With a lack of blood circulation. Prevention of high blood pressure in hypertension. Variants of chronic heart failure

The activity of the circulatory system plays an extremely important role for the health of the whole body. After all, it is the blood that supplies to all the cells of our body nutrients and vital oxygen, and it cleanses the body of decay products. So, if the composition of the blood changes, or its normal movement through the body is disturbed, it becomes noticeable very quickly. A fairly common problem of this kind is circulatory failure, the treatment and extent of which will be discussed further, and we will also talk about its symptoms and causes in a little more detail.

By circulatory insufficiency is meant the state of the body in which activity is disrupted, which manifests itself in its inability to supply blood to all tissues and organs in the volumes necessary for their full-fledged work.

Causes of circulatory failure

In fact, circulatory failure is not individual disease. Most often, it is considered as a symptom of some diseases or their consequence. Many factors can cause circulatory failure.

So such a violation is quite often provoked low quantity oxygen needed for optimal functionality. Circulatory insufficiency is often diagnosed in patients with and in people who have physiological abnormalities in the structure of the anatomical valves. This annoyance can be explained inflammatory processes that developed against the background of infection, various hormonal disruptions, alcoholic or drug addiction And .

If circulatory failure is vascular character, it is provoked different kind damage to veins or arteries. Similar pathology can be caused by mechanical influences (injuries), infectious lesions, significant blood loss, or severe burns.

Circulatory failure - degrees and symptoms

Modern doctors distinguish three main stages (degrees) of the disease, they are determined by the presence of complaints in the patient, the severity of symptoms, as well as the results of clinical studies. Doctors also take into account the severity of the underlying disease that caused circulatory failure.

At the initial (first) stage symptoms of circulatory failure are as follows: patients report worsening sleep, severe fatigue and rapid heartbeat. Even minor physical activity leads to an abnormal increase in heart rate and causes shortness of breath. All the symptoms of the main ailment from the heart are observed.

In the second stage of the disease- at developing insufficiency blood circulation - negative symptoms are significantly enhanced. The heart increases in size, tachycardia is permanent, shortness of breath occurs even faster. Also, patients are concerned about swelling of the feet and legs, the volume of urine discharge is significantly reduced, and the liver begins to increase in size. At this stage, circulatory failure proper treatment And bed rest help to reduce the severity of unpleasant symptoms by an order of magnitude, but it will never disappear completely (unlike patients with the first degree).

Third stage- this is a neglected circulatory failure, which is chronic. With such a violation of health, patients are disturbed even at rest, cyanosis increases, severe swelling. The pathology is so progressive that patients can only sleep in a characteristic semi-sitting position. They are concerned about frequent bouts of nausea, a significant decrease in body weight and a significant increase in the size of the heart. At this stage, the neglected patient needs emergency therapy, otherwise he may die.

Treatment

Patients with circulatory insufficiency are shown a whole range of measures that help reduce the load on cardiovascular system, and create optimal living conditions that allow you to maintain the normal functioning of the body. Therapy is selected depending on the degree of violation. Medications help optimize water-salt exchange and restore the function of the heart muscle.

In the event that the patient was diagnosed with circulatory failure of the first degree, he is allowed to perform physical exercises and even engage in sports disciplines that do not require special stress.

If the disease has reached the second stage of development, the patient should not be engaged in heavy physical labor and sports.
In the event that circulatory insufficiency is in the third degree of development, the patient must comply with a half-bed rest, full sleep is important for him and complete failure from all kinds of physical activity.

All patients with circulatory failure need to slightly change their lifestyle - go to proper nutrition and cut down on food intake. They must definitely refuse to consume those products that excite the activity of the heart - coffee, etc.

Drug treatment helps strengthen contractile activity heart and remove excess water from the body. In case of circulatory failure, cardiac glycosides, digitalis preparations (for example, or Isolanide) can be used. In case of circulatory failure, Strofantin is used either. To eliminate excess fluid, diuretics are used, but their dosage is selected exclusively by the attending physician. Another extremely important role is played by the creation of optimal conditions for staying in the room where the patient is located. most time. For such patients the best option the temperature is considered to be 20-22C and the air humidity is not less than 50%.

Circulatory insufficiency is a rather serious health disorder, which, if detected early, is quite amenable to correction.

Alternative treatment

Traditional medicine specialists use the most different means for the treatment of circulatory failure. So, to clean blood vessels from cholesterol, healers advise preparing fifty grams of flowers or fruits and pouring them with half a liter of vodka. Infuse this remedy for a month, then strain. Take the finished medicine in a teaspoon three times a day.

Another excellent effect is the use of an infusion based on. Grind it to a powder state. Brew a teaspoon of prepared raw materials with a glass of boiling water and insist in a thermos throughout the night (eight to ten hours). Strain the finished medicine, then take it in a couple of teaspoons about a quarter of an hour before a meal. The duration of such therapy is three to four months.

Also, traditional medicine experts advise treating circulatory failure with help. To prepare the medicine, chop two hundred grams of garlic and pour such raw materials with half a liter of vodka. Infuse this medicine for two weeks in a rather dark place at room temperature. Strain the finished tincture and mix it with the juice squeezed from five lemons. Drink the finished medicine in a tablespoon immediately before a meal. Drink it with water.

Also, patients with circulatory failure should combine one hundred grams of dried flowers. Grind the prepared ingredients. Brew fifty grams of the finished collection with half a liter of boiling water and leave for three to four hours to infuse. Sweeten the strained medicine with honey. Drink it in the morning instead of breakfast.

It is worth noting that folk remedies in case of circulatory insufficiency, it can be used only after consultation with the doctor. Self-medication with such a violation of health is categorically contraindicated.

