Diagnosis of anasarca in bedridden patients. Cardiac edema. Causes, symptoms, signs, diagnosis and treatment of pathology. Diuretics in chronic heart failure

So called cardiac edema are one of the syndromes that often accompanies various diseases of the cardiovascular system. It is most characteristic of pathologies in which stagnation of blood develops in the systemic circulation. The edema itself is formed due to the release of the liquid part of the blood into the intercellular space, where normally there is practically no free fluid.

Cardiac edema is a fairly common problem. This is due to the fact that according to WHO data ( World Health Organization) diseases of the cardiovascular system are perhaps the most common problem in the world. For many years they have confidently ranked first among the main causes of death. Many researchers believe that this is due to changes in lifestyle and nutrition, which are characteristic of the population of developed countries. The prevalence of cardiovascular diseases against this background remains very high. Accordingly, cardiac edema in medical practice is very common. It is impossible to obtain exact figures in this case, since the edematous syndrome itself is not a separate nosological unit ( independent disease), and no statistics are collected on it.

Cardiac edema can appear in both women and men. They occur at any age, but are more common in the elderly. The fact is that it is in old age that heart problems are mostly chronic. Well, cardiac edema appears precisely in the chronic course of the disease ( in acute, they simply do not have time to form).

Edema in diseases of the cardiovascular system has a number of differences from those in other disorders ( kidney disease, liver disorders). They appear periodically and may disappear on their own ( normalization of the heart). By themselves, cardiac edema cannot cause the death of a patient. However, their appearance indicates an unfavorable course of the disease and the need to seek medical help. In addition, prolonged neglect of the edematous syndrome can lead to a number of local disorders. These complications will require separate treatment in the future.

Anatomy and physiology of the cardiovascular system

Anatomically, the cardiovascular system consists of the following sections:

• heart;
• small circle of blood circulation;
• a large circle of blood circulation;
• blood.

Heart

From the point of view of anatomy, the following components are distinguished in the heart:

• shells of the heart. The inner lining is called the endocardium. It lines the chambers of the heart and ensures normal blood flow ( without eddies and clots) and form the heart valves. The second, thickest layer of the heart wall is formed by the myocardium. This is the heart muscle, which contracts under the action of bioelectric impulses. In his work, two main phases can be distinguished - systole ( abbreviation proper) and diastole ( relaxation). In systole, blood is expelled from the chamber of the heart, and in diastole, on the contrary, it enters. The most superficial membrane is the pericardium or cardiac sac. It is formed by two sheets, between which there is a small gap - the pericardial cavity. The sheets of the heart sac separate the heart from other organs of the chest and contribute to the sliding of the walls during contractions. For this, the pericardium normally contains a small amount of a special fluid.
• chambers of the heart. The human heart consists of 4 cavities - two atria and two ventricles. The left departments normally do not communicate with the right. Blood enters the heart from large veins - the superior and small vena cava. It enters the right atrium located in the upper right part of the body). From here, when the muscle contracts, blood is expelled into the right ventricle ( right lower quarter of the organ). With its contraction, blood is ejected into the pulmonary circulation, passing through the lungs. From the lungs through the pulmonary veins, arterial blood enters the left atrium ( at the top left of the heart). From here it travels to the left ventricle lower left quarter), which ejects it under pressure into a large circle, providing oxygen to all organs and tissues.
• conduction system of the heart. This system consists of several bundles of special fibers that conduct bioelectric impulses very well. These bundles pass through the thickness of the myocardium and are responsible for the correct propagation of impulses. Due to this, all chambers of the heart contract in the correct sequence ( first comes atrial systole, and a little later - ventricular systole). This ensures a consistent flow of blood and its normal pumping. Violations in the conduction system lead to chaotic contraction of the myocardium and circulatory disorders.
• valve apparatus. This system is represented by four valves that prevent blood flow in the opposite direction ( e.g. from ventricle to atrium). At the outlet of the right atrium is the tricuspid valve, at the outlet of the right ventricle is the pulmonary valve. In the left departments are located the mitral ( at the exit from the left atrium) and aortic ( out of the left ventricle) valves. When the valve narrows, its capacity decreases, and blood enters the next chamber of the heart worse. When the valve expands, its cusps cannot close the hole tightly, and part of the blood returns back.
• coronary vessels. The coronary vessels are called myocardial vessels that carry blood to the heart muscle. They begin at the base of the aorta ( immediately after its release from the heart) and entangle the heart with a thick net. The walls of the left ventricle are best supplied with blood, since here the muscle is the thickest, and it does the greatest amount of work.

Small circle of blood circulation

Systemic circulation

The venous network leading to the heart is formed by the following veins(arranged in order of decreasing caliber):

• inferior vena cava;
• portal vein ( collects blood from the stomach, spleen, intestines, pancreas);
• iliac veins;
• femoral veins;
• veins of the lower extremities.

Blood

The following blood components play the most important role in the development of cardiac edema:

• Blood proteins. Albumins and, to a lesser extent, globulins are very large molecules that are not normally able to pass through the wall of blood vessels or the filtration barrier in the kidneys. They keep a significant part of the liquid part of the blood inside the vessels. This phenomenon is called oncotic pressure.
• Glucose. This substance has a high osmotic activity. The liquid, as it were, is drawn into the medium where the concentration of glucose is greater.
• Sodium. It is also an osmotically active substance capable of retaining liquid.
• Hormones. Some hormones ( aldosterone, renin, angiotensin, etc.) can directly affect blood vessels. Under their action, the permeability of the vascular walls increases or decreases, the lumen of the vessels itself expands or narrows.

