able to correctly determine the type of stroke and provide the necessary first aid. All further treatment will take place in the hospital.

But a stroke in its treatment is often accompanied by pneumonia and bedsores. These complications in themselves can cause a lot of problems for the patient, and pneumonia, again, can lead to death.

Everyone should know that acute heart failure and stroke are very dangerous conditions. Everyone should be aware of what needs to be done to prevent their development. And you don’t need to do so much for this: lead a healthy lifestyle, do not drink alcohol, do not smoke, monitor your weight, do not overwork and avoid stress, measure blood pressure daily and just enjoy life. It is worth knowing that a stroke is not only a disease of the elderly. Under certain circumstances, it also affects people of a fairly young age.

Acute heart failure: first aid

Heart failure is the leading cause of death in cardiovascular disease. Due to coronary heart disease, hypertension, or valvular defects, the heart cavities lose their ability to contract synchronously. The pumping function of the heart is reduced. As a result, the heart ceases to supply tissues and organs with oxygen and nutrients. A person is waiting for disability or death.

Acute heart failure (AHF) is an acute clinical syndrome that is caused by a violation of the systolic and diastolic function of the ventricles of the heart, leading to a drop in cardiac output, an imbalance between the body's need for oxygen and its delivery, and, as a result, dysfunction of organs.

Clinically, acute heart failure manifests itself in several ways:

1. Right ventricular heart failure.
2. Left ventricular heart failure.
3. Small ejection syndrome (cardiogenic shock).

Left ventricular acute heart failure

Symptoms

Left ventricular acute heart failure occurs as a result of stagnation in the pulmonary circulation, which leads to impaired gas exchange in the lungs. This is manifested by cardiac asthma. whose characteristic features are:

• sudden shortness of breath
• suffocation
• heartbeat
• cough
• severe weakness
• acrocyanosis
• pale skin
• arrhythmia
• lowering blood pressure.

To alleviate the condition, the patient takes a forced position and sits with his legs down. In the future, the symptoms of congestion in the small circle may increase and turn into pulmonary edema. The patient develops a cough with the release of foam (sometimes mixed with blood), bubbling breath. The face acquires a cyanotic hue, the skin becomes cold and sticky, the pulse is irregular and weakly palpable.

First aid for acute left ventricular heart failure

Pulmonary edema is a medical emergency. The first thing to do is call an ambulance.

1. The patient is placed in a sitting position with legs down.
2. Under the tongue give nitroglycerin or ISO-MIC.
3. Provide access to fresh air.
4. Put tourniquets on the thighs.

After hospitalization, the patient undergoes further treatment:

• Reduce the increased excitability of the respiratory center. The patient is prescribed narcotic analgesics.
• Reducing congestion in the pulmonary circulation and increasing the contractile function of the left ventricle. With high blood pressure, drugs are administered that expand the peripheral vessels. At the same time, diuretics are administered.

With normal blood pressure, nitrates (nitroglycerin preparations) and diuretics are prescribed. With low blood pressure, Dopamine, Dobutamine are administered.

Right ventricular acute heart failure

Right ventricular acute heart failure is manifested by venous congestion in the systemic circulation. It most often occurs as a result of pulmonary embolism (PE).

It develops suddenly and is manifested by the following symptoms:

• shortness of breath, dyspnea, chest pain, bronchospasm
• blueness, cold sweat
• swelling of the neck veins
• liver enlargement, tenderness
• rapid thready pulse
• decrease in blood pressure
• swelling in the legs, ascites.

First aid for acute right heart failure

Before the ambulance arrives:

1. Elevated position of the patient in bed.
2. Access to fresh air.
3. Nitroglycerin under the tongue.

In the intensive care unit:

1. Oxygen therapy.
2. Anesthesia. When excited, a narcotic analgesic is prescribed.
3. The introduction of anticoagulants and fibrinolytic drugs.
4. The introduction of diuretics (with PE is usually not prescribed).
5. Introduction to prednisolone.
6. The appointment of nitrates, which reduce the load on the heart and improve the function of the right ventricle.
7. In small doses, cardiac glycosides are prescribed along with polarizing mixtures.

Low cardiac output syndrome

Cardiogenic shock occurs as a result of myocardial infarction. cardiomyopathy, pericarditis, tension pneumothorax, hypovolemia.

It is manifested by pain syndrome, a drop in blood pressure down to 0, a frequent thready pulse, pallor of the skin, anuria, collapsed peripheral vessels. The course may develop further with pulmonary edema, renal failure.

Eczema causes stroke and heart failure

(Average score: 4)

Due to skin problems, people often lead an unhealthy lifestyle.

Eczema can cause heart failure and stroke. Doctors came to such conclusions after analyzing the health status of 61,000 adults aged 18 to 85 years.

The study found that people with eczema were 54% more likely to be obese and 48% more likely to have hypertension.

In adults with skin disease, doctors have noted an increased risk of heart failure and stroke.

The risk may be the result of poor lifestyle and bad habits. As the doctors explained, eczema often manifests itself in childhood and leaves its mark on a person's life: it reduces self-esteem and self-esteem. Due to psychological problems, people resort to bad habits.

“Eczema is not just a skin disease. It affects every aspect of a patient's life,” explained lead researcher Dr. Jonathan Silverberg, assistant professor of dermatology at the Feinberg School of Medicine at Northwestern University in Chicago.

So, scientists have found that people with eczema drink and smoke more than others. In addition, a person with problematic skin is less likely to play sports: sweating and fever provoke scabies.

Although, as scientists explained, even if harmful factors are removed, eczema itself causes problems with the heart and blood vessels due to chronic inflammation.

Blood pressure after a stroke

A stroke of hemorrhagic or ischemic type is a severe cardiovascular catastrophe that affects the operation of the entire system. BP, as one of the main indicators, is also undergoing significant changes, but it cannot be said that in some situations it will be guaranteed to have such values, in others - completely different.

In fact, everything is a little more complicated, since several factors act at once, each of which, one way or another, affects the indicator.

The relationship between hypertension and stroke

Arterial hypertension (hereinafter referred to as hypertension) can significantly increase the risk of developing hemorrhagic stroke - American researchers claim that by 4-6 times. The thing is that chronic hypertension causes thickening of the walls of blood vessels and the deposition of atherosclerotic plaques. For this reason, the elasticity of arterial vessels, capillaries and veins is lost, after which a balloon increase in their diameter immediately occurs. As a result, microaneurysms appear in the brain parenchyma. A sudden hypertensive crisis causes them to rupture, leading to a hemorrhagic stroke.

From all of the above, we can draw an elementary conclusion that the risk of stroke is directly related to elevated blood pressure. In addition, there is an opinion that hypertension contributes to the manifestation of stroke by indirectly affecting various pathophysiological mechanisms, among which oxidative stress, endothelial dysfunction, increased peripheral vascular resistance, HMC and small vessel disease, and many others should be noted.

Some researchers argue that high blood pressure after a stroke is the norm, and this indicates that the cardiovascular system is still working (in other words, a relatively favorable outcome is implied, since there are no signs of developed heart failure). In fact, everything is somewhat different - the norm of pressure after a stroke remains the same as before it, and if nothing is done to lower arterial hypertension, then there is a high probability of a recurrence of a hemorrhagic stroke, after which there is practically no chance of recovery no longer - lethality tends to 100%.

Normal pressure readings

Contrary to the common stereotype that the BP numbers for everyone should be in approximately the same range, we can safely say that this indicator is purely individual, and in fact depends on the action of a variety of factors. In other words, for each person, the norm of blood pressure is purely individual, but in most cases this value ranges from 100-140 upper and 50-90 lower. The absolute norm is from 110-130 SBP and 60-90 DBP. Again, these values ​​​​are relevant only for adults - in children they will be somewhat different (at the age of 15 years, the level of blood pressure will be slightly lower).

Many have a completely logical question as to why the pressure should not fall quickly if hypertension is considered the main etiological factor in the occurrence of hemorrhagic stroke. In fact, if the pressure starts to "jump" - that is, after a short-term increase, it is immediately followed by a sharp decrease (for example, from 160 and above to 100), there will be even greater dissonance and disruption of the functioning of the cardiovascular system.

In other words, a jump in blood pressure is an even more dangerous factor in the manifestation of hemorrhagic stroke than banal hypertension.

High blood pressure

An elevated level of blood pressure, which can definitely be considered pathological, is a value exceeding 140 to 90. The pressure value that was given above is the most important symptom of hypertension. If it is registered for a certain amount of time, then you can make a diagnosis of hypertension.

The level of AL varies from the amount of blood sent by the heart to the vascular bed, and OPSS - vascular resistance to blood flow in the arteries. From this we can conclude that the greater the volume of incoming blood pumped by the heart, and the narrower the diameter of the arteries, the higher the blood pressure will be.

An uncontrolled increase in this indicator increases the risk of developing health problems, which include a stroke with a heart attack. Although, essential hypertension may not manifest itself for several years and proceed almost asymptomatically, making itself felt with some episodic (and then short-term) headaches, dizziness when changing body position and (only occasionally) nosebleeds.