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(V.Kh. Vasilenko, M.D. Strazhesko, 1935)

(Adopted at the XII All-Union Congress of Therapists)

A. Chronic circulatory failure (progressive, stationary, regressive, recurrent).

Initial stage (functional or organic origin).

Circulatory insufficiency is manifested only during exertion (shortness of breath, tachycardia, fatigue); at rest, hemodynamics, organ functions and metabolism are not changed; work capacity is reduced.

severe circulatory insufficiency: hemodynamic disturbance (stagnation in the pulmonary and systemic circulation), dysfunction of organs and metabolism are expressed at rest, working capacity is sharply reduced:

Period A - signs of circulatory insufficiency are characterized by congestion in one of the circles of blood circulation.

Period B - signs of circulatory insufficiency are characterized by stagnation in both the systemic and pulmonary circulation.

The final stage, the stage of dystrophic changes:

Persistent disorders of hemodynamics and metabolism; the functions and structure of all organs and tissues are impaired (ascites, pleurisy, pericarditis).

B. Acute circulatory failure.

Syndromes: acute insufficiency circulation of the whole heart; acute insufficiency of the left ventricle; acute insufficiency of the right ventricle; acute insufficiency of the left atrium; acute insufficiency of both the heart and blood vessels; acute vascular insufficiency (shock, collapse, fainting).

The classification of circulatory insufficiency proposed by the New York Heart Association (NYHA) in 1964 has become widely used in the world.

New York classification of circulatory failure

(Proposed by the New York Heart Association (NYHA), 1964)

Functional nature of changes

Patients with cardiac pathology that does not limit their physical activity. Ordinary physical activity does not cause excessive fatigue, palpitations, shortness of breath, or angina attacks.

Patients with cardiac pathology, which leads to limitation of physical activity. At rest, they are in good health. Ordinary physical activity leads to increased fatigue, palpitations, shortness of breath, or angina attacks.

Patients with cardiac pathology, which leads to a significant limitation physical activity. At rest, they are in good health. Light physical activity leads to increased fatigue, palpitations, shortness of breath, or angina attacks.

Patients with cardiac pathology who are unable to perform physical activity without deterioration of health. Subjective sensations of heart failure or angina may occur even at rest. Any physical activity leads to a deterioration in well-being.

In May 1997, the VCongress of Cardiology of Ukraine approved the Working Classification of Heart Failure, proposed by the Ukrainian Scientific Society of Cardiology.

Working classification of chronic heart failure Ukrainian Scientific Society of Cardiology

Stages Types Options Functional

I Left Ventricular Systolic I

IIA Right Ventricular Diastolic II

IIB Mixed MixedIII

Left ventricular- characterized by transient or constant hypervolemia of the pulmonary circulation, which is due to the insufficiency of the pumping function of the left heart.

Clinic: stagnation in the pulmonary circulation (congestive rales in the lungs: muffled crepitant rales, moist fine bubbling, dry buzzing rales), tachycardia, shortness of breath, hemoptysis, diffuse cyanosis.

Right ventricular- characterized by transient or permanent hypervolemia of the systemic circulation, which is due to insufficient pumping function of the right heart.

Clinic: tachycardia, shortness of breath, acrocyanosis, liver enlargement, peripheral edema.

Options:

systolic dysfunction is characterized by a violation of the expulsion of blood into the vascular bed, due to a decrease in the number and / or functional activity of cardiomyocytes, which is accompanied by an increase in the volume of the heart cavities and a decrease in ejection fraction. Occurs with myocarditis, dilated cardiomyopathy, coronary artery disease / heart attack, aortic stenosis.

The main criterion: the value of the ejection fraction of the left ventricle (EF)< 40%

diastolic dysfunction is characterized by impaired active relaxation and/or increased passive stiffness, due to hypertrophy, fibrosis, or infiltrative damage to the myocardium, which is accompanied by an increase in ventricular filling pressure and pulmonary congestion. Occurs in arterial hypertension, mitral and tricuspid stenosis, pericarditis, myxoma, restrictive cardiomyopathy.

The main criterion: the presence of clinical signs of heart failure, congestion in the pulmonary and / or systemic circulation with preserved EF> 50%

Main clinical manifestations heart failure:

Tachycardia develops as a result of increased pressure in the right atrium (Bainbridge reflex).

Cyanosis- an increase in the content of reduced hemoglobin in the blood as a result of:

stagnation of blood in the pulmonary circulation and worsening of arterialization of blood in the lungs;

slowing down blood flow and increasing the utilization of oxygen by tissues;

expansion of the skin vein network and increased pressure in the veins.

Dyspnea- irritation of the respiratory center with carbon dioxide, which has accumulated in the blood as a result of hypoxia and acidosis.

Edema:

increased hydrostatic pressure in the capillaries and extravasation of fluid into the tissue;

as a result of the release of rinin, activation of the renin-angiotensin system and an increase in the secretion of aldosterone due to a deterioration in the blood supply to the kidneys, which leads to sodium and water retention in the body;

as a result of increased production antidiuretic hormone and slowing down its destruction in the congestive liver;

as a result of an increase in the amount of circulating blood;

as a result of a decrease in blood pressure due to a violation of the protein-synthetic function of the liver.

Enlargement of the heart.

Principles of treatment of heart failure:

Salt intake control;

Avoid drinking large amounts of fluids in patients with severe heart failure;

Avoid drinking alcohol;

Stop smoking;

Daily physical activity.