Causes of cardiac edema

• Establishment of heart failure. As soon as the pumping function of the blood is impaired ( for various reasons), heart ( or one of its departments) becomes unable to pump all the volume of blood that comes to it. Because of this, blood gradually begins to accumulate in large vessels going to the heart. In case of insufficiency of the left sections, the vessels of the pulmonary circulation are overfilled ( that at first does not threaten the appearance of peripheral edema). With insufficiency of the right sections, the pressure in the inferior and superior vena cava increases sequentially. Prolonged stagnation gradually spreads to all the veins of the large circle. Under the influence of gravity, blood accumulates in the lower extremities. The walls of the veins are stretched, and it becomes easier for fluid to penetrate into the intercellular space.
• Decreased cardiac output. With heart failure, not only the stagnation of venous blood occurs. It also reduces the amount of arterial blood that the heart gives to the tissues. The body, feeling a lack of oxygen, activates a number of protective systems. The release of vasopressin and activation of the sympathetic-adrenal system are of the greatest importance.
• Vasoconstriction. This reaction occurs to maintain blood pressure at a normal level. The problem is that vasoconstriction lowers the filtration rate in the kidneys. Because of this, less urine is produced and more fluid is retained in the body.
• Increased vascular permeability. Occurs under the action of biologically active substances that are released against the background of hypoxia ( lack of oxygen). These substances act on the cells in the walls of blood vessels. As a result, the permeability of blood vessels increases, and the fluid enters the intercellular space more easily.
• Increased water reabsorption. Under the action of vasopressin in the tubules of the kidneys, a significant amount of primary urine is reabsorbed. It also contributes to water retention and congestion of the veins with blood.
• Decreased oncotic pressure. This mechanism of development is activated in the later stages of chronic heart failure, when the liver is affected due to prolonged venous congestion. It ceases to synthesize blood proteins normally, which leads to a decrease in oncotic pressure. Because of this, the fluid leaves the vessels more easily.

The following pathologies can be the reasons for the development of chronic heart failure:

• rheumatic heart disease;
• congenital heart defects;
• constrictive pericarditis;
• amyloidosis.

Cardiosclerosis

Cardiomyopathy

All primary cardiomyopathies are divided into three main types:

• dilated, in which there is overstretching and thinning of the heart wall, as well as an increase in the volume of the chamber ( ventricle or atrium);
• hypertrophic, in which the wall of the heart, on the contrary, thickens, and the volume of the chambers of the heart decreases;
• restrictive, at which the elasticity of the wall is broken, and contractions are weakened.

Rheumatic heart disease

Usually rheumatic heart disease(rheumatic inflammation of the heart)goes through the following stages:

• signs of intoxication weakness, lack of appetite, headaches);
• moderate aching pain in the region of the heart;
• moderate decrease in blood pressure;
• rhythm disturbances;
• listening to pathological noises due to valve damage;
• development of heart failure.

congenital heart defects

Factors contributing to the appearance of congenital heart defects in children are:

• genetic and chromosomal diseases (including Down syndrome, Patau, Edwards, etc.);
• ionizing radiation (contact with radioactive substances during pregnancy, the passage of contraindicated medical procedures);
• exposure to chemical mutagens (alcohol, nicotine, nitrates, organic dyes, etc.);
• taking a number of medicines (thalidomide, some antibiotics);
• certain infections carried by the mother during pregnancy (measles, rubella, hepatitis B in the third trimester, severe exacerbation of herpes infection).

In all these cases, the normal development of the child is disrupted. With congenital malformations, the prognosis may be different. If there is a serious circulatory disorder, urgent surgery is required to save the child's life. However, with less significant anomalies, the disease can only make itself felt after many years. Then the patient already in adulthood may suffer from the periodic appearance of cardiac edema.

Arrhythmias

The main types of cardiac arrhythmias are:

• Tachycardia. With tachycardia, too frequent contraction of the heart muscle occurs. Because of this, the heart does not have time to fill with blood in diastole, and a smaller volume is ejected into systole. There is a stagnation of blood in the vessels that bring blood to the heart.
• Bradycardia. With bradycardia, the heart rate, on the contrary, slows down. The chambers of the heart have time to completely fill with blood and throw it out in full. But the total amount of blood pumped per minute is falling.
• Arrhythmia. An arrhythmia may have a normal heart rate but no regular pattern ( rhythm). The intervals between contractions of different lengths, due to which part of the blood during systole can be thrown back ( from the ventricles to the atria, from the atria to the great veins).

Pulmonary heart

However, in the later stages, a number of problems appear. First, the hypertrophied myocardium consumes more oxygen. Secondly, due to the thickening of the walls, the volume of the ventricle decreases. Thirdly, there are problems with the rhythm ( thickened muscle contracts longer than normal). In sum, this gives stagnation of venous blood in the right atrium and large veins. Cardiac edema appears later, when the period of circulatory decompensation begins. In this case, they will be one of the most characteristic manifestations of pathology.

Constrictive pericarditis

One of the possible outcomes of pericarditis is its constrictive form. At the same time, adhesions from the dense substance of fibrin are formed between the sheets of the pericardium. This greatly limits the mobility of the heart walls. That is, during systole, the myocardium not only struggles with internal pressure, expelling blood from the ventricles, but also stretches the dense strands of fibrin. This can cause hypertrophy of the heart muscle, rhythm disturbances, and lead to chronic heart failure. The problem is even more serious if the so-called "armored" heart appears. In this case, calcium salts are deposited between the fibrin strands. This forms a thick, strong shell that squeezes the heart from all sides.

In patients with constrictive pericarditis, edema begins to appear as adhesions form and calcium salts are deposited. The more the heart is compressed, the more severe the circulatory disorders will be. The edematous syndrome is usually very pronounced and poorly amenable to drug treatment.