In the event that in one month it was noted that the pressure can rise to values ​​​​of 150 and above (the upper figure, and the lower ones reach 100-110), and several times, then this is definitely not normal, and this indicator must be lowered , taking antihypertensive drugs, and as soon as possible, because otherwise adverse effects may occur for the brain and heart.

Low blood pressure in stroke

The most negative sign of the clinical course of this disease is low blood pressure in the first two to three days after a stroke. Hypertension is not as terrible as heart failure or collapse. In addition, the prognosis regarding the prospects for recovery and the time required for rehabilitation will be much less favorable.

The reasons that cause low blood pressure can be a variety of factors - not always heart failure is the direct cause of persistent hypotension. Very often, the condition under consideration is the result of a significant overdose of antihypertensive drugs - this phenomenon is encountered, as a rule, if the patient is self-medicating and drinking his own medicines for hypertension, which were not previously prescribed to him by the attending physician.

Statistical data indicate that too low pressure - just like too high, noted in the first two days after the onset of the disease, lead to death in the vast majority of cases.

In the event that, after a stroke, a consistently low level of pressure is observed, the prognosis can be considered unfavorable, especially if the pulse is also not increased. The rehabilitation of such a patient will be extremely difficult. The thing is that these symptoms clearly indicate in favor of the formation of heart failure. And a pressure jump is also not worth waiting for, because the heart simply does not perform its assigned functions of pumping blood.

If you do not start giving special pills and making droppers that allow you to speed up the work of the heart and squeeze the maximum out of the myocardium (drugs mezaton, dopamine), then blood pressure may generally drop to zero, which will lead to the inevitable death of the patient.

Blood pressure indicators in stroke

It is important to know which blood pressure indicators in hemorrhagic or ischemic stroke are critical and with a high degree of probability lead to death. So, it is customary to consider the most dangerous values ​​\u200b\u200bthat are less than 40 units between the systolic and diastolic levels (in other words, between the upper and lower indicators). Yes, it may be that the patient tolerates the increase in blood pressure values ​​well, without experiencing any deterioration in well-being; in principle, the same can be said about low blood pressure, however, reducing the difference between these two figures is almost always critical.

Hemorrhagic stroke, in essence, is an intracranial hematoma. That is, unlike an ischemic stroke, in this case there is an excessive "supply" of blood to the GM tissue, and such that necrotic damage occurs due to it. Consider, the more blood is kept in the meninges, the more significant the lesions will be. It is for this reason that it is necessary to make sure that fluid is removed from the cranium as soon as possible.

It is possible to normalize the blood circulation of the GM tissues only if the level of blood pressure is stabilized. In the event that it is elevated, 25% magnesium sulfate, 5 ml should be administered even at the prehospital stage; otherwise, another drug of choice will be administered in the hospital - adrenaline or mezaton.

Recovery period

The modern classification distinguishes three periods that are observed during post-stroke rehabilitation:

1. Early recovery - its duration is from 3 to 6 months from the moment of the disease manifestation. This period is considered to be the most productive for rehabilitation (restorative) treatment and should not be postponed under any circumstances. This approach is easily explained by the fact that it is during this period that the body has the highest recovery potential.
2. Late recovery - lasts from 6 to 12 months from the moment the pathology manifests. Recognized as a fertile period for rehabilitation activities, the recovery potential is still high, but it is inferior to the early recovery period.
3. The period of delayed consequences is more than a year from the moment of manifestation of the necrotic process. Recovery here is already much slower than in earlier recovery periods.

Another important point that makes sense to pay attention to is that with a relatively favorable course of nosology, it makes sense to carry out all rehabilitation measures right at the patient's bedside in a hospital (meaning the early recovery stage).

After abrupt changes in the state of the CCC can be stabilized, even a slight drop in blood pressure is not even so dangerous. With a high degree of probability, it can be argued that after the decrease there will be no significant jump in blood pressure numbers, which in most cases becomes the direct cause of death. If the numbers reach stable values ​​and stay at a certain level for several days, then even if they increase, it will not be difficult to lower blood pressure to the normal level.

Prevention of pressure fluctuations

The most dangerous during the period of post-stroke recovery is precisely the fluctuation of blood pressure. Even if it is kept at a consistently high level, it does not pose such a big threat to the life and health of the patient. To avoid such fluctuations, you must follow a number of simple rules:

• Taking medications strictly in the dosage and with the frequency that were prescribed by the attending doctor.
• Any actions (walking, sitting, mental stress) should be gradual. Even if the patient feels full of strength, one should not give a sharply large load on the body.
• It's important to watch your diet. Food should be fractional. Too dense lunch can also provoke a sharp jump in pressure.
• Avoid nervous stress.

Acute heart failure, stroke

Heart failure is one of the severe pathological conditions of the body. In this state, the heart does not perform the entire amount of necessary work, as a result of which the tissues of the body experience oxygen starvation. The most severe complication of heart failure is cerebrovascular accident, which can lead to a stroke.

Acute heart failure is a condition that occurs instantly. This is a terminal state that can easily lead to death. It is important to know the symptoms of this condition and be able to prevent it and provide the necessary assistance in time.

The cause of acute heart failure can be myocardial infarction, impaired coronary blood flow, cardiac tamponade, pericarditis, infections, and much more.

The attack occurs abruptly and develops within a few minutes. At this time, the patient feels a sharp lack of oxygen, there is a feeling of squeezing in the chest. The skin becomes bluish in color. These symptoms are often accompanied by loss of consciousness, pulmonary edema, myocardial infarction, or hypertensive crisis.

If you notice such symptoms in a person, you should provide him with the necessary assistance. The first thing to do is call an ambulance. It is necessary to ensure the flow of fresh air to the patient, free him from tight clothing.

Good oxygenation will ensure that the patient takes a certain position: it is necessary to put him down, lower his legs down, put his hands on the armrests. In this position, a large amount of oxygen enters the lungs, which sometimes helps to stop an attack.

If the skin has not yet acquired a bluish tint and there is no cold sweat, you can try to stop the attack with a nitroglycerin tablet. These are activities that can be carried out before the ambulance arrives. Only qualified specialists can stop an attack and prevent complications.

One of the complications of acute heart failure can be a stroke. A stroke is the destruction of brain tissue due to a previous hemorrhage or an acute cessation of blood flow. Hemorrhage can occur under the lining of the brain, into its ventricles and other places, the same applies to ischemia. The further state of the human body depends on the place of hemorrhage or ischemia.

Various factors can provoke a stroke. If a stroke is the cause of a hemorrhage, then such a stroke is called hemorrhagic. The cause of this type of stroke can be a sharp increase in blood pressure, atherosclerosis of cerebral vessels, blood diseases, traumatic brain injury, etc.

Ischemic stroke can be triggered by thrombosis, sepsis, infections, rheumatism, DIC, a sharp drop in blood pressure due to acute heart failure, and much more. But one way or another, all these reasons are associated with disruption of the cardiovascular system.

If the patient's blood pressure rises sharply, blood flow to the head increases, sweat appears on the forehead, then we can talk about the occurrence of a hemorrhagic stroke. This is all accompanied by loss of consciousness, sometimes vomiting and paralysis on one side of the body.

If the patient experiences dizziness, headache, general weakness, then these may be symptoms of an ischemic stroke. With this type of stroke, there may be no loss of consciousness, and paralysis develops slowly. Ischemic stroke accompanies a drop in blood pressure, fainting, pallor of the patient's skin is noted.

If you notice these symptoms, call an ambulance immediately. Lay the patient on a horizontal surface, ensure free breathing. The patient's head must be turned on its side - prevention of retraction of the tongue and suffocation with vomit.

It is advisable to put a heating pad at the feet. If, before the arrival of the ambulance, you notice a lack of breathing and cardiac arrest in a patient, it is urgent to carry out an indirect heart massage and artificial respiration.

Acute heart failure, stroke are life-threatening conditions. It is impossible to trace their appearance and they are very poorly treated. Therefore, the most important task facing us is the prevention of these conditions.

Lead a healthy lifestyle, do not abuse drugs, avoid stress and take care of your health.

Stroke and heart failure

Heart failure is the most severe pathological condition of the human body. It lies in the fact that the heart, for one reason or another, is not able to perform its function of pumping blood completely.

Because of this, the entire body, each of its cells, each organ experiences a very strong oxygen starvation. But the most serious complication of heart failure is a stroke, which is caused by a severe violation of blood circulation in the brain.

Acute heart failure develops very, very quickly, almost instantly. It refers to terminal states and can easily lead to the death of the patient. And therefore, stroke and heart failure are the diseases whose symptoms everyone should know.

What can lead to the fact that the heart will start to work incorrectly and not work with all its strength? In the first place among such causes is, of course, myocardial infarction - a very common disease that most often occurs in men. This is followed by a violation of the coronary blood flow and compression of the heart by other organs. Compression of the heart or tamponade very often occurs with pulmonary edema or tumors that are located in the chest. At the same time, the heart simply does not have enough space for normal work, and it begins to give severe failures. Often, heart failure occurs with infectious lesions of the pericardium or myocardium, when bacteria and microbes literally destroy the walls of this organ.