II. Pharmacological therapy:

Diuretics: (loop-furosemide; thiazide-hydrochlorothiazide; potassium-sparing-veroshpiron.);

angiotensin-converting enzyme inhibitors (ACE inhibitors): captopril, enalapril, etc.;

Cardiac glycosides: digoxin and others;

Vasodilators: nitropreparations;

Beta-adrenergic antagonists: metoprolol, bisoprolol, carvedilol;

Inotropic sympathomimetics: dopamine;

Anticoagulants;

antiarrhythmic drugs;

Oxygen.

Surgery:

1. Revascularization;

   pacemakers;

   Ultrafiltration, hemodialysis;

   Heart transplant.

Acute heart failure- a complication of various diseases (conditions), consisting in circulatory disorders due to a decrease in the pumping function of the heart or its filling with blood

Causes of acute heart failure:

Acute disorder of the transport function of the heart.

1. Decreased heart rate: acute infarction myocardium, myocarditis, toxic lesions(alcohol, diphtheria, ionizing radiation, etc.), metabolic disorders (azidosis, thyrotoxicosis, etc.), systemic diseases, primary cardiomyopathy.

   Relaxation disorders: amyloidosis, subaortic stenosis, hyperparathyroidism, sarcoidosis.

   Mechanical causes: regurgitation (acute insufficiency of the mitral or aortic valve, rupture of the interventricular septum, acute aneurysm of the left ventricle), obstruction of blood outflow (aortic stenosis, subaortic stenosis).

   Rhythm disturbance.

Acute obstruction to the filling of the cavities of the heart,

1. External influences: cardiac tamponade, pericarditis, tension pneumothorax.

   Obstruction of blood flow: mitral stenosis, atrial myxoma.

   Acute right ventricular failure: pulmonary embolism. Primary pulmonary hypertension, stenosis pulmonary artery, right ventricular infarction.

After heart surgery.

The main clinical manifestations of acute left ventricular failure (ALF).

Clinical ALN is characterized by the development of an attack of cardiac asthma, the extreme manifestation of which is pulmonary edema. Patients complain of severe shortness of breath (suffocation) with difficulty breathing, aggravated in the supine position, which makes the patient take forced position(orthopnea), pressure sensation chest, heartbeat. Objectively: diffuse cyanosis, percussion sound above the lungs changes from a clear pulmonary sound to dull tympanitis with a transition to a dull percussion sound, the nature of breathing changes, it becomes hard, then weakened, and finally bronchial. With alveolar edema of the lungs, crepitating, moist fine and medium bubbling rales are heard, first in the lower sections, and then over the entire surface of the lungs. Later, large bubbling rales appear from the trachea and large bronchi, audible at a distance, abundant foamy, sometimes with a pink tinge of sputum. Breath becomes wheezing. Auscultation of the heart shows tachycardia, a weakening of the I tone at the apex, an accent of the II tone over the pulmonary artery, and a protodiastolic gallop rhythm (appearance of a pathological III tone). A valuable aid in the diagnosis is the assessment of the response to sublingual administration of nitroglycerin, which gives a quick and clear positive effect in acute left ventricular failure.

Urgent Care

1. Place the patient in a sitting position to reduce venous return;

2. Assign inhalation of humidified oxygen 100% through a mask;

3. Nitroglycerin 1-2 tab. sublingually with an interval of 5 minutes until the attack stops or until the moment when i.v. nitroglycerin begins to act;

4. Diuretics: IV furosemide at a dose of 40-100 mg. With a decrease in BCC - exfusion of venous blood (250-400 ml), or the imposition of tourniquets on the limbs;

5. Continuation of treatment with vasodilators, β-adrenergic blockers, subject to stabilization of the patient's condition, Ca antagonists with high blood pressure;

6. Consider the need to prescribe morphine sulfate from 3 to 5 mg intravenously for 3 minutes (contraindications: cerebral hemorrhage, chronic pulmonary heart, bronchial asthma);

7. Sympathomimetic amines (dopamine, dobutamine) with the ineffectiveness of therapy, subject to a decrease in blood pressure;

8. In some cases, eufillin at a dose of 240-480 mg slowly over 10-12 minutes;

9. If hypoxemia and hypercapnia persist, tracheal intubation is performed

The main clinical manifestations of acute right ventricular failure (ARF).

The most common cause of acute right ventricular failure is pulmonary embolism (PE). For the diagnosis of PE, one should take into account the history data, risk factors for the development of thromboembolism, and the suddenness of the onset of the disease. The degree of clinical manifestations depends on the massiveness of the lesion. Sudden shortness of breath, independent of body position, accompanied by acute, often associated with breathing, pain in the right side of the chest with arterial hypotension, sharp pain in the right hypochondrium after a long illness or surgery, as a rule, is due to PE. Characteristic is the discrepancy between severe shortness of breath and a meager auscultatory picture in the lungs. Other common clinical signs of PE are: fever from the first day, pale cyanotic color of the skin or sharp diffuse cyanosis of the upper half of the body, swelling of the jugular veins, shortening of percussion sound, weakening of breathing over the lesion, pleural friction noise, expansion of cardiac dullness to the right , tachycardia, accent and splitting of II tone over the pulmonary artery, thready pulse. To clarify the diagnosis and determine the massiveness of the lesion, instrumental and laboratory research methods are used: ECG - sinus tachycardia or atrial fibrillation is recorded, deviation of the electrical axis to the right, often P-pulmonale, signs of blockade right leg bundle of His; R-graphy of the chest, where there are signs of atelectasis or infiltration of the lung tissue, often fluid in the pleural cavity, signs of amputation of the pulmonary vessel. Pulmonary angiography, pulmonary scintigraphy, computed tomography, echocardiography are also performed. A study aimed at detecting deep vein thrombosis - ultrasonography is mandatory.

Urgent Care.