Amyloidosis

Patients with amyloidosis of the heart may not have any symptoms or manifestations of the disease in the early stages. However, as the protein settles in the thickness of the myocardium, its work is disrupted. There are signs of chronic heart failure, which begins to slowly progress. Accordingly, cardiac edema also makes itself felt more and more often. The prognosis in this case will be unfavorable, since there is no specific treatment aimed at eliminating the pathological protein. Means are prescribed to improve the work of the heart, which only for a while improve its work and reduce swelling.

With any of the above diseases, the pumping function of the heart is impaired to one degree or another. Stagnation occurs in the systemic circulation ( and later in small) and heart failure. If this process is acute, edematous syndrome may not have time to develop. The fact is that it takes quite a long time to increase the pressure in the vessels and spread it to the peripheral sections. That is why cardiac edema does not develop in 1 to 2 days, as is usually the case with renal failure. If acute heart failure is not eliminated, the death of the patient will occur before the edematous syndrome manifests itself. That is why it is believed that the underlying cause of cardiac edema is precisely chronic heart failure, in which there are no rapid and pronounced disturbances in the work of the heart.

Symptoms of cardiac edema

The hallmarks of cardiac edema are:

• Localization. Cardiac edema always develops symmetrically. They usually appear first at the ankles and spread up the legs as heart failure progresses. Asymmetric swelling of the legs may be due to the presence of varicose veins. However, in this case, the edema will be present on both legs, just its size will be different. If the patient complies with bed rest, or his condition does not allow getting out of bed, cardiac edema is localized in the thighs and lower back. Here it is less noticeable, therefore, a separate study of this area is required in the diagnostic process. Symmetry can also be broken if the patient lies on his side.
• Conditions for increased edema. Swelling of the legs usually increases in the evening. This is due to the fact that during the day the patient most of the time is in a sitting or standing position. Under the influence of gravity, the bulk of the blood accumulates in the veins of the lower extremities, increasing swelling. Heart failure in this case does not allow to fully pump blood up from there. At night, due to the horizontal position of the body, the swelling of the legs decreases ( but most of the time it doesn't go away completely.). You can notice early cardiac edema in the legs simply by examining the feet in the evenings. When removing shoes that used to fit, impressions from laces, buckles or stripes from sandals remain on the skin for some time.
• Skin temperature. Since edema develops mainly due to the accumulation of venous blood, tissue hypoxia occurs. Cells suffer from oxygen starvation, and the process of oxidation of substances in them slows down. Energy is not produced and the skin temperature drops. Cold to the touch skin is one of the most important differences in edematous syndrome in heart disease. With edema of renal origin, for example, the temperature of the skin in the area of ​​edema does not differ much from body temperature, but with inflammatory edema ( e.g. erysipelas) the skin, on the contrary, is hot to the touch.
• Color of the skin. Due to the stagnation of venous blood, the edema acquires a bluish tint, and sometimes purple. Its intensity also depends on the individual characteristics of the organism ( in people with darker skin, it is more difficult to notice a change in color).
• Consistency ( density) . To the touch, cardiac edema is quite dense. The fluid leaking from the vessels, as if bursting the tissue. The skin in the edema area is stretched. If you press your finger on the edematous area and hold it for several seconds, then an impression is formed that does not disappear immediately. This is also a distinguishing feature of cardiac edema from renal edema.
• Feelings of the patient. When pressing on the edematous area, the patient does not complain of pain. He feels only the pressure itself, feels that the tissues are bursting with liquid. This is the main difference from inflammatory edema, in which pressure causes sharp pain. In general, local ( local) skin sensitivity in cardiac edema may be reduced. This is due to cell hypoxia and compression of the nerve pathways.
• Development speed. Unlike renal edema, which can develop literally overnight, cardiac edema usually develops gradually. The heart does not stop pumping blood. Edema is formed, as it were, from small portions of venous blood, which the heart did not have time to pump. In addition, it takes some time for this residual volume of blood to move under the influence of gravity into the venous network of the legs, and for the fluid to leave the vascular bed.
• Disappearance conditions. Cardiac edema is poorly amenable to local influence ( compresses, lotions, massage). They disappear quite quickly in the treatment of the underlying heart disease. Pumping function is restored and heart failure enters a compensated phase, when blood is pumped through the vessels at a normal pace. Only under this condition the edema subsides.
• Association with other symptoms. As a rule, cardiac edema is not the only manifestation of the underlying disease. Even before their appearance and as the problem grows) you can notice other symptoms of heart failure, which will be discussed later.

Associated symptoms of heart failure may include:

• weakness;
• dizziness;
• skin cyanosis;
• pain in the region of the heart;
• pain in the right hypochondrium;
• palpitations;
• fingers of Hippocrates.

Dyspnea

Actually shortness of breath is a failure of the rhythm of breathing, in which the depth and frequency of inspiration are disturbed. The patient complains of a subjective feeling of lack of air. Shortness of breath is an objective criterion for assessing the severity of heart failure. In mild forms, when there may be no edema, it occurs only during significant physical exertion. When the edema has already formed, and we are talking about decompensated heart failure, even a slight effort can provoke shortness of breath ( getting out of bed abruptly, climbing stairs at a normal pace).

Weakness

Dizziness

Skin cyanosis

Pain in the region of the heart

Pain in the right hypochondrium

Heartbeat disorders

Fingers of Hippocrates

If one of the above symptoms is found in a patient with edema, their cardiac origin can be suspected. However, further diagnostic measures are required in this case. In rare cases, situations are observed when patients with compensated heart failure develop renal or hepatic edema. Then the presence of cardiac symptoms can mislead the doctor, and the treatment of heart disease will not lead to the disappearance of the edematous syndrome.