An attack of heart failure develops in a few minutes. Such a state is always sudden and unexpected both for the patient himself and for his relatives. At the same time, the patient feels that he simply has nothing to breathe and everything is squeezed in his chest. The skin of a person begins to turn blue sharply and quickly due to a lack of oxygen supplied to it. The person loses consciousness. But the worst thing is that very often all these symptoms are accompanied by complications such as pulmonary edema, myocardial infarction and hypertensive crisis. And, of course, a stroke. Stroke and heart failure are two diseases that in most cases occur in parallel.

A stroke is a sudden interruption of blood flow to the veins and arteries of the brain. There are 3 varieties of this serious disease.

The first variety is the ischemic type or cerebral infarction. This condition most often develops after the age of 60. For the development of this condition, there must be some prerequisites - heart defects, diabetes mellitus, or the same heart failure. Most often, cerebral infarction develops at night.

The second type is a hemorrhagic stroke or cerebral hemorrhage. This pathology very often manifests itself in people aged 45 to 60 years. The cause of this condition is usually high blood pressure or hypertensive crisis. This condition develops very suddenly and more often in the daytime after a strong emotional or physical stress.

And finally, the third type of stroke is subarachnoid hemorrhage. It occurs at the age of 30 - 60 years. Here, the leading factor is most often smoking, a one-time consumption of a huge amount of alcohol, high blood pressure, excess body weight or chronic alcoholism.

A sudden onset of a stroke may well end in the death of a person, which is why you should definitely call an ambulance immediately. Only professional medical workers will be able to correctly determine the type of stroke and provide the necessary first aid. All further treatment will take place in the hospital.

But a stroke in its treatment is often accompanied by pneumonia and bedsores. These complications in themselves can cause a lot of problems for the patient, and pneumonia, again, can lead to death.

Everyone should know that acute heart failure and stroke are very dangerous conditions. Everyone should be aware of what needs to be done to prevent their development. And you don’t need to do so much for this: lead a healthy lifestyle, do not drink alcohol, do not smoke, monitor your weight, do not overwork and avoid stress, measure blood pressure daily and just enjoy life. It is worth knowing that a stroke is not only a disease of the elderly. Under certain circumstances, it also affects people of a fairly young age.

Acute heart failure: first aid

Heart failure is the leading cause of death in cardiovascular disease. Due to coronary heart disease, hypertension, or valvular defects, the heart cavities lose their ability to contract synchronously. The pumping function of the heart is reduced. As a result, the heart ceases to supply tissues and organs with oxygen and nutrients. A person is waiting for disability or death.

Acute heart failure (AHF) is an acute clinical syndrome that is caused by a violation of the systolic and diastolic function of the ventricles of the heart, leading to a drop in cardiac output, an imbalance between the body's need for oxygen and its delivery, and, as a result, dysfunction of organs.

Clinically, acute heart failure manifests itself in several ways:

1. Right ventricular heart failure.
2. Left ventricular heart failure.
3. Small ejection syndrome (cardiogenic shock).

Left ventricular acute heart failure

Symptoms

Left ventricular acute heart failure occurs as a result of stagnation in the pulmonary circulation, which leads to impaired gas exchange in the lungs. This is manifested by cardiac asthma. whose characteristic features are:

• sudden shortness of breath
• suffocation
• heartbeat
• cough
• severe weakness
• acrocyanosis
• pale skin
• arrhythmia
• lowering blood pressure.

To alleviate the condition, the patient takes a forced position and sits with his legs down. In the future, the symptoms of congestion in the small circle may increase and turn into pulmonary edema. The patient develops a cough with the release of foam (sometimes mixed with blood), bubbling breath. The face acquires a cyanotic hue, the skin becomes cold and sticky, the pulse is irregular and weakly palpable.

First aid for acute left ventricular heart failure

Pulmonary edema is a medical emergency. The first thing to do is call an ambulance.

1. The patient is placed in a sitting position with legs down.
2. Under the tongue give nitroglycerin or ISO-MIC.
3. Provide access to fresh air.
4. Put tourniquets on the thighs.

After hospitalization, the patient undergoes further treatment:

• Reduce the increased excitability of the respiratory center. The patient is prescribed narcotic analgesics.
• Reducing congestion in the pulmonary circulation and increasing the contractile function of the left ventricle. With high blood pressure, drugs are administered that expand the peripheral vessels. At the same time, diuretics are administered.

With normal blood pressure, nitrates (nitroglycerin preparations) and diuretics are prescribed. With low blood pressure, Dopamine, Dobutamine are administered.

Right ventricular acute heart failure

Right ventricular acute heart failure is manifested by venous congestion in the systemic circulation. It most often occurs as a result of pulmonary embolism (PE).

It develops suddenly and is manifested by the following symptoms:

• shortness of breath, dyspnea, chest pain, bronchospasm
• blueness, cold sweat
• swelling of the neck veins
• liver enlargement, tenderness
• rapid thready pulse
• decrease in blood pressure
• swelling in the legs, ascites.

First aid for acute right heart failure

Before the ambulance arrives:

1. Elevated position of the patient in bed.
2. Access to fresh air.
3. Nitroglycerin under the tongue.

In the intensive care unit:

1. Oxygen therapy.
2. Anesthesia. When excited, a narcotic analgesic is prescribed.
3. The introduction of anticoagulants and fibrinolytic drugs.
4. The introduction of diuretics (with PE is usually not prescribed).
5. Introduction to prednisolone.
6. The appointment of nitrates, which reduce the load on the heart and improve the function of the right ventricle.
7. In small doses, cardiac glycosides are prescribed along with polarizing mixtures.

Low cardiac output syndrome

Cardiogenic shock occurs as a result of myocardial infarction. cardiomyopathy, pericarditis, tension pneumothorax, hypovolemia.

It is manifested by pain syndrome, a drop in blood pressure down to 0, a frequent thready pulse, pallor of the skin, anuria, collapsed peripheral vessels. The course may develop further with pulmonary edema, renal failure.

Eczema causes stroke and heart failure

(Average score: 4)

Due to skin problems, people often lead an unhealthy lifestyle.

Eczema can cause heart failure and stroke. Doctors came to such conclusions after analyzing the health status of 61,000 adults aged 18 to 85 years.

The study found that people with eczema were 54% more likely to be obese and 48% more likely to have hypertension.

In adults with skin disease, doctors have noted an increased risk of heart failure and stroke.

The risk may be the result of poor lifestyle and bad habits. As the doctors explained, eczema often manifests itself in childhood and leaves its mark on a person's life: it reduces self-esteem and self-esteem. Due to psychological problems, people resort to bad habits.

“Eczema is not just a skin disease. It affects every aspect of a patient's life,” explained lead researcher Dr. Jonathan Silverberg, assistant professor of dermatology at the Feinberg School of Medicine at Northwestern University in Chicago.

So, scientists have found that people with eczema drink and smoke more than others. In addition, a person with problematic skin is less likely to play sports: sweating and fever provoke scabies.

Although, as scientists explained, even if harmful factors are removed, eczema itself causes problems with the heart and blood vessels due to chronic inflammation.

Fundamentals of life safety
Grade 11

Lesson 14
First aid
in acute heart failure and stroke

Acute heart failure

In most cases, it occurs when the activity of the heart muscle (myocardium) is weakened, less often - with heart rhythm disturbances.

Causes of acute heart failure there may be rheumatic lesions of the heart muscle, heart defects (congenital or acquired), myocardial infarction, cardiac arrhythmias with infusions of large amounts of fluid. Heart failure can also occur in a healthy person with physical overstrain, metabolic disorders and beriberi.

Acute heart failure usually develops within 5-10 minutes. All pathological phenomena are growing rapidly, and if the patient is not provided with urgent assistance, this can be fatal. Acute heart failure usually develops unexpectedly, often in the middle of the night. The patient suddenly wakes up from a nightmare, a feeling of suffocation and lack of air. When the patient sits down, it becomes easier for him to breathe. Sometimes this does not help, and then shortness of breath increases, a cough appears with the release of viscous sputum mixed with blood, breathing becomes bubbling. If the patient is not provided with urgent medical care at this moment (Scheme 23), he may die.

Stroke

A stroke occurs when there is a sharp reduction in blood flow to one part of the brain. Without proper blood supply, the brain does not receive enough oxygen, brain cells are quickly damaged and die.

Although most strokes occur in older people, they can happen at any age. More commonly seen in men than in women.

Strokes can be caused by a blood clot blocking a blood vessel or bleeding from the brain.

A blood clot that causes a stroke usually occurs when an artery supplying the brain has become atherosclerotic and cuts off blood flow, cutting off blood flow to the brain tissue supplied by that vessel.

The risk of clot formation increases with age, as diseases such as atherosclerosis, diabetes, and hypertension are more common in older people. Improper diet, smoking also increase the susceptibility to stroke.

Chronically high blood pressure or a swollen part of an artery (aneurysm) can cause a cerebral artery to rupture suddenly. As a result, part of the brain stops getting the oxygen it needs to live. Moreover, blood accumulates deep in the brain. This further compresses the brain tissue and causes even more damage to the brain cells. A stroke from a cerebral hemorrhage can happen unexpectedly at any age.