Hemodynamic and respiratory support: oxygen therapy, vasopressor

drugs (adrenaline, norepinephrine), etc.;

thrombolytic therapy;

Surgical embolectomy;

Anticoagulant therapy (fraxiparine, clexane).

Equipment, visual aids:

ECG, PCG, chest X-ray, oxygen bag, artificial ventilation lungs, phantoms: lungs-heart, heart

Control tasks:

List the signs of acute left ventricular failure. What diseases complicate this syndrome?

List the signs of acute right ventricular failure. What diseases complicate this syndrome?

Name the clinical signs of heart failure stage IIB.

4. Carrying out test - control. Solution of situational problems.

Literature:

Main:

Propaedeutics of internal diseases /under the editorship of Grebenev A.L./. Moscow, Medicine, 2002.

Yavorsky O.G., Yushchik L.V. Propaedeutics of internal diseases in questions and answers, K .: Health, 2003.- 300 p.

Lecture on the topic of the lesson.

Additional:

1. Internal diseases (edited by Smetnev A.S., Kukes V.G.), M., "Medicine", 1982.

LACK OF CIRCULATION

Professor A.S. Senatorova

Circulatory failure is a syndromic concept. It includes the state of the myocardium of the atria, ventricles, blood vessels, the dynamism and effectiveness of the relationship of regulatory systems, the level of functioning of all organs, their maturity, etc. last years received valuable information about common arrangements adaptation of a child with circulatory insufficiency (NC), revealed the mechanisms of violation contractility myocardium, changes at the level of cells, organelles and molecules are specified.

Terminology. Circulatory insufficiency is a combination of hemodynamic disorders leading to impaired blood supply to organs and tissues, as well as to pathological redistribution of blood volume in the cardiovascular system. Circulatory failure is accompanied by characteristic changes in central and peripheral hemodynamics, neuroendocrine and immune homeostasis. It is necessary to distinguish between the concepts of "heart failure" and "circulatory failure".

Heart failure is a clinical syndrome that develops when the systolic, diastolic or systolic-diastolic functions of the heart are disturbed. Traditionally, heart failure is defined as the inability of the heart to convert venous return into adequate cardiac output. Insufficiency of blood circulation combines violations of myocardial contractility, functional or organic vascular insufficiency, failure of neurohumoral regulatory mechanisms. In each case, the development of circulatory failure can be due to the state of all factors, and the predominant influence of one of them.

Classification. Currently, the classification of circulatory disorders is based on the provisions developed by N.D. Strazhesko, V.Kh. Vasilenko and G.F. Lang in 1935. In 1987, N.A. Belokon, taking into account the features childhood proposed a classification of circulatory insufficiency based on literature data, classifications of the above authors and N.M. Mukharlyamov (1978).

Classification of circulatory failure

First of all, one should distinguish between heart and vascular insufficiency. The causal factors in these two forms of circulatory disorders differ significantly, therefore, the medical tactics. The etiological factors of heart failure mainly violate the contractility of the myocardium, and in vascular they damage regulatory mechanisms and vascular patency.

Downstream NK can be acute or chronic. Since it is difficult to determine the timing of development, a purely clinical meaning should be put into the concept of "acute" and "chronic" NK. If heart failure is accompanied by vascular failure, then the latter may be isolated or caused by cardiac decompensation. Each variant of vascular insufficiency (fainting, collapse, shock) has its own clinical and hemodynamic characteristics. Acute vascular insufficiency can be attributed to the syndrome of acute and chronic coronary insufficiency in children early age with neurotoxicosis (hypermotile toxicosis).

At the heart of heart failure (HF) is a decrease in the contractile function of the myocardium, due to cardiac and extracardiac causes. There are left-hearted type of heart failure, right-hearted and combined. left-hearted the type is characterized by transient or constant hypervolemia of the pulmonary circulation due to pumping insufficiency of the left heart. right-hearted the type is characterized by transient or permanent hypervolemia of the systemic circulation due to pumping insufficiency of the right chambers of the heart. Combined characterized by a combination of criteria inherent in left-heart and right-heart types of heart failure. Acute heart failure may present as pulmonary edema, cardiogenic shock, acute cor pulmonale. Chronic heart failure may be due predominantly to systolic dysfunction (impaired myocardial contractility) or diastolic (impaired ventricular filling), determined using ultrasound hearts

In 1997, the classification of chronic heart failure was developed and proposed by the Ukrainian Scientific Society of Cardiology, approved at the VI National Congress of Cardiologists of Ukraine in 2000.

Classification of chronic heart failure

Ukrainian Scientific Society of Cardiology (1997)

IA(preclinical). Shortness of breath and palpitations physical activity

absent, however, an instrumental examination of the patient reveals at least one of the following signs of dysfunction of the heart muscle:

LV ejection fraction less than 50%;

increase in size (volume index);

end-diastolic pressure in the left ventricle or pulmonary capillary pressure more than 12 mm Hg;

end-diastolic pressure in the left ventricle 7 mm Hg

IB Shortness of breath is combined with the presence of instrumental signs of cardiac dysfunction.

IIA Dyspnea, during physical exertion, episodes of orthopnea are combined with clinical and radiological signs of congestion in the pulmonary circulation (with an isolated pathology of the right heart, congestion in a large circle).

IIB Shortness of breath occurs with minimal physical exertion, orthopnea is combined with severe congestion in the pulmonary and systemic circulation.

III Pronounced hemodynamic disturbances are combined with persistent irreversible structural and functional changes. internal organs(cardiac cirrhosis of the liver, ascites, impaired nitrogen excretion of the kidneys) and general exhaustion.