Diagnosis of cardiac edema

In the diagnosis of cardiac edema, the following methods can be used:

• physical examination of the patient;
• anthropometric data;
• Kaufman experiment;
• measurement of central venous pressure ( CVP);
• electrocardiography ( ECG);
• echocardiography ( echocardiography);
• radiography;
• ultrasound procedure ( ultrasound);
• blood analysis;

Physical examination of the patient

Physical examination of the patient includes the following methods:

• Collection of anamnesis. The history taking includes a detailed interview with the patient. An important point is to find out exactly when the problems with the heart appeared. If in the past there are past diseases of the cardiovascular system or chronic heart failure has ever been diagnosed, it is safe to talk about the cardiac origin of edema. It is also important to find out exactly when the edema appeared, how quickly they formed, under what conditions they increase or decrease.
• visual inspection. During a visual examination, special attention is paid to the edematous area itself, its boundaries are determined. This is important so that when you re-examine the patient, you will notice an increase or decrease in the volume of fluid. Also pay attention to cyanosis of the skin, swelling of the jugular veins, the shape of the fingers and other possible symptoms of chronic heart failure.
• Palpation. This method is a study of tissues and organs by probing. Edema is palpated to determine its consistency. It is also important to determine the location of the heart impulse on the chest. This is the point at which the beat of the heart is given the most. With cardiomegaly and some other heart diseases, this point may be displaced or not even palpable at all. Abdominal palpation may help detect ascites or liver enlargement due to blood stasis. Palpation can also include the determination of the pulse. As a rule, with cardiac edema, it is not palpable on the lower extremities. At the wrist, the pulse is usually weakened, may be quickened.
• Percussion. This method is a tapping of the anterior abdominal wall and chest with fingers. The sound produced by percussion gives an idea of ​​the density of tissues. Based on this, an experienced doctor can approximately establish the boundaries of the heart, liver, and other internal organs without the help of special equipment. In the place of the edema itself, percussion is not performed.
• Auscultation. This method is listening with a stethophonendoscope. It is very important for assessing the work of the heart. In chronic heart failure, an abnormal third tone may appear. In the case of hydropericardium, heart sounds will be muffled ( due to the presence of liquid). Auscultation also helps to suspect complications such as pulmonary edema, hydrothorax.
• Pressure measurement. Blood pressure is usually measured using an ordinary sphygmomanometer. In chronic heart failure in the decompensation phase, it can be both low and high ( depending on the disease that caused the disease).

Anthropometric data

An important indicator for detecting edema is the weight of the patient. With latent edema ( especially in the lumbar region) fluid accumulation is not always visible. However, daily determination of the exact weight of the patient helps to identify the problem. Every day, due to fluid retention, the patient will gain weight by 0.25 - 1 kg ( depending on the severity of heart failure). If such dynamics is observed within 3-4 days, one should more actively look for the place of formation of latent edema.

However, anthropometric data is not an unambiguous indicator. Limb enlargement or weight gain can be caused by other problems that are not related to the formation of edema.

Kaufman experiment

A patient with edematous syndrome is asked to drink a large amount of liquid with a small interval in time ( e.g. 400 ml every hour for 3 hours). Then three consecutive maneuvers are carried out. The first 2 hours the patient is in a supine position, then he lies with his legs raised for two hours ( a pillow or roller is placed under the feet so that they are above chest level). The patient then mostly walks or stands for two hours. During breaks when changing positions ( i.e. every 2 hours) a urine sample is taken from him.

If there is edema due to heart failure, the results of the experiment will be as follows. After the first period, the amount and density of the urine sample is determined. They serve as a guide for subsequent trials. second portion ( after the patient was lying with their legs elevated) is characterized by a significantly larger volume of urine, but its density is lower. This is due to the fact that under the influence of gravity, the fluid moves closer to the kidneys. The heart does not have to pump it, as gravity helps its work. In the kidneys, a significant part of the fluid is filtered and excreted in the urine. As a result, a large amount of it and a strong dilution are obtained. After the third period ( walking and standing) swelling increases markedly. Fluid accumulates in the veins of the lower extremities, and it becomes difficult for the heart to raise it to the level of the kidneys. Because of this, the third urine sample will be the smallest volume, but the highest density.

This experiment clearly shows the dynamics of blood circulation in heart failure. It can be carried out only in the case when the edema is not so pronounced ( latent cardiac edema), and the doctor has some doubts. In decompensated heart failure and severe edema, fluid intake and a change in body position can aggravate the patient's condition, so the experiment cannot be performed.

Central venous pressure measurement

There are 2 main ways to measure CVP:

• Insertion of a catheter. A special catheter with a sensor is inserted through a large vein into the cavity of the right ventricle. It measures pressure directly at the confluence of the veins of the systemic circulation. With developing heart failure, here it increases first of all, this allows you to quickly make a diagnosis and take the necessary measures. If the patient already has edema at the time of the procedure, the pressure in the right atrium will be greatly increased. This method of measuring CVP is the most accurate, but is rarely performed. The thing is, it comes with some risk. infection, provoking a severe attack of arrhythmia), since the introduction of a catheter into the heart is a small operation with a dissection of a large vessel.
• Measurement with a Waldman phlebotonometer. This method is less accurate, but safer. It requires a central catheter ( usually in the subclavian vein), which is present in almost all seriously ill patients in the hospital. A phlebotonometer is connected to the catheter - a special tube with liquid. The pressure in the vein is equalized with the pressure of the fluid in the tube according to the law of communicating vessels. In this case, the phlebotonometer tube should be located at the level of the patient's pectoralis major muscle ( then the readings will be most accurate).