Symptoms of a stroke: severe headache, nausea, dizziness, loss of sensation on one side of the body, drooping of the corner of the mouth on one side, confusion of speech, blurred vision, asymmetry of the pupils, loss of consciousness.

Do not give the victim food or drink during a stroke: he may be unable to swallow.

Questions and tasks

1. In what cases does acute heart failure occur?

2. Name the causes of stroke.

3. What complications in the body does a stroke cause and what consequences can it have?

4. Name the symptoms of a stroke.

5. In what order should first aid be provided for acute heart failure and stroke?

Task 39

To provide first aid for acute heart failure, you need:

a) put heating pads on the victim;
b) give the victim validol, nitroglycerin or corvalol;
c) call an ambulance;
d) sprinkle cool water on the face and neck of the victim and let him smell a cotton swab moistened with ammonia;
e) give the victim a comfortable semi-sitting position in bed and provide fresh air.

Place the indicated actions in the required logical sequence.

Task 40

One of your acquaintances has a severe headache, nausea, dizziness, one side of the body has become less sensitive, there is asymmetry of the pupils. Define:

a) what happened to your friend;
b) how to properly provide him with first aid.

Acute heart failure, stroke

Heart failure is one of the severe pathological conditions of the body. In this state, the heart does not perform the entire amount of necessary work, as a result of which the tissues of the body experience oxygen starvation. The most severe complication of heart failure is cerebrovascular accident, which can lead to a stroke.

Acute heart failure is a condition that occurs instantly. This is a terminal state that can easily lead to death. It is important to know the symptoms of this condition and be able to prevent it and provide the necessary assistance in time.

The cause of acute heart failure can be myocardial infarction, impaired coronary blood flow, cardiac tamponade, pericarditis, infections, and much more.

The attack occurs abruptly and develops within a few minutes. At this time, the patient feels a sharp lack of oxygen, there is a feeling of squeezing in the chest. The skin becomes bluish in color. These symptoms are often accompanied by loss of consciousness, pulmonary edema, myocardial infarction, or hypertensive crisis.

If you notice such symptoms in a person, you should provide him with the necessary assistance. The first thing to do is call an ambulance. It is necessary to ensure the flow of fresh air to the patient, free him from tight clothing.

Good oxygenation will ensure that the patient takes a certain position: it is necessary to put him down, lower his legs down, put his hands on the armrests. In this position, a large amount of oxygen enters the lungs, which sometimes helps to stop an attack.

If the skin has not yet acquired a bluish tint and there is no cold sweat, you can try to stop the attack with a nitroglycerin tablet. These are activities that can be carried out before the ambulance arrives. Only qualified specialists can stop an attack and prevent complications.

One of the complications of acute heart failure can be a stroke. A stroke is the destruction of brain tissue due to a previous hemorrhage or an acute cessation of blood flow. Hemorrhage can occur under the lining of the brain, into its ventricles and other places, the same applies to ischemia. The further state of the human body depends on the place of hemorrhage or ischemia.

Various factors can provoke a stroke. If a stroke is the cause of a hemorrhage, then such a stroke is called hemorrhagic. The cause of this type of stroke can be a sharp increase in blood pressure, atherosclerosis of cerebral vessels, blood diseases, traumatic brain injury, etc.

Ischemic stroke can be triggered by thrombosis, sepsis, infections, rheumatism, DIC, a sharp drop in blood pressure due to acute heart failure, and much more. But one way or another, all these reasons are associated with disruption of the cardiovascular system.

If the patient's blood pressure rises sharply, blood flow to the head increases, sweat appears on the forehead, then we can talk about the occurrence of a hemorrhagic stroke. This is all accompanied by loss of consciousness, sometimes vomiting and paralysis on one side of the body.

If the patient experiences dizziness, headache, general weakness, then these may be symptoms of an ischemic stroke. With this type of stroke, there may be no loss of consciousness, and paralysis develops slowly. Ischemic stroke accompanies a drop in blood pressure, fainting, pallor of the patient's skin is noted.

If you notice these symptoms, call an ambulance immediately. Lay the patient on a horizontal surface, ensure free breathing. The patient's head must be turned on its side - prevention of retraction of the tongue and suffocation with vomit.

It is advisable to put a heating pad at the feet. If, before the arrival of the ambulance, you notice a lack of breathing and cardiac arrest in a patient, it is urgent to carry out an indirect heart massage and artificial respiration.

Acute heart failure, stroke are life-threatening conditions. It is impossible to trace their appearance and they are very poorly treated. Therefore, the most important task facing us is the prevention of these conditions.

Lead a healthy lifestyle, do not abuse drugs, avoid stress and take care of your health.

Proper first aid for acute heart failure and stroke

• • Indirect cardiac massage
• Providing first aid

First aid for acute heart failure and stroke should be provided to the patient by surrounding people in a timely manner if a critical situation arises. There is a very high mortality rate from these terrible diseases in the world.

The mechanism of development of heart pathology

Heart failure is not considered an independent disease. This is a syndrome that is the result of a number of long-term developing ailments: severe pathology of the heart valves, problems with coronary vessels, rheumatic heart disease, impaired tone of the arteries, veins, capillaries with uncompensated arterial hypertension.

There comes a moment when, due to poor pumping of blood, the heart cannot cope with its pumping function (full pumping, blood supply to all body systems). There is an imbalance between the body's need for oxygen and its delivery. First, the fall in cardiac output occurs during exercise. Gradually, these pathological phenomena intensify. Eventually, the heart begins to work hard at rest.

Heart failure is a complication of other diseases. Its appearance may be preceded by a previous myocardial infarction, because each such pathological case is the death of a separate section of the heart muscle. At a certain point in a heart attack, the remaining viable sections of the myocardium cannot cope with the load. There is a sufficient number of patients who have a mild degree of this pathology, but they are not diagnosed. Therefore, they can suddenly feel a sharp deterioration in their condition.

Symptoms of acute heart failure

The main manifestations of cardiac dysfunction are:

1. The most striking signs of this syndrome are wheezing, nocturnal cough, increasing shortness of breath during movement, physical exertion, climbing stairs. Cyanosis appears: the skin turns blue, blood pressure rises. Patients feel constant fatigue.
2. In heart failure, first dense peripheral swelling of the legs quickly develops, and then the lower abdomen and other parts of the body swell.

People who have noticed such clinical signs in themselves should immediately consult a doctor and tell about their problem. As directed by a specialist, they will undergo diagnostics. When heart failure occurs in a patient, a cardiographic study is very effective, according to the results of which a cardiologist can determine the presence or absence of structural disorders of the heart muscle. If there is a disease, the necessary treatment will be prescribed according to the scheme in order to normalize myocardial metabolism and cardiac output through the selection of rational therapy.

Heart disease is highly treatable if diagnosed early. In this case, the patient is easier to treat, the disease can be compensated. If he receives the right treatment, the patient's cardiovascular system can function successfully for many years. If the course of the disease is delayed, as the patient does not go to the doctor and is not treated, the situation is aggravated. The patient's body suffers from a lack of oxygen, there is a gradual death of body tissues. If the patient does not receive immediate treatment, he may lose his life.

How is emergency care carried out in the event of acute heart failure?

With this pathology, the full functioning of the heart, the functions of the circulatory system can be impaired for several hours and even minutes. Sometimes signs of pathology develop gradually. There is moderate pain and discomfort. People don't understand what's going on. They wait too long before seeking medical help. Only urgent measures in this situation can save the patient's life. Immediately after the onset of clinical symptoms of heart failure, an ambulance team should be called. Doctors will take the necessary measures and offer the patient mandatory hospitalization.

While waiting for specialists, it is necessary to provide first aid to the patient:

1. Since panic can be harmful, the patient should be tried to calm down so that anxiety and fear disappear from him.
2. Fresh air must be provided, so the windows must be opened.
3. The patient should be freed from clothing that restricts his breathing. The collar of the shirt must be unbuttoned and the tie must be untied.
4. With a horizontal position of the body, as a result of the accumulation of blood in the lungs and the lack of air, the patient's shortness of breath increases. Therefore, the patient should be in an intermediate position between the lying and sitting posture (i.e., half-sitting). This helps to unload the heart, reduce shortness of breath and swelling.
5. Then, in order to reduce the total volume of blood circulating in the body, you need to clamp the veins. To do this, a venous tourniquet is applied for several minutes on both hands above the elbow and on the hips.
6. 1 tablet of nitroglycerin under the tongue every 10 minutes is given to stop an attack. But you can not give more than 3 tablets.
7. Blood pressure should be under constant control.
8. This pathology significantly reduces the well-being of a patient with a cardiovascular disease. Often, the patient's chances of saving a life depend on the people who are nearby at a critical moment.
9. If a cardiac arrest has occurred, people around should do chest compressions until the arrival of the medical team in order to return the patient to life.