Variants of chronic heart failure.

systolic - hemodynamic disturbance is mainly due to insufficiency systolic function ventricle(s) (characteristic of inflammatory myocardial lesions, dilated cardiomyopathy, postinfarction cardiosclerosis with left ventricular dilatation, decompensated valvular regurgitation).

The main criterion is the LV ejection value less than 50%.

Additional criteria;

Normalized Vcf less than 0.9 s -1

decline top speed systolic ejection (SI max.) less than 4 s -1

diastolic - violation of hemodynamics is mainly due to a violation of the diastolic filling of the ventricle (s) (typical for hypertrophic cardiomyopathy, restrictive heart disease, constrictive pericarditis, hypertensive heart, clinically compensated aortic stenosis)

Main criteria:

Pulmonary edema, cardiac asthma, or the presence of radiological signs congestion in the pulmonary circulation with
the presence of an LV ejection fraction of more than 50%

Reducing the size (volume index) of the ventricular cavity(s)

Additional criteria:

The value of the ratio of the anteroposterior size of the left atrium to
end-diastolic LV size more than 0.7

Decreased early diastolic filling rate (E/A less than 1)

Reducing the filling fraction of the fast filling phase is less than 50%

Mixed - characterized by a combination of criteria inherent in systolic and diastolic variants of heart failure.

However, in young children it can be difficult to distinguish clinical stages and the severity of heart failure due to the rapid dynamics of the development of the pathological process, the lability of clinical symptoms of heart failure, often associated with extracardiac causes (shortness of breath, tachycardia may increase when the child cries, feeds, dysregulatory effects from the central nervous system; liver enlargement may be due not only to hemodynamic factors, but be detected in anemia, rickets, malnutrition). In practice, it is possible to use the clinical criteria for heart failure in young children, proposed by N.A. Belokon (1984)

Signs and stages of heart failure

The severity of heart failure should be based on objective data. ultrasound diagnostics heart, indicators of central and peripheral hemodynamics, intracardiac kinetics, indicating a violation of myocardial contractility. The classification of circulatory insufficiency by severity, which is based on the integral indicator of the contractility of the left ventricular myocardium - ejection fraction and decreased exercise tolerance, was proposed by Cohn J.N. (1995).

Classification of NC according to the degree of severity CohnJ.N. (1995)

*This indicator is not informative for concomitant lung diseases, anemia, muscle pathology (including severe detraining)

The preclinical stage of heart failure can be detected only by instrumental methods (echocardiography, Doppler echocardiography) and with the use of dosed physical activity.

Etiology. There are 3 groups of etiological factors of circulatory failure: acting on the contractile function of the heart muscle, the state of the vessels and the centers various levels regulating blood circulation. Circulatory failure can be due to cardiac and extracardiac causes.

In the systolic form of heart failure, a decrease cardiac output due to a decrease in the contractile function of the myocardium, which is associated with myocardial damage (myocarditis, endocardial fibroelastosis, myocardial dystrophy, dilated cardiomyopathy).

Constrictive pericarditis, obstructive cardiomyopathy, tumors, paroxysmal tachycardia.

Myocardial contractility is impaired by overloading the heart with pressure (stenosis of the aorta, pulmonary valves, aortic hypertension) or volume (mitral insufficiency,

aortic and tricuspid valves of the heart, congenital heart defects with shunting of blood from left to right).

Extracardiac causes of NK can be various diseases lungs, liver, kidneys, hematopoietic organs, electrolyte disorders, thyrotoxicosis, chronic liver disease, intoxication, infectious diseases, violations of the regulation of blood circulation against the background of increased intracranial pressure, severe hereditary vagotonia, brain injury, etc.

In recent years, drugs have been isolated that can provoke (aggravate heart failure) (Giles J.D., Sander G.E., 1993): non-steroidal anti-inflammatory drugs, corticosteroids, indirect vasodilators, calcium antagonists, antiarrhythmic drugs IA, IC class, sympathomimetics, antibiotics, etc. ).

Rhythm and conduction disorders of the heart (paroxysmal tachycardia, atrial fibrillation, complete atrioventricular blockade, chronic non-paroxysmal tachycardia) are directly related to the development of circulatory disorders, especially in young children. With a long-term dysrhythmia, arrhythmogenic cardiomyopathy develops, accompanied by heart failure.

Especially difficult is the process of establishing the causes of heart failure in newborns. Cardiac causes of HF include: congenital heart defects, carditis, dysrhythmias; to extracardiac - a violation of the process of restructuring intrauterine circulation to extrauterine, infections, intoxication, severe anemia, thyrotoxicosis, respiratory distress syndrome, pneumonia, asphyxia. NK in the neonatal period most often develops with such congenital heart defects as transposition of the main vessels, critical pulmonary artery stenosis, pulmonary atresia, tricuspid valve atresia, tetralogy of Fallot, abnormal pulmonary venous drainage, Ebstein anomaly, large ventricular and interatrial septal defects,

atrioventricular communication, severe aortic coarctation, large open ductus arteriosus, severe aortic stenosis, abnormal origin of the left coronary artery from the pulmonary artery, endocardial fibroelastosis.

All factors that require restructuring of hemodynamics cause cardiovascular insufficiency: volume overload of the heart due to fetal, fetoplacental transfusion, iatrogenic excessive fluid administration, acute disorders cerebral circulation, pneumopathy, syndrome of persistent fetal circulation in newborns, permanent, paroxysmal and chronic vascular insufficiency in autonomic dysfunction.

Pathogenesis. Blood circulation performs a specific function, delivering oxygen to the tissues of the body and transferring metabolic products. However, this is only possible if the following components are not violated:

circulation (right ventricular failure) and an increase in hydrostatic pressure in...

Chronic circulatory failure(HNK) - pathological condition, at which work of cardio-vascular system does not provide the body's needs for oxygen, first during exercise, and then at rest.