Electrocardiography

With the help of electrocardiography, the following indicators can be assessed:

• heart rate;
• the sequence of contraction of various parts of the heart;
• participation in the reduction of various parts of the myocardium;
• approximate position of the heart in the chest cavity;
• direction of impulse propagation;
• signs of coronary heart disease.

echocardiography

EchoCG provides the following information:

• wall thickness of the chambers of the heart important for the diagnosis of ventricular hypertrophy);
• determining the size of the chambers of the heart;
• determination of blood flow velocity in the heart and large vessels;
• evaluation of heart valves.

ECG and EchoCG are completely safe and painless studies that can be repeated. The average duration of the procedure is 5 - 15 minutes. At the same time, the information obtained with their help often helps to make a final diagnosis. All this makes these methods the most common in the diagnosis of cardiovascular diseases.

Radiography

Even in the absence of these pathologies, radiography with edematous syndrome can show stagnation of blood in the pulmonary circulation or an increase in some organs. With a number of cardiac diseases ( ventricular hypertrophy, dilated cardiomyopathy) the heart shadow will be enlarged on a chest x-ray. Also, the contours of the heart can be changed ( in the form of a drop). A specific symptom - cardiomegaly - is recorded if the transverse size of the heart exceeds the norm ( more than 15.5 cm in men and more than 14.5 cm in women).

Ultrasound procedure

With the help of ultrasound, the following information can be obtained, which is important for the treatment of cardiac edema:

• location and size of internal organs;
• vessel sizes ( with stagnation of blood in a large circle, the portal vein expands);
• organ density ( liver thickening may occur in later stages);
• kidney test ( kidney stones or other signs of diseases of the excretory system can exclude a cardiac origin of edema and help to make the correct diagnosis);
• measurement of blood flow velocity in vessels ( done in Doppler mode and directly indicates circulatory failure).

Currently, ultrasound is prescribed for most patients with edematous syndrome and other signs of heart failure. The examination takes an average of 10-15 minutes and is absolutely painless. The procedure is carried out as in a hospital setting ( hospitalized patients), and in polyclinics ( with a single visit).

Blood analysis

In a blood test in a patient with cardiac edema, there may be the following changes:

• Anemia(low levels of hemoglobin and red blood cells). The appearance of anemia is associated with stagnation of blood in the vessels of the digestive tract. Poor cell nutrition leads to a deterioration in the absorption of substances such as vitamin B12, folic acid, and iron.
• An increase in hematocrit. Hematocrit is the ratio of the total volume of blood cells to the liquid part of the blood. It is expressed as a percentage. Since during edema a significant part of the fluid accumulates in the intercellular space and body cavities, the hematocrit will be increased. Blood cells are too large to leak through capillary walls so easily.
• Increased liver enzymes(alanine aminotransferase - ALT, aspartate aminotransferase - AST). An increase in the concentration of these enzymes is associated with the destruction of liver cells. It occurs against the background of prolonged stagnation of blood in the inferior vena cava and portal vein.
• Reduced protein content (albumin). It can be observed in violation of the liver. It is she who synthesizes this protein and maintains its normal content in the blood. A decrease in total blood protein lowers oncotic pressure. Because of this, fluid leaves the blood vessels more easily and swelling increases.
• Elevated levels of creatinine and urea. These substances are normally excreted in the urine. Their accumulation suggests that renal filtration also suffers due to circulatory disorders. This also contributes to the further development of edema.
• Ionogram changes. Normally, the blood contains a certain amount of free ions. Some of them ( mostly sodium) are osmotically active substances. A decrease in their concentration leads to the release of fluid from the vascular bed.

Analysis of urine

In addition to the above methods of examination, there are general criteria for chronic heart failure. If these criteria are found in a patient with edematous syndrome, then the causes of edema really lie in the heart, which simply does not have time to pump blood. To confirm the diagnosis, it is necessary to detect one major and two minor criteria in the patient. Detection of some of them is only possible using the diagnostic methods listed above.

Criteria for the diagnosis of chronic heart failure

Treatment of cardiac edema

The reasons for the further increase in edema and the appearance of complications may be:

• lack of adequate treatment;
• alcohol consumption;
• non-compliance with the prescribed diet;
• concomitant disorders of the kidneys;
• taking medications without consulting your doctor;
• concomitant endocrinological diseases.

The main methods of dealing with cardiac edema are:

• drug treatment;
• surgery;
• diet and diet;
• treatment with folk remedies.

Medical treatment

In general, drug treatment is the main way to deal with edema. It is shown to all patients with this problem. Three groups of drugs are considered key - angiotensin-converting enzyme inhibitors ( ACE), diuretics and cardiac glycosides. Each of these groups includes a number of drugs with a similar mechanism of action.

ACE inhibitors inhibit the enzyme that converts angiotensin I to the active hormone angiotensin II. Due to this, blood pressure decreases, kidney function and blood composition normalize. In combination, this improves heart function and restores blood circulation. The drugs of this group are actively used in all forms of chronic heart failure.

ACE inhibitors in chronic heart failure

Angiotensin antagonistsII in chronic heart failure

Diuretic drugs are another component of treatment that is necessary for all patients with edematous syndrome. Diuretics act on the filtration apparatus of the kidneys, increasing the excretion of fluid from the body. At the same time, some drugs also have the ability to change the water-electrolyte balance in the blood, retaining certain substances or, conversely, excreting them in the urine. As a rule, diuretics are selected individually for each patient. There is a wide choice of these drugs, and their dosages can also vary greatly. The correct appointment can only be made by the attending physician after a full examination of the patient.