Indirect cardiac massage

Since its implementation is ineffective on a soft bed, the patient should lie on a hard shield, floor or ground. Hands are placed on the central part of the chest. She squeezes hard several times. As a result, the volume of the chest decreases, blood is squeezed out of the heart into the lungs and the systemic circulation. This allows you to restore the pumping work of the heart and normal blood circulation.

Stroke as one of the causes of death

Often, patients and people around them take the symptoms of a stroke simply as signs of poor health. They explain the strange and unusual behavior of a person as a reaction to the weather, fatigue. But if others are attentive, the symptoms of a stroke can be recognized in a timely manner. The patient's life can be saved if qualified medical assistance is provided immediately.

The main symptoms of acute cerebrovascular accident

The development of a stroke can be suspected if some problems appear:

1. You need to ask the patient to smile. If a stroke occurs, one side of the face does not obey the person, the smile will turn out to be crooked, tense.
2. The tip of the tongue changes its correct position and deviates to the side.
3. Since the muscles become weak during a stroke, the patient will not be able to raise his arms with his eyes closed even for 10 seconds.
4. In response to your request to repeat any simple phrase, the patient will not be able to do this, because with this pathology the perception of speech and the pronunciation of meaningful words are impaired.

If a person could not perform such actions or does it with difficulty, it is urgent to call a medical team.

Providing first aid

First aid for a stroke:

1. The patient must be in a horizontal position. His head needs to be turned to the side. Clothing that restricts breathing should be unbuttoned.
2. The head should be cooled with an ice pack, a cold wet towel, or food from the freezer.
3. It is strictly forbidden to move the patient.
4. It is necessary to monitor the state of his breathing, pulse, blood pressure indicators.
5. Medical assistance to the patient must be provided within three hours after the stroke occurred.

Each person should have the skills of PMP (First Aid).

Often precious time is lost as a result of waiting for the arrival of the medical team. Many patients lost their lives because eyewitnesses to an attack of heart failure or stroke failed to provide them with first aid. Therefore, each person needs to learn how to provide first aid for stroke, heart attack, heart failure.

Chronic heart failure and ischemic stroke

Abstract. Chronic heart failure (CHF) is one of the leading causes of hospitalization, morbidity and mortality worldwide. This review summarizes current data on CHF as a risk factor for ischemic stroke. CHF is associated with an increased risk of thrombosis and is accompanied by a 2–3-fold increase in the risk of stroke. Moreover, stroke in patients with CHF is associated with poor outcome and high mortality. Available data on additional "vascular" risk factors for stroke in patients with CHF are contradictory and are mainly obtained from the results of cohort studies or retrospective analyses. According to current standards for the provision of medical care, patients with CHF and concomitant atrial fibrillation are indicated for the appointment of anticoagulants, but there are no recommendations for anticoagulant therapy in patients without arrhythmia. Prospective studies are needed to determine the impact of early detection and optimal treatment of CHF on reducing the neurological and neuropsychological consequences of stroke.

By definition, heart failure is the inability of the heart to supply the body's tissues with the amount of blood they need to meet their needs. Clinical symptoms of heart failure include dyspnea at rest or on exertion, fatigue, tiredness, and leg swelling. In addition, patients present with typical signs of heart failure (tachycardia, tachypnea, rales, pleural effusion, increased jugular venous pressure, peripheral edema, and hepatomegaly) and objective evidence of structural or functional cardiac abnormalities (eg, cardiomegaly, heart murmurs, changes in on an echocardiogram and an increase in the level of natriuretic peptide). A distinction is made between systolic and diastolic dysfunction, with the latter occurring in at least one-third of all patients with heart failure. While in patients with heart failure and systolic dysfunction, the ejection fraction (EF) is reduced, in patients with diastolic dysfunction, the EF is not changed, but the end-diastolic pressure in the ventricles of the heart is increased. Chronic heart failure (CHF) can be caused by congenital anomalies or develop against the background of acquired diseases. The main risk factors for developing CHF are arterial hypertension, myocardial infarction, heart defects, diabetes mellitus and atrial fibrillation (AF). Heart failure occurs in approximately 1–2% of all adults in developed countries; with age, its prevalence rises sharply. Today, one in 10 people over the age of 80 suffers from CHF, and the lifetime prevalence of CHF is 1 in 5 cases among people over the age of 40 years. Thus, in the coming years, due to the aging of the population, the absolute number of patients with CHF will increase.

Heart failure is the most common reason for hospitalization in patients over 65 years of age. The five-year survival rate is ≈35%. Systolic dysfunction is associated with a total annual mortality rate of 15 to 19%, and diastolic dysfunction is associated with an annual mortality rate of 8 to 9%. When daily activity is limited in people with CHF (equivalent to New York Heart Association functional class III), the 1-year survival rate is 55%, and if CHF symptoms occur at rest (New York Heart Association functional class IV), 1 -year survival rate is only 5–15%.

Thus, on average, the prognosis in patients with CHF is more unfavorable than in men with bowel cancer or women with breast cancer. The prevalence of concomitant AF in CHF ranges from 10 to 17% and increases with an increase in the diameter of the left atrium and an increase in the functional class according to the classification of the New York Heart Association, reaching almost 50% in patients with functional class IV according to the classification of the New York Heart Association. This is relevant, since AF is associated with an increased risk of stroke and mortality in patients with CHF.

Stroke as a consequence of CHF

CHF is a common cause of ischemic stroke. Several pathophysiological mechanisms of its development have been described (Table 1).

The most common cause of cardioembolic stroke in patients with CHF is increased thrombus formation associated with AF or left ventricular (LV) hypokinesia. Due to the activation of the sympathetic autonomic nervous system and the renin-angiotensin-aldosterone system in patients with CHF, a hypercoagulable state develops, platelet aggregation increases and fibrinolytic activity decreases. In addition, there is evidence of endothelial dysfunction in patients with CHF, changes in blood rheology associated with an increase in blood flow velocity and impairment of cerebral autoregulation. Along with a causal relationship between CHF and ischemic stroke, both of these nosological forms are manifestations of the same underlying factors, such as arterial hypertension and diabetes mellitus. Thus, in patients with CHF, the risk of developing a stroke due to atherosclerosis of large arteries or occlusion of small vessels is increased. Moreover, in patients with symptomatic carotid stenosis, the volume of the ipsilateral ischemic focus was greater in patients with CHF and systolic dysfunction. In addition, arterial hypotension in patients with CHF may be an additional risk factor for stroke. It is still unknown whether impaired cerebrovascular autoregulation in patients with CHF is a significant cause of stroke. Thus, the presence of CHF is clearly associated with the risk of ischemic stroke. It is likely that in CHF, the embolic variant of stroke develops first, but it is necessary to take into account the possibility of developing other pathogenetic variants of stroke.

Table 1. High Risk Mechanisms for Stroke in Patients with Chronic Heart Failure

The prevalence of stroke among patients with CHF

Based on epidemiological, cohort and case series data, approximately 10–24% of all stroke patients have CHF, while CHF is considered to be the likely cause of stroke in approximately 9% of all patients. However, epidemiological data on the prevalence and incidence of stroke in patients with CHF are limited due to the different design of published studies and the differing clinical characteristics of patients with CHF. Data from the Framingham Study and a recent cohort study showed that the risk of ischemic stroke is 2-3 times higher in patients with CHF than in patients without CHF. According to a recent population-based prospective study, Rotterdam Scan, the risk of stroke is highest within 1 month after the diagnosis of heart failure (hazard ratio [RR]=5.8; 95% confidence interval [CI] 2.2 to 15.6) , and then decreases within 6 months . In the 1990s, according to data from prospective studies of CHF and several subsequent analyzes of large trials of CHF, the annual incidence of stroke was from 1.3 to 3.5%, but approximately 10-16% of patients with CHF enrolled in the study had concomitant AF. , as P.M. later clarified. Pullicino et al. . According to a meta-analysis of the results of 15 clinical trials and 11 cohort studies published up to 2006, from the onset of symptoms of CHF, the incidence of stroke is 18 and 47 cases per 1000 patients with CHF for 1 and 5 years, respectively.

However, the validity of this meta-analysis is limited because data on LVEF, prevalence of AF, and drug prevention of stroke were missing. In a 2007 subgroup analysis of the multicenter prospective Sudden Cardiac Death in Heart Failure Trial ( SCD-HeFT) showed that the mean annual incidence of stroke in 2114 patients with CHF without AF was 1%, despite the fact that a third of all patients received anticoagulant therapy, and the remaining two-thirds received antiplatelet drugs. The most important limitation of this analysis is that, initially, stroke was not considered as a primary endpoint or was not included in the assessment by the Critical Events Review Committee. In a prospective randomized trial of Warfarin and Antiplatelet Therapy in Chronic Heart Failure ( WATCH) involved 1587 patients with CHF, LV EF 35% and preserved sinus rhythm (SR). Over a mean follow-up period of 21 months, the unplacebo-controlled warfarin study was associated with fewer non-fatal strokes than aspirin or clopidogrel (0.6% and 2.3%, respectively). However, the trial was terminated early due to slow patient recruitment, which limited its usefulness.