Classification of chronic circulatory failure(N. D. Strazhesko, V. Kh. Vasilenko, 1935)

• Stage I - initial, latent circulatory insufficiency, manifests itself only during physical exertion, at rest hemodynamics is not disturbed.
• Stage II - severe, prolonged circulatory failure, hemodynamic disturbance (stagnation in the pulmonary and systemic circulation), organ dysfunction and metabolism are expressed even at rest, working capacity is sharply limited.
• IIA stage - hemodynamic disturbance is moderately expressed, there is a violation of the function of any part of the heart (right or left ventricular failure).
• IIB stage - deep violations hemodynamics, the entire cardiovascular system is involved in suffering, severe violations hemodynamics in the small and large circle.
• III stage- final dystrophic. Severe circulatory failure, persistent changes in metabolism and organ functions, irreversible changes in the structure of organs and tissues, severe dystrophic changes, complete disability.

Classification of heart failure(N. M. Mukharlyamov, 1978)

• I. By origin: I. Pressure overload. 2. Volume overload. 3. Primarily myocardial insufficiency.
• II. By cardiac cycle: 1. Systolic insufficiency. 2. Diastolic insufficiency. 3. Mixed insufficiency.
• III. Clinical variants: 1. Predominantly left ventricular. 2. Predominantly right ventricular. 3. Total. 4. Hyperkinetic. 5. Collaptoid. 6. Saved sinus rhythm. 7. Bradycardic.
• IV. Stage: I - period A, period B; II - period A, period B; III - period A, period B.

Stage I, period A - preclinical period. There are no complaints and clinics of insufficiency either at rest or during physical exertion. However, during exercise, the ejection fraction decreases, and the end-diastolic pressure slightly increases.

Stage I, period B - corresponds to stage I according to Strazhesko - Vasilenko.

Stage II, period A - corresponds to the PA stage according to Strazhesko - Vasilenko.

Stage II, period B - corresponds to the PB stage according to Strazhesko - Vasilenko.

Stage III, period A - with active modern complex therapy with the use of blood ultrafiltration, it is still possible to achieve a decrease in congestion and improve the clinic, stabilize hemodynamics.

Stage III, period B - modern active therapy using blood ultrafiltration does not give any positive results, an absolutely irreversible stage.

IN practical medicine The Strazhesko-Vasilenko classification is the most widespread.

Etiology:

• 1) myocardial damage (myocarditis, myocardial dystrophy, cardiomyopathy, cardiosclerosis);
• 2) overload of the heart muscle: a) pressure (stenosis of the tricuspid, mitral valves, aortic orifice, pulmonary artery, hypertension of the pulmonary or systemic circulation); b) volume (valvular insufficiency, intracardiac shunts); c) combined (complex heart defects, a combination of pathological processes leading to volume and pressure overload);
• 3) violation of diastolic filling of the ventricles (adhesive pericarditis, restrictive cardiomyopathy).

The main pathogenetic factors: decrease in cardiac output and perfusion of organs and tissues, activation of the sympathoadrenal system, constriction of arterioles and venules (which exacerbates impaired tissue perfusion), increased production of ADH, decreased secretion of atrial natriuretic factor, activation of the renin-angiotensin-aldosterone system. Retention of sodium and water, the development of edema, an increase in the volume of circulating blood.

I stage - initial. 1. Subjective manifestations - fast fatiguability, slight shortness of breath and palpitations during normal physical activity. 2. Examination - slight acrocyanosis, pastosity of the legs by the end of the day. 3. Examination of the cardiovascular system - the pulse at rest is normal, with a load it is quickened, the borders of the heart are moderately expanded, the tones are muffled, not loud systolic murmur at the apex, in general, the auscultatory and percussion picture corresponds to the underlying disease. 4. The liver and spleen are not enlarged.

II stage. Period A - signs of circulatory insufficiency at rest are moderately expressed, hemodynamic disturbances in the systemic or pulmonary circulation.

With the defeat of the left parts of the heart (left ventricular failure), congestion is observed in the small circle.

1. Complaints - shortness of breath (especially during exercise), asthma attacks (usually at night), palpitations, dry cough, often hemoptysis, fatigue.

2. Examination - pallor, cyanotic blush on the cheeks in the form of a "butterfly" (typical for patients with mitral stenosis), acrocyanosis. There are no edema. 3. Examination of the cardiovascular system - the left border of the heart is enlarged, with mitral stenosis - the upper one, sometimes also the right one; during auscultation, a picture characteristic of the underlying disease is determined, often extrasystole, gallop rhythm, deafness of tones, atrial fibrillation. 4. Liver, spleen are not enlarged. 5. Harsh breathing is heard in the lungs, often dry rales, with pronounced symptoms of stagnation - fine bubbling rales, muffled crepitus.

With the defeat of predominantly the right parts of the heart (right ventricular failure), congestion is observed in the systemic circulation.

1. Complaints - heaviness and pain in the right hypochondrium, thirst, decrease in diuresis, swelling, enlargement and feeling of distension of the abdomen, shortness of breath during movements. 2. Examination - acrocyanosis, swelling of the neck veins, swelling in the legs, in severe cases- ascites. 3. Examination of the cardiovascular system - the auscultatory picture is determined by the underlying disease, however, tachycardia, often extrasystole, atrial fibrillation, gallop rhythm, systolic murmur in the area are characteristic xiphoid process, aggravated on inspiration (Rivero-Corvalho symptom) due to relative insufficiency of the tricuspid valve; the borders of the heart are expanded in all directions; the pulse is frequent, small, often arrhythmic. 4. The liver is significantly enlarged, its surface is smooth, the edge is rounded, painful; palpation of the liver causes swelling of the jugular veins (symptom of Plesh). In the PA stage, treatment fully compensates for the condition of patients.