Begin the course of treatment with the weakest of the effective drugs. This allows you to leave a kind of reserve for the future ( if the patient begins to develop edema again). It is also recommended to give minimal doses at first to avoid a kind of dependence on diuretics ( not to be confused with drug addiction, since here we are only talking about a possible violation of the filtration function of the kidneys). Diuretics can be successfully combined with ACE inhibitors, which allows you to lower the dose of the drug. Treatment is carried out with constant control of diuresis ( measure the amount of urine produced and fluid intake) and body weight ( weighing 1 - 2 times a day).

Diuretics in chronic heart failure

Cardiac glycosides are the third of the main components of drug therapy. These drugs improve the functioning of the heart by increasing its contractions without significantly increasing the need for oxygen. They also have an antiarrhythmic effect, normalizing the heart rate. The most common drug in this group is digoxin. It is prescribed for chronic heart failure of 3-4 degrees at a dose of 125-500 mcg 1 time per day.

Such a three-component drug treatment scheme allows you to quickly and effectively remove even severe cardiac edema. Further treatment requires the fight against the underlying disease ( which caused congestive heart failure) and preventive measures, which will be described below.

Sometimes, with the development of cardiac edema, drugs are also prescribed to strengthen the vascular wall ( angioprotectors). They do not affect chronic heart failure and cannot improve heart function. The meaning of their purpose is to strengthen the vascular walls and normalize the cellular composition of the blood ( less). As a result, less fluid can seep into the intercellular space, and the formation of edema will slow down. For these purposes, ascorutin, etamsylate, troxevasin, calcium dobesilate can be prescribed. The choice of drug and dose in this case remains with the attending physician. The main criterion is the general condition of the patient and the results of blood tests. Some drugs ( especially their high doses) may be contraindicated due to the risk of blood clots.

Surgery

It should be understood that surgical treatment is always associated with certain risks. In this case, it is aimed specifically at eliminating heart failure. In the presence of only edematous syndrome ( without severe shortness of breath or other serious symptoms) do not use these methods. Indications for surgical intervention may be some complications. For example, with ascites, a puncture is performed to remove fluid from the abdominal cavity, and with trophic ulcers, surgical debridement may be required.

Diet and Diet

The diet for cardiac edema should consist of the following components:

• Optimal energy value and balanced diet. On average, the daily energy value of the diet should be from 2200 to 2500 kcal. The amount of proteins and carbohydrates is recommended to be kept within physiological norms - 90 g and 350 - 400 g, respectively. Animal proteins should account for about half of the total amount of protein in the daily diet. The amount of fat ( lipids) must be reduced to 70 - 80 g per day ( to prevent atherosclerosis and improve blood properties). Also, foods rich in vitamins and minerals must be included in the diet.
• Fractional diet. The entire daily diet must be divided into 5-6 equal small parts ( last serving should be scheduled 3 to 4 hours before bedtime). This separation creates optimal conditions for the digestion of food in the gastrointestinal tract and for the rapid absorption of nutrients.
• Limiting fluid intake. Excess fluid entering the body can create additional stress on the heart and increase swelling. An acceptable daily volume can be considered 1 - 1.2 liters of water ( including borscht, soups, milk porridges and other liquids). In severe cases, the doctor may recommend a more severe restriction.
• Restriction of salt intake. Salt is also recommended to be reduced to a minimum ( 5 - 7 grams per day) consumption or in general, if possible, remove it from the diet. It directly contributes to fluid retention in body tissues. An additional load on the heart is created, and more fluid accumulates in the tissues ( swelling is growing). In severe cases, salt intake is reduced to 1 - 1.5 g, including the amount that is added during cooking.
• Good mechanical and thermal processing of food. All food items ( especially meat) must be finely chopped and then steamed, boiled or baked at the optimum temperature ( depending on the specific dish.). You should avoid frying, smoking, cooking on a fire.

Indicative list of products in the diet of patients with cardiac edema

Treatment with folk remedies

With the appearance of cardiac edema, the following folk methods can be used:

• Elder root infusion. To prepare the infusion, 150 g of finely chopped elderberry root is poured over two glasses of vodka ( only 300 – 350 ml). Infusion lasts at least a week ( preferably 10 days). After that, the infusion is filtered and taken drip before meals. Depending on the intensity of the edematous syndrome, the dose varies from 10 to 20 drops at a time. The remedy is taken three times a day for several weeks.
• Parsley decoction. The product is prepared in milk at the rate of 700 - 800 g of greens per liter. The gradual heating of the pan leads to the evaporation of milk. When approximately half of the original volume remains in the saucepan ( 0.5 l) is removed from the fire. After that, the broth is filtered and taken 1-2 tablespoons at least 10 times a day ( every hour). The tool has a good diuretic effect and quickly removes excess fluid from the body.
• Tincture of calendula. It is purchased in pharmacies in finished form. A dose of 20 - 30 drops three times a day improves cardiac activity and contributes to the gradual removal of edema. The effect becomes noticeable at 2-3 weeks of treatment, but persists for a long time.
• Flax seed. To prepare a decoction, you need 4 tablespoons of seeds per 1 liter of water. The pot is put on a small fire and covered with a lid. After the water boils, you need to wait another 5 minutes. After that, the pan is removed from the heat and wrapped in a towel or blanket. Its gradual cooling and infusion lasts 3-4 hours. After that, the broth is filtered and drunk 0.5 cups 3-6 times a day. The effect is noticeable only a week after the start of treatment.

Consequences of edema

Possible problems when starting cardiac edema can be:

• anasarka;
• trophic ulcers;
• lymphedema;
• ascites;
• pulmonary edema;
• hydrothorax;
• hydropericardium.