In addition, in accordance with the results of retrospective studies, in patients with CHF who have had a stroke, the risk of developing a second stroke is from 9-10% per year. A retrospective analysis of medical records from Olmsted County, Minnesota showed that patients with CHF who had a stroke had an odds ratio (OR) of having a recurrent stroke of 2.1 (95% CI, 1.3 to 3.5) compared with patients who stroke survivors without CHF. Based on the results of a 5-year follow-up, a similar pattern (OR=2.2, 95% CI 0.96 to 5.2) in the development of recurrent stroke in patients from Finland with the first stroke occurring before the age of 49 years was revealed. In general, in patients with CHF, the risk of developing ischemic stroke is 2–3 times higher than in patients without CHF.

Additional risk factors for stroke in patients with CHF

Current data on additional risk factors for stroke in heart failure are primarily based on the results of retrospective, cohort studies, or post hoc analyzes of large clinical trials. At the same time, there are significant contradictions between the results of these studies. A review of data from Olmsted County found that previous stroke, older age, and diabetes mellitus were significant risk factors for stroke in 630 patients with heart failure, while a history of AF or hypertension did not reach statistical significance in a multivariate analysis. Although these results may be explained by the fact that this population-based study was not large enough to find such associations, a retrospective analysis of the prospective Survival and Ventricular Enlargement study ( SAVE) also showed no significant effect of arterial hypertension (and diabetes mellitus) on the development of stroke in 2231 patients with CHF. In contrast to these data, in a prospective study SCD-HeFT randomization of 2144 patients with CHF without AF revealed that the OR for stroke was 1.9 (95% CI 1.1 to 3.1) in the presence of arterial hypertension.

In addition, the presence of hypertension was associated with an increased risk of hospitalization for stroke (OR=1.4; 95% CI 1.01 to 1.8) in 7788 patients with heart failure in the Digitalis Investigation Group trial. As previously reported, the Olmsted County data showed a significant but modest association between stroke risk and older age (RR = 1.04; 95% CI 1.02 to 1.06). In addition, the primary analysis of the study SAVE showed similar results (RR=1.18; 95% CI 1.05 to 1.3; for every 5 years of life). However, the results of the Framingham study showed that an increased risk of stroke in old age is not associated with the presence of CHF. In the Framingham study, the presence of AF was associated with a 2-fold increased risk of stroke in patients with heart failure and reached statistical significance in women. The different assessment of AF may explain the conflicting results of further reports on the association between AF and stroke in patients with CHF.

Interestingly, a retrospective analysis of the Studies of Left Ventricular Dysfunction ( SOLVD) also demonstrated significant gender differences in CHF patients without AF. While in 5457 men with CHF the risk of thromboembolic events was increased in old age, in the presence of arterial hypertension, diabetes mellitus and a previous stroke, in 958 women with CHF the risk of stroke correlated with the presence of diabetes mellitus and a decrease in EF. In addition, the results of the study SAVE showed that the RR of stroke with a decrease in LV EF by 5% is 1.2 (95% CI from 1.02 to 1.4), and in the study SCD-HeFT found an increased risk of thromboembolic complications with LV EF ≤20% without adjustment for gender. The Olmsted County study found a reverse trend: for LV EF

ESSAY

on the topic: "First aid for acute heart failure, stroke"

11 A class students

Budnik Sergey Vladimirovich

Salavat, 2015

2. Causes of acute heart failure

3. How to determine the OSN

4. First aid for AHF
5. Prevention of AHF

9. How to recognize a stroke attack

10.First aid for stroke

1.DOS

It is extremely important that first aid for heart failure arrives on time, as this is a very common occurrence among people with impaired cardiovascular function. This condition is manifested by a sharp decrease in the flow of oxygen to the tissues as a result of a violation of the normal functioning of the heart.

First aid for acute heart failure should be provided directly at the site of the attack, as this will help buy time before the ambulance arrives. The main tasks in the treatment of acute heart failure at any stage are the elimination of excess heart load and the redistribution of blood from the pulmonary circle.

Acute heart failure is a condition (often appearing in a few minutes) when the heart is not able to pump all the flowing blood (despite satisfactory filling with venous blood) and provide blood circulation in the body due to a decrease in myocardial contractility due to a violation of the structure of the heart or blood vessels.

Causes of AHF

There are primary and secondary causes, although such a classification is conditional. Most often, a mixed type of violations is observed.

To primary - include myocardial damage in acute infectious diseases (flu, rheumatism, measles and scarlet fever in children, hepatitis, typhoid fever) and poisoning with toxic poisons (carbon monoxide, carbon monoxide, chlorine, methyl alcohol, food poisoning). Under these conditions, acute inflammation or dystrophy of muscle cells occurs, the supply of oxygen and nutrients that provide energy is disrupted. Violation of nervous regulation worsens the condition of the myocardium.

Secondary causes are considered that do not directly affect the heart muscle, but contribute to overwork and oxygen starvation. Such conditions occur during paroxysmal arrhythmias, hypertensive crisis, with severe atherosclerotic damage to the coronary vessels.

How to identify acute heart failure

At first glance, acute heart failure should have signs of heart damage. But in this situation, signs of pulmonary edema predominate. This is due to the fact that the heart muscle can not cope with pumping blood to the periphery, and venous blood is stagnant. All this increases the pressure in the vascular system, as a result of which the fluid leaks into the tissues, including the lungs.

The main signs of heart failure:

1. Increasing shortness of breath. It happens pretty quickly.

2. The patient is forced to take a more comfortable position for breathing: half-sitting with legs down.

3. The skin is pale, the extremities are cold, cyanotic.

4. Cough with frothy pink sputum.

5. Increase and then decrease in blood pressure.

6. Tachycardia, frequent shallow breathing.

First aid for AHF

If such a situation arose, then the person needs to be helped, since urgent measures can save his life. Hospitalization is mandatory, so the call of doctors should be made immediately after the onset of symptoms.

1. Call an ambulance.

2. Seat the victim in such a way that the back is raised as much as possible, pillows should be placed under the back.

3. Make sure that the person gets as much fresh air as possible.

4. Give Andipal (1 tablet), Corvalol (for tachycardia) or valerian tincture (1 drop per year of life)

5. The imposition of tourniquets on the limbs. In this case, one limb should be free from the tourniquet. The free limb must be changed periodically so that there is no prolonged compression of the limb. Change the tourniquet as often as possible, but at least every hour.

6. If a cardiac arrest occurs, then cardiopulmonary resuscitation must be performed.

Cardiopulmonary resuscitation

To begin with, a strong precordial blow to the region of the heart is performed. Then rhythmic pressures on the chest are performed with the hands at a frequency of about 100 per minute. Together with compression of the heart area, artificial respiration should be performed. To do this, you need to lay a person, throw back his head and push his jaw forward. Then you need to open the victim's mouth and pinch his nose with his fingers. You need to perform breaths in relation to chest compressions as 2:15.

Prevention of AHF

The best cure for heart failure is its prevention. As we have seen heart failure syndrome in most cases occurs as a complication of one or another diseases of the cardiovascular system. Therefore, regular preventive examinations by a cardiologist, timely and correct treatment of arterial hypertension, prevention atherosclerosis and other cardiovascular diseases gives considerable chances to avoid heart failure syndrome. In addition, and this also applies to every person, it is necessary to avoid excessive stress on the heart. The human heart has enormous potentials: despite the fact that at rest it pumps about 5 liters of blood per minute on average, the permissible load level for it is 30 liters! Six times more! It would seem that it is simply impossible to “overload” it. However, we do it all the time without noticing it. The best prevention of heart failure, like most diseases of cardio-vascular system, serves what has long been known to everyone under the name "healthy lifestyle". Proper nutrition, fresh air, the absence of bad habits, physical activity, resistance to stress, self-confidence and a bright attitude to the world - this is what makes the heart healthy and strong.

Stroke

A stroke is a transient disorder of the brain due to disturbances in its blood supply. When acute cardiovascular failure occurs, various organs that lack oxygen suffer. The nervous system is the first to respond to oxygen starvation. As a result, a stroke may develop. In case of a stroke against the background of acute cardiovascular insufficiency, it is necessary to restore the pumping function of the heart as quickly as possible, since further oxygen restriction will aggravate the symptoms.

Causes of a stroke

All risk factors are divided into several categories - predisposing, behavioral and "metabolic".
Predisposing factors include aspects that are not subject to correction:

1. age (the frequency of strokes increases after 50 years and grows every year);
2. gender (in men after 40 years, the risk of stroke is higher than in women);
3. family history and hereditary predisposition.

Behavioral factors contributing to the development of strokes are:

• smoking (doubling the risk of strokes);
• psychological factors (stress, depression, fatigue);
• taking alcohol, drugs and medications (oral contraceptives);
• overweight and obesity;
• atherogenic diet;
• physical activity (physical inactivity increases the risk of ischemic strokes).