II stage. Period B - pronounced signs of heart failure, severe hemodynamic disturbances in both the systemic and pulmonary circulation. 1. Complaints - shortness of breath at the slightest physical stress and at rest; palpitations, interruptions in the region of the heart, swelling, pain and heaviness in the right hypochondrium, general weakness, bad dream. 2. Examination - orthopnea, acrocyanosis, edema, often ascites. 3. Examination of the cardiovascular system - tachycardia, atrial fibrillation, extrasystole, often a gallop rhythm, otherwise the auscultatory picture is determined by the nature of the underlying disease; the borders of the heart are expanded in all directions. 4. With auscultation of the lungs - breathing hard, dry and inaudible moist rales, crepitus, in severe cases - hydrothorax. 5. The liver is enlarged, dense, painless, with a smooth surface, often with a pointed edge.

III stage - final, dystrophic, with severe hemodynamic disorders, metabolic disorders, irreversible changes in the structure of organs and tissues. At this stage, the condition of patients is very serious. There are pronounced shortness of breath, edematous-ascitic syndrome, hydrothorax, atrial fibrillation with pulse deficit, congestion in the lungs. Some patients at this stage develop a “dry dystrophic or cachectic type” (according to V. Kh. Vasilenko), manifested by significant atrophy of organs, tissues, subcutaneous tissue, a sharp decrease in body weight, along with severe ascites.

Laboratory data

Changes depend on the disease that led to HNK. In case of severe circulatory failure and liver enlargement, ESR slows down, and erythrocytosis is possible in chronic pulmonary heart. With severe edematous syndrome, hypoproteinemia is determined, with active treatment saluretics may develop hypokalemia, hypochloremia.

Instrumental Research

Catheterization of the cavities of the heart and great vessels with the measurement of end diastolic pressure (increases), contractility indices based on the rate of change in pressure in the ventricles and their filling (decreased contractility), blood ejection fraction. These methods are not widely used. Echocardiography: dilatation of the cavities of the heart, an increase in wall thickness, a decrease in stroke volume. The echocardiographic picture also depends on the underlying disease. Tetrapolar thoracic rheography: reduced stroke volume. A study of BCC with "311-albumin: an increase in BCC. Phase analysis of cardiac activity: hypodynamia syndrome of the heart, which is characterized by lengthening of the phase of isometric contraction, shortening of the period of expulsion and mechanical systole. Phase analysis of the heart is performed using polycardiography - synchronous recording of ECG, FCG, sphygmogram central pulse Spirography: decrease vital capacity lungs, hyperventilation. Measurement of CVP: increased with right ventricular failure.

Complications

With the long-term existence of chronic circulatory insufficiency, the development of complications is possible, which are essentially a manifestation of damage to organs and systems in conditions of chronic venous congestion, insufficiency of blood supply and hypoxia: a) violation acid-base balance and electrolyte metabolism; b) thrombosis and embolism; c) syndrome of disseminated intravascular coagulation; d) rhythm and conduction disorders; e) cardiac cirrhosis of the liver with possible development liver failure; e) "stagnant" kidney, etc.

Survey program

1. OA of blood, urine. 2. TANK: total protein, protein fractions, cholesterol, triglycerides, β- and pre-β-LP (total according to Burstein), sialic acids, fibrin, seromucoid, transaminases, aldolase, sodium, potassium, chlorides. 3. ECG. 4. FKG. 5. Echocardiography with determination of the volume of cavities, shock and minute volumes. 6. Polycardiography and phase analysis of cardiac activity. 7. X-ray examination of the heart and lungs 8. For the diagnosis of early, latent stages HNK - the study of hemodynamic parameters under VEM conditions, spirography after exercise.

Formulation of the diagnosis

deployed clinical diagnosis is formulated taking into account: the underlying disease, the stage of chronic circulatory insufficiency, complications of chronic circulatory insufficiency.

Examples of the formulation of the diagnosis

• 1.IHD, circulatory failure IIA Art. (mainly left ventricular).
• 2. Rheumatism, inactive phase, aortic valve insufficiency, HIIBst.
• 3. Hypertension III stage, rapidly progressive course, circulatory failure IIA stage. (mainly left ventricular with frequent attacks of cardiac asthma).

Diagnostic Handbook of Therapist. Chirkin A. A., Okorokov A. N., 1991

During daily physical activity, healthy person you can observe an increase in heart contractions (tachycardia), an increase in pressure in the veins, and as a result, an increase in the mass of circulating blood. These adaptive responses healthy body identical to the first signs of vascular insufficiency. Therefore, it is important to recognize these pathological signs. Circulatory failure always occurs with.

Kinds

By clinical symptoms types of circulatory insufficiency have the following classification: heart and vascular insufficiency, which, in turn, are divided into acute and chronic.

Heart failure is of the following types:

• Left ventricular heart failure. It is characterized by congestion in the lungs, an increase in blood volume in the pulmonary circulation, the left half of the heart is enlarged, there are symptoms of insufficient oxygen supply to the brain and the heart itself.
• Right ventricular failure of the heart. It is characterized by congestion in the veins and in the systemic circulation, expansion of the right half of the heart. Often right ventricular failure appears after left ventricular failure.
• Complete heart failure. It develops in the pathology of the heart muscle (with myocarditis, myocardial dystrophy). Last stages heart disease occurs with cardiosclerosis, myocardial infarction, hypertension.