Anasarca

With anasarca, edema is located not only in the area of ​​\u200b\u200bthe feet or on the lower back. They also cover the thighs, genitals, arms, face and neck. There is no immediate threat to life. Serious disturbances in the work of organs are observed only with the further development of the pathological process. Timely hospitalization of the patient allows to eliminate anasarca. However, its appearance in itself indicates an unfavorable prognosis for the patient ( there are serious circulatory disorders).

Trophic ulcers

The appearance of trophic ulcers in cardiac edema is caused by the following reasons:

• prolonged tissue hypoxia;
• stagnation of venous blood;
• clamping of the arteries by the accumulation of fluid;
• violation of innervation.

Lymphedema

Ascites

With prolonged decompensated heart failure, so much fluid accumulates in the abdominal cavity that it becomes noticeable to the naked eye. As a rule, at this stage, the disease is already aggravated by disorders in the functioning of the liver and kidneys. On palpation of the abdominal cavity, one can clearly feel the fluctuation ( fluctuations) liquids.

Ascites is dangerous by squeezing the internal organs, an increased risk of developing peritonitis, the formation of adhesions between intestinal loops. A temporary measure to remove fluid from the abdominal cavity is a puncture. A full-fledged treatment should include the normalization of blood circulation, the restoration of the liver, and the maintenance of a normal blood composition.

Pulmonary edema

hydrothorax

Hydrothorax can cause severe breathing problems. The severity of the condition depends on the amount of accumulated fluid. The larger it is, the more the lungs are compressed. They can not fully deal with the breath, and the body ceases to receive enough oxygen. Against the background of circulatory disorders ( which actually led to hydrothorax) creates a direct danger to life. An effective method of treatment is the puncture of the pleural cavity and the removal of fluid from it.

Hydropericardium

Hydropericardium can be recognized by muffled heart sounds during auscultation and heart enlargement ( percussion or x-ray). Echocardiography helps to accurately determine the volume of accumulated fluid. If there is a threat to the life of the patient and drug treatment ( diuretics) does not help, then a pericardial puncture is done. The accumulated liquid is removed using a special syringe.

The lack of timely treatment of most heart diseases contributes to the development of heart failure, against which blood pressure decreases. The heart cycle slows down and pumping a sufficient amount of blood is disturbed. A change in the work of the heart contributes to the supply of an insufficient amount of oxygen to the internal organs of the human body. The amount of blood ejected by the heart into the vessels decreases, blood pressure decreases. This process can lead to death.

What is the meaning of heart failure?

Heart failure is a disease of the human body due to a lack of blood in its circulation. The heart contracts slightly and blood enters the arteries in an amount insufficient for proper circulation. In this process, the heart chambers begin to stretch to increase blood circulation. Stretching the chambers briefly maintains normal heart pressure, but increasing the load on the organ greatly weakens its muscle.

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Forms of the disease

A decrease in heart rate causes a decrease in the amount of blood in the blood vessels.

In the event of a sharp malfunction in the work of the heart and a sudden decrease in its ability to contract, an acute form of heart failure develops. With a decrease in blood in the vessels, water and sodium are retained in the body, and stagnation of these substances begins to develop. The weakening of the functions of the left or right atrium and ventricle causes the development of acute right ventricular or left ventricular failure. With hypertension, the symptoms of the disease develop little by little, over time, the disease develops into a chronic form (CHF).

CNS develops in 0.5 - 2% of the population, and in the elderly, the disease spreads in 10%.

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CHF stages

1. The initial is characterized by tachycardia, shortness of breath and instant fatigue during exercise.
2. Expressed is determined by the appearance of stagnation in both circles of blood circulation. A person's ability to work is reduced or completely stopped.
3. Dystrophic or final is characterized by a complete violation of blood circulation and irreversible changes in metabolism and the functionality of internal organs.

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Causes of the disease

The occurrence of the disease is preceded by such factors:

• hypertensive crises;
• kidney disease;
• anemia;
• transferred infectious diseases;
• uncontrolled medication;
• mental overstrain of the body.

Reasons for the development of the disease:

• transferred heart attack;
• insufficient supply of oxygen to the heart muscle through the coronary arteries;
• pathology of the heart muscle;
• high pressure;
• lack of insulin.

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Symptoms of the disease

Shortness of breath is one of the common signs of heart disease.

The disease is accompanied by the appearance of characteristic symptoms, but may be asymptomatic. Severe forms of the disease can be characterized by asymptomatic development, and the presence of several severe signs of the disease is caused by scanty disturbances in the functioning of the heart. Typical symptoms are listed in the table.

Form of heart failure

What's happening

Symptoms

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What happens to blood pressure in heart failure?

There are two indicators of blood pressure in large arteries:

• systolic (upper) - blood pressure at the time of maximum contraction of the heart;
• diastolic (lower) - at the moment of maximum relaxation of the heart.

A severe drop in diastolic pressure can be fatal.

With heart failure, there is a strong decrease in diastolic pressure, and systolic practically does not decrease. The heart rate decreases, there is a small pulse pressure. The disease is characterized by a decrease in pressure in the arteries simultaneously with an increase in venous pressure. With a disease, blood pressure lowers its performance by 25–30 mm Hg. Art. compared to normal. In severe cases, the disease occurs against the background of high blood pressure.

The beautiful Greek word anasarca hides a serious complication of severe heart or kidney disease.

Edema warns of the development of many diseases. But anasarca is not a warning, but a complication of these diseases. Anasarca is a large-scale swelling of the subcutaneous tissue and soft tissues, which initially covers the lower body - legs, lower back, torso.

Insufficient treatment leads to a rapid deterioration of the condition, the fluid is retained not only in the subcutaneous layers of the entire body, but also in the internal organs. In this case, there may come a moment of resistance of the formed edema to diuretic therapy.

Why does

Like all edema, the development of anasarca begins with violations of the transcapillary fluid exchange between the blood and tissues. Reasons for the accumulation of interstitial fluid:

• increase in hydrostatic pressure, squeezing fluid out of the vessels;
• decrease in the concentration of protein molecules in the blood;
• congestion in the blood vessels;
• a decrease in plasma oncotic pressure, which normally opposes hydrostatic pressure;
• an increase in the concentration of electrolytes in the blood - primarily sodium ions;
• change in endocrine regulation;
• increased permeability of the vascular walls.

Usually, these factors do not appear alone, but one change leads to another. It does not matter what causes the edema: stagnation of blood circulation, changes in the composition of the blood, or disruption of the kidneys. A complication such as anasarca can cause almost every disease, the symptoms of which include edematous phenomena.

Common diseases leading to anasarca.

Heart disease

• heart attack;
• cardiomyopathy;
• decompensated heart failure;
• congenital pathologies of the heart;
• ischemic disease;
• hypertonic disease;

Diseases of the excretory system

• glomerulonephritis;
• pyelonephritis;
• urolithiasis disease;
• kidney tumors;
• amyloidosis of the kidneys;

Diseases of the endocrine system

• prolonged hypothyroidism;
• hyperaldosteronism.

Anasarca symptoms

The symptoms that anasarca manifests itself and the intensity of its progression are directly affected by the underlying pathology. Mandatory features are:

• dyspnea.

For diseases of the cardiovascular system, the slow development of edema of the distal lower extremities in the evenings is characteristic. This is where the hydrostatic pressure is highest due to the distance from the heart. In case of severe heart failure, massive edema covers not only the legs, but also the lower back, genitals, anterior abdomen, and chest. In bedridden patients, under the influence of gravity, swelling is more pronounced in the region of the sacrum and back, or the side on which the patient lies. When symptomatic treatment is insufficient, anasarca is accompanied by fluid accumulation in the abdominal cavity (ascites) and pulmonary edema (hydrothorax).

With pathologies of the kidneys or urinary system, normal filtration in the fluid is disturbed, it is retained in the body. Due to the increase in the volume of circulating blood, there is a lack of protein molecules in the plasma, oncotic pressure decreases, which leads to swelling of the subcutaneous tissue. The onset of diseases is reported by such symptoms as bags under the eyes in the first hours after waking up, puffiness of the face, and swelling of the hands. But with the progression of nephrotic syndrome against the background of mineral metabolism disorders, the risk of anasarca increases. At the same time, it develops rapidly, and only systemic hemodialysis can alleviate the patient's condition.

As anasarca develops, patients begin to experience shortness of breath. It occurs as a result of the accumulation of fluid in the lower sections of the pleural cavities. The reasons for this may be different: congestion in the vessels of the lungs with cardiac pathologies, a pronounced nephrotic syndrome. Bilateral hydrothorax causes compression of the mediastinal organs, aggravating the patient's condition with respiratory disorders, and developing hypoxia maintains swelling.

Hormonal changes in the body activate mechanisms that disrupt the amount of albumin. In hypothyroidism, a lack of albumin leads to the leaching of protein in the urine and the development of edema due to a decrease in oncotic pressure. With an excess of albumin produced by the adrenal cortex, anasarca is caused by a malfunction of electrolyte processes - an abundance of sodium ions retain water in the human body.

Anasarca treatment

Edema at an early stage can be easily corrected by special diets that reduce the intake of sodium in the body and provide sufficient amounts of potassium and protein. But anasarca warns that the state of the body is approaching critical. The danger is not so much external swelling as fluid retention in the internal cavities and subsequent squeezing of the internal organs.

The main symptomatic treatment of complications involves taking diuretics, regardless of what disease caused the edema. But you can not abuse diuretic drugs and take them without consulting a doctor. A large load on the kidneys, as well as protein loss along with urine, can worsen the condition. Torasemide and furosemide, ideally acting in critical situations, with prolonged use significantly reduce the level of potassium. Potassium-sparing diuretics and aldosterone antagonists (veroshpiron, amiloride) do not have such a strong effect on the kidney nephrons, but have their own contraindications. In case of resistance to diuretic drugs, surgery is possible to remove fluid from the internal cavities of the body.

Otherwise, anasarca therapy involves an active fight against the underlying disease. The more accurately the diagnosis is made, the safer and more reliable the treatment will be. But the selection of drugs is always carried out individually. Means that help eliminate large-scale edema in some diseases can be dangerous in others. Therefore, self-diagnosis and self-treatment of this complication are unacceptable.

There are many diseases that lead to an imbalance in the fluid balance in the human body, and subsequently cause edema or multiple swelling throughout the body. However, anasarca is not the cause of swelling, but a consequence of this problem. This term rather has a conditional meaning of the diagnosis and implies an extremely serious condition of the patient, when he already needs urgent medical treatment. Despite this, anasarca has its own signs, and all therapeutic procedures are often aimed at eliminating the primary source.

Anasarca, what is it

To begin with, you need to better understand this condition. Most people know that by their very nature, edema is an excessive accumulation of fluid in problem areas of the body, as the body tries to report various disorders within itself. However, such a diagnosis as anasarca is directly a complication against the background of the lack of timely treatment of the primary source of the problem. It is worth remembering that the liquid tends to linger not only in the subcutaneous layers (which is expressed by the usual, recognizable swelling on the outside), but also in the internal organs. This already leads to serious consequences (pericarditis, ascites, pleurisy).

Many are interested in what anasarca is and why this term was coined at all. Initially, this is