Signs of a stroke

May include one or more symptoms:
■ weakness, paralysis (inability to move), or numbness of the face or limbs on one side of the body;
■ a sharp deterioration in vision, blurring of the image, especially from one eye;
■ sudden speech difficulties, slurred speech, drooping tongue, unilateral deviation of the tongue;
■ unexpected difficulties in understanding speech;
■ sudden difficulty swallowing;
■ unexplained falls, dizziness, or loss of balance. Attention: if a person has not consumed alcohol, but behaves "like a drunk" - this symptom may indicate the development of a stroke. The presence of alcohol intoxication also does not exclude the development of a stroke. Be careful of people who look "like drunk" - you may be able to save someone's life!
■ sudden severe (worst ever) headache or a new unusual pattern of headache with no known cause;
■ drowsiness, confusion or loss of consciousness.

The sudden onset of any of these three symptoms indicates the possibility of a stroke. It is urgent to call an ambulance! It is better to overestimate the severity and danger of the patient's condition than to underestimate!

When evaluating a patient's condition, keep the following in mind:
- A stroke can change a person's level of consciousness.
- In many cases, with a stroke, “nothing hurts”!
- A stroke victim can actively deny their disease state!
- A stroke victim may not adequately assess his condition and symptoms: focus on your subjective opinion, and not on the patient's answer to the question "How does he feel and what worries him?"

How to recognize a stroke

1. Ask the person to SMILE. With a stroke, the smile turns out to be “crooked”, since the muscles of one side of the face are much less obeyed.

2. TALK to him and ask him to answer a simple question like "What's your name?" Usually, at the moment of a brain crash, a person cannot even pronounce his own name coherently.

3. Have him RAISE BOTH HANDS at the same time. As a rule, the patient fails to cope with this task, the hands cannot rise to one level, since one side of the body obeys worse.

Acute heart failure, stroke

Heart failure is one of the severe pathological conditions of the body. In this state, the heart does not perform the entire amount of necessary work, as a result of which the tissues of the body experience oxygen starvation. The most severe complication of heart failure is cerebrovascular accident, which can lead to a stroke.

Acute heart failure is a condition that occurs instantly. This is a terminal state that can easily lead to death. It is important to know the symptoms of this condition and be able to prevent it and provide the necessary assistance in time.

The cause of acute heart failure can be myocardial infarction, impaired coronary blood flow, cardiac tamponade, pericarditis, infections, and much more.

The attack occurs abruptly and develops within a few minutes. At this time, the patient feels a sharp lack of oxygen, there is a feeling of squeezing in the chest. The skin becomes bluish in color. These symptoms are often accompanied by loss of consciousness, pulmonary edema, myocardial infarction, or hypertensive crisis.

If you notice such symptoms in a person, you should provide him with the necessary assistance. The first thing to do is call an ambulance. It is necessary to ensure the flow of fresh air to the patient, free him from tight clothing.

Good oxygenation will ensure that the patient takes a certain position: it is necessary to put him down, lower his legs down, put his hands on the armrests. In this position, a large amount of oxygen enters the lungs, which sometimes helps to stop an attack.

If the skin has not yet acquired a bluish tint and there is no cold sweat, you can try to stop the attack with a nitroglycerin tablet. These are activities that can be carried out before the ambulance arrives. Only qualified specialists can stop an attack and prevent complications.

One of the complications of acute heart failure can be a stroke. A stroke is the destruction of brain tissue due to a previous hemorrhage or an acute cessation of blood flow. Hemorrhage can occur under the lining of the brain, into its ventricles and other places, the same applies to ischemia. The further state of the human body depends on the place of hemorrhage or ischemia.

Various factors can provoke a stroke. If a stroke is the cause of a hemorrhage, then such a stroke is called hemorrhagic. The cause of this type of stroke can be a sharp increase in blood pressure, atherosclerosis of cerebral vessels, blood diseases, traumatic brain injury, etc.

Ischemic stroke can be triggered by thrombosis, sepsis, infections, rheumatism, DIC, a sharp drop in blood pressure due to acute heart failure, and much more. But one way or another, all these reasons are associated with disruption of the cardiovascular system.

If the patient's blood pressure rises sharply, blood flow to the head increases, sweat appears on the forehead, then we can talk about the occurrence of a hemorrhagic stroke. This is all accompanied by loss of consciousness, sometimes vomiting and paralysis on one side of the body.

If the patient experiences dizziness, headache, general weakness, then these may be symptoms of an ischemic stroke. With this type of stroke, there may be no loss of consciousness, and paralysis develops slowly. Ischemic stroke accompanies a drop in blood pressure, fainting, pallor of the patient's skin is noted.

If you notice these symptoms, call an ambulance immediately. Lay the patient on a horizontal surface, ensure free breathing. The patient's head must be turned on its side - prevention of retraction of the tongue and suffocation with vomit.

It is advisable to put a heating pad at the feet. If, before the arrival of the ambulance, you notice a lack of breathing and cardiac arrest in a patient, it is urgent to carry out an indirect heart massage and artificial respiration.

Acute heart failure, stroke are life-threatening conditions. It is impossible to trace their appearance and they are very poorly treated. Therefore, the most important task facing us is the prevention of these conditions.

Lead a healthy lifestyle, do not abuse drugs, avoid stress and take care of your health.

Proper first aid for acute heart failure and stroke

• • Indirect cardiac massage
• Providing first aid

First aid for acute heart failure and stroke should be provided to the patient by surrounding people in a timely manner if a critical situation arises. There is a very high mortality rate from these terrible diseases in the world.

The mechanism of development of heart pathology

Heart failure is not considered an independent disease. This is a syndrome that is the result of a number of long-term developing ailments: severe pathology of the heart valves, problems with coronary vessels, rheumatic heart disease, impaired tone of the arteries, veins, capillaries with uncompensated arterial hypertension.

There comes a moment when, due to poor pumping of blood, the heart cannot cope with its pumping function (full pumping, blood supply to all body systems). There is an imbalance between the body's need for oxygen and its delivery. First, the fall in cardiac output occurs during exercise. Gradually, these pathological phenomena intensify. Eventually, the heart begins to work hard at rest.

Heart failure is a complication of other diseases. Its appearance may be preceded by a previous myocardial infarction, because each such pathological case is the death of a separate section of the heart muscle. At a certain point in a heart attack, the remaining viable sections of the myocardium cannot cope with the load. There is a sufficient number of patients who have a mild degree of this pathology, but they are not diagnosed. Therefore, they can suddenly feel a sharp deterioration in their condition.

Symptoms of acute heart failure

The main manifestations of cardiac dysfunction are:

1. The most striking signs of this syndrome are wheezing, nocturnal cough, increasing shortness of breath during movement, physical exertion, climbing stairs. Cyanosis appears: the skin turns blue, blood pressure rises. Patients feel constant fatigue.
2. In heart failure, first dense peripheral swelling of the legs quickly develops, and then the lower abdomen and other parts of the body swell.

People who have noticed such clinical signs in themselves should immediately consult a doctor and tell about their problem. As directed by a specialist, they will undergo diagnostics. When heart failure occurs in a patient, a cardiographic study is very effective, according to the results of which a cardiologist can determine the presence or absence of structural disorders of the heart muscle. If there is a disease, the necessary treatment will be prescribed according to the scheme in order to normalize myocardial metabolism and cardiac output through the selection of rational therapy.

Heart disease is highly treatable if diagnosed early. In this case, the patient is easier to treat, the disease can be compensated. If he receives the right treatment, the patient's cardiovascular system can function successfully for many years. If the course of the disease is delayed, as the patient does not go to the doctor and is not treated, the situation is aggravated. The patient's body suffers from a lack of oxygen, there is a gradual death of body tissues. If the patient does not receive immediate treatment, he may lose his life.

How is emergency care carried out in the event of acute heart failure?

With this pathology, the full functioning of the heart, the functions of the circulatory system can be impaired for several hours and even minutes. Sometimes signs of pathology develop gradually. There is moderate pain and discomfort. People don't understand what's going on. They wait too long before seeking medical help. Only urgent measures in this situation can save the patient's life. Immediately after the onset of clinical symptoms of heart failure, an ambulance team should be called. Doctors will take the necessary measures and offer the patient mandatory hospitalization.

While waiting for specialists, it is necessary to provide first aid to the patient:

1. Since panic can be harmful, the patient should be tried to calm down so that anxiety and fear disappear from him.
2. Fresh air must be provided, so the windows must be opened.
3. The patient should be freed from clothing that restricts his breathing. The collar of the shirt must be unbuttoned and the tie must be untied.
4. With a horizontal position of the body, as a result of the accumulation of blood in the lungs and the lack of air, the patient's shortness of breath increases. Therefore, the patient should be in an intermediate position between the lying and sitting posture (i.e., half-sitting). This helps to unload the heart, reduce shortness of breath and swelling.
5. Then, in order to reduce the total volume of blood circulating in the body, you need to clamp the veins. To do this, a venous tourniquet is applied for several minutes on both hands above the elbow and on the hips.
6. 1 tablet of nitroglycerin under the tongue every 10 minutes is given to stop an attack. But you can not give more than 3 tablets.
7. Blood pressure should be under constant control.
8. This pathology significantly reduces the well-being of a patient with a cardiovascular disease. Often, the patient's chances of saving a life depend on the people who are nearby at a critical moment.
9. If a cardiac arrest has occurred, people around should do chest compressions until the arrival of the medical team in order to return the patient to life.