Vascular insufficiency in its course is acute and chronic. Acute insufficiency ─ collapse, fainting, shock. Chronic deficiency - occurs in patients with rheumatism,.

stages

There are such stages of circulatory failure and their impact on a person's ability to work:

• First stage (hidden)─ in a calm state, no visible manifestations of pathology are observed; only after active physical exertion can one see excessive fatigue and a strong pulse.
• Second stage A─ characterized by pronounced shortness of breath and which can be observed already with little physical exertion or at complete rest.
• Second stage B─ stagnation develops in the lungs, blood circulation throughout the body is disturbed.
• Third stage (dystrophic)─ all signs characteristic of heart failure are maximally manifested, irreversible changes occur in the structure of the liver and lungs.

In the first stage of heart failure, the load on the body should be strictly limited, in the second - it is allowed to perform light work associated with insignificant physical energy costs. Patients in the third stage are bedridden and completely disabled people.

The main function of large veins in the circulatory system is delivery to the heart the right amount blood pressure. This function is impaired in vascular insufficiency. Understanding the mechanism of blood flow disorders in the circulatory system, it is possible to clearly determine what signs appear when there are violations in the blood circulation of the vessels and the heart.

Collapse. This is a mild form of acute vascular insufficiency. The collapse occurs due to a violation of the tone of the central nervous system. The main symptoms: the patient lies motionless, indifferent to others, reluctant to answer questions, complains about severe weakness and chills. There is a sharp pallor, changing (blue tint). The skin is covered with sticky sweat. Patients also have rapid pulse and accelerated shallow breathing. Blood pressure drops, may be vomiting.

Fainting. This is a short-term form of acute vascular insufficiency. It is caused by the weakness of the nervous system to such irritants as being in a stuffy room, the sight of blood. Clinically, syncope is manifested by short-term blanching, cold skin sudden onset of nausea. The patient has a darkening in the eyes due to insufficient blood supply to the retina. Due to insufficient blood supply, the brain does not receive enough oxygen, which leads to loss of consciousness.

Shock. This is a severe reaction of the body that develops after trauma, mental shock, intoxication. shock is pathological process, in which there is a sharp, progressive decrease in all vital important functions organism. Most severe shock with acute vascular insufficiency ─ this is a traumatic shock. There is pallor of the skin, cold skin, covered with sweat, the person remains conscious. Patients complain of thirst, lack of air. The heart decreases in size, blood circulation in the body slows down. Traumatic shock occurs with severe tissue damage, which leads to a strong growing irritation of the nervous system.

Treatment of patients should be comprehensive. It should take into account the individual characteristics of the patient and the pathology of the organism as a whole.

Circulatory failure is treated with a set of measures aimed not only at the heart and blood vessels, but also at all kinds of sources of pathological irritation - elimination of foci of infection (cholelithiasis, prolapse of the kidneys, diseases of the female genital organs), which can be a source of vascular insufficiency.

The main methods of treating circulatory failure of the brain and other organs:

• The correct mode of rest and dosed loads (training).
• Widely used tonic effect on nervous system─ massage, walking, which promotes the promotion of venous blood, prevents the formation of blood clots.
• One of the effective forms complex treatment heart patients is Spa treatment: change of scenery, measured mode, elimination of many unwanted irritations, constant medical supervision. Resorts are contraindicated for patients with acute inflammatory processes (endocarditis, rheumatism).
• Carbon dioxide baths - facilitate blood circulation, dilate blood vessels and improve blood flow to the heart.
• Terrenkur ─ systematic measured walks along the paths with a dosed unsharp rise.
• Glucose is essential for the nutrition of brain cells and heart muscles.
• oxygen therapy.
• Widely used means that regulate the activity of the brain ─ bromine, caffeine, barbiturates.

Directly related to the disruption of the heart and blood vessels. As a rule, people of mature age suffer from this disease. Harbingers of the disease are signs such as systematic headaches, dizziness, fatigue, disability.

The first manifestations of the disease are noise in the head, sleep disturbance, partial memory loss. The problem is that a person tries not to notice these symptoms, which subsequently leads to serious and serious illnesses.

Circulatory failure of the brain is acute () and chronic.

People suffering from this disease, to prevent complications and severe conditions, it is necessary to strictly adhere to the daily routine, strict rules of behavior and diet:

• full night sleep (9 ─ 10 hours);
• transition to light work;
• daytime rest if possible;
• regular walks in the fresh air (calm walking);
• severe restriction of salt intake;
• observance of emotional calm (you can not be nervous and exposed to stressful situations).

Bleeding

Bleeding is divided into internal and external:

• External bleeding ─ this is nasal, uterine, hemoptysis, bleeding with inflammation hemorrhoids, bleeding resulting from a violation of the integrity of the skin during injuries (with open fracture damage to large blood vessels).
• occur in various pathologies ─ diseases of the internal organs, genetic diseases. One of these diseases that contribute to the appearance of bleeding is circulatory failure. Causes ─ thinning of the walls of blood vessels, a violation of elasticity, which can lead to rupture. With internal bleeding, blood loss leads to the destruction of the tissue structure.

The walls of blood vessels can acquire their vulnerability as a result of purulent inflammation, tissue necrosis. Vitamin deficiency and malnutrition can make the walls of blood vessels weak. Gastric juice, corroding the walls of the stomach with gastritis and ulcers, leads to stomach bleeding. Another reason internal bleeding there may be a violation of microcirculation. Such bleeding occurs with hypertension, hemorrhages in the brain with strokes.

Bleeding, as one of the forms of circulatory disorders, is capillary, small and extensive. The level of danger of bleeding depends on its location.

A serious threat to life is hemorrhage in such vital important organs like the brain or lungs. And rupture of the aorta leads to the instantaneous loss of large volumes of blood, and in the vast majority of cases to death.