Indirect cardiac massage

Since its implementation is ineffective on a soft bed, the patient should lie on a hard shield, floor or ground. Hands are placed on the central part of the chest. She squeezes hard several times. As a result, the volume of the chest decreases, blood is squeezed out of the heart into the lungs and the systemic circulation. This allows you to restore the pumping work of the heart and normal blood circulation.

Stroke as one of the causes of death

Often, patients and people around them take the symptoms of a stroke simply as signs of poor health. They explain the strange and unusual behavior of a person as a reaction to the weather, fatigue. But if others are attentive, the symptoms of a stroke can be recognized in a timely manner. The patient's life can be saved if qualified medical assistance is provided immediately.

The main symptoms of acute cerebrovascular accident

The development of a stroke can be suspected if some problems appear:

1. You need to ask the patient to smile. If a stroke occurs, one side of the face does not obey the person, the smile will turn out to be crooked, tense.
2. The tip of the tongue changes its correct position and deviates to the side.
3. Since the muscles become weak during a stroke, the patient will not be able to raise his arms with his eyes closed even for 10 seconds.
4. In response to your request to repeat any simple phrase, the patient will not be able to do this, because with this pathology the perception of speech and the pronunciation of meaningful words are impaired.

If a person could not perform such actions or does it with difficulty, it is urgent to call a medical team.

Providing first aid

First aid for a stroke:

1. The patient must be in a horizontal position. His head needs to be turned to the side. Clothing that restricts breathing should be unbuttoned.
2. The head should be cooled with an ice pack, a cold wet towel, or food from the freezer.
3. It is strictly forbidden to move the patient.
4. It is necessary to monitor the state of his breathing, pulse, blood pressure indicators.
5. Medical assistance to the patient must be provided within three hours after the stroke occurred.

Each person should have the skills of PMP (First Aid).

Often precious time is lost as a result of waiting for the arrival of the medical team. Many patients lost their lives because eyewitnesses to an attack of heart failure or stroke failed to provide them with first aid. Therefore, each person needs to learn how to provide first aid for stroke, heart attack, heart failure.

Stroke prevention: how to avoid and what means

Timely initiated stroke prevention can prevent the development of this pathology in 80% of cases. Let's talk briefly about the causes of the disease, which must be prevented.

Effective prevention of cerebral stroke is impossible without knowledge of the causes of this disease.

Depending on the causes of its occurrence, it is divided into 2 main types: ischemic stroke or cerebral infarction and hemorrhagic stroke or cerebral hemorrhage.

A cerebral infarction occurs when the flow of blood through the arteries that feed a certain part of the brain stops. This may happen for the following reasons:

• growth of atherosclerotic plaque;
• a detached blood clot that enters the blood vessels of the brain from the heart valves at the time of the sudden onset of arrhythmia;
• a drop in blood pressure or a decrease in the amount of blood pumped by the heart;
• increase in blood viscosity with the formation of its clots in the vessels of the brain.

The main cause of hemorrhage in the substance of the brain is a sharp jump in blood pressure. Unable to withstand it, the vessels rupture. In rare cases, with constantly high blood pressure values, there is a gradual "squeezing" of blood through the vessel wall into the brain tissue. With the accumulation of a sufficient amount of blood, neurological symptoms develop.

Thus, the considered causes help to understand how to prevent a stroke and prevent the development of neurological complications.

Who cares about stroke prevention?

Doctors have compiled a list of conditions (risk group) in which prevention is mandatory:

• women over 50, men over 45;
• hypertension (high blood pressure);
• heart failure;
• heart disease with rhythm disturbances (arrhythmias);
• high blood pressure (hypertension);
• diseases accompanied by the formation of blood clots;
• diabetes;
• experienced smokers.

A special place among these conditions is the prevention of stroke in the elderly. In people after 50 years, normal age-related changes in blood vessels occur - a decrease in the elasticity of the vascular wall, which may not withstand a sharp increase in pressure, for example, against the background of stress or strong emotions.

Stroke Prevention Measures

Since the causes of the development of circulatory disorders in the brain completely coincide with those in acute disorders of the blood supply to the heart muscle, therefore, the prevention of stroke and myocardial infarction can be carried out according to a single scheme.

For the convenience of patients, a “Memo on Stroke Prevention” has been compiled. It includes 7 items.

Point 1. Blood pressure - under control

In 99% of cases, hypertension is to blame for the development of cerebral hemorrhage. Therefore, it is necessary to keep the level of blood pressure under control. Its normal values ​​are: systolic ("upper") - no higher than 140 mm Hg. Art., diastolic ("lower") - no higher than 90 mm Hg. Art.

How to avoid stroke in patients with hypertension? To do this, you must have a personal device for measuring blood pressure. Elderly patients should choose automatic or semi-automatic models, because they do not require special skills to use them. The results must be recorded in a diary: in the morning after waking up, at lunchtime, in the evening before going to bed, noting the date and the values ​​obtained.

If high blood pressure values ​​​​are detected for the first time, you should immediately consult a doctor. If hypertension has already been diagnosed, blood pressure monitoring will help evaluate the effectiveness of prescribed drugs and change the treatment regimen if necessary.

Item 2. Fight against cardiac arrhythmia

Blood clots that form in the cavity of the heart and on its valves in some diseases can enter the general circulation and block the lumen of the cerebral vessels. The risk of this increases if there is a violation of the heart rhythm - arrhythmias. Patients belonging to the risk group must undergo an ECG (electrocardiography) without fail once every six months. If abnormal heart rhythms are detected, take prescribed antiarrhythmic drugs to prevent stroke.

Point 3. Bad habits - stop!

Stroke occurs in smokers twice as often as people without bad habits. This is because nicotine narrows the cerebral arteries and reduces the elasticity of the vascular wall. Under adverse conditions, the vessels may not withstand a sharp rise in blood pressure and burst.

It has been proven that if you stop smoking, then after 5 years the likelihood of developing a stroke decreases to an average level in patients of this age.

Item 4. Cholesterol - no

Prevention of ischemic stroke is to prevent the formation of atherosclerotic plaques. All patients who are at risk should have their blood checked for lipids at least once every six months.

You need to start lowering your cholesterol levels by changing your eating habits and exercising.

The menu for those who want to prevent the development of a stroke should include: steamed, boiled and stewed meat products, greens, low-fat dairy products, lean meat, fish, olive oil.

Physical exercises should be selected, taking into account age and existing diseases. The main thing is that physical activity is daily. Walking at a leisurely pace for 30-60 minutes every day is appropriate for most patients.

If non-pharmacological methods are insufficient, the doctor should prescribe anti-lipid (anti-cholesterol) drugs to prevent stroke.

Point 5. Attention, diabetes!

Changes in the vascular wall in diabetes mellitus are an important factor in increasing the risk of developing circulatory disorders in the brain. Therefore, it is so important to regularly examine the level of blood glucose: once every six months, if there are no complaints, and strictly according to the scheme proposed by the doctor if the diagnosis has already been made.

Item 6. Prevention of blood clots

Drugs for the prevention of stroke and heart attack, acting on the ability of blood to clot, can prevent the formation of microclots. They are vital for patients who have undergone various types of operations and have vein diseases (varicose veins).

Point 7. Do not miss the time

A cerebral infarction, unlike a hemorrhage, rarely develops suddenly. Most often, it is possible to identify the precursors of a stroke, recognizing which in time can prevent the development of serious neurological disorders.

You should immediately call an ambulance if the following symptoms are observed:

• sudden weakness, dizziness;
• numbness in the arms, legs, or any side of the face;
• difficulty speaking;
• sudden blurred vision;
• acutely developed severe headache.

For the convenience of the patient and a reminder of the main directions for the prevention of cerebrovascular accidents, you can print and hang in prominent places the pictures “stroke prevention”.

The power of nature for vascular health

Stroke prevention with folk remedies can be carried out exclusively as an addition to the drugs prescribed by the doctor for this purpose.

Traditional medicine can prevent the development of a stroke, mainly by strengthening the vascular wall and cleansing the body of excess cholesterol.

Sophora japonica tincture

Japanese Sophora will help to give vessels strength and restore elasticity. Take its dried buds and pour a 70% solution of medical alcohol at the rate of 1 spoonful of raw materials per 5 tablespoons of liquid. Infuse for 2-3 days, avoid storage in the light. Take 20 drops after each meal (3-4 times a day).

Lemon honey paste

This recipe will help lower cholesterol and cleanse blood vessels. Wash 1 lemon, 1 orange thoroughly with a brush and scroll in a meat grinder along with the peel. Drain excess juice. The mass should be thick. In the resulting gruel, add 1 tablespoon of natural thick honey and mix. The effect can be achieved by taking 1 tsp. pasta after every meal.

Common colza

To strengthen the blood vessels and prevent cholesterol from settling on them will help the common colza herb. Dried raw materials insist on boiling water in a glass bowl for 1 hour. For infusion, 1 part of the herb and 20 parts of water are taken. Drink half a glass 4 times a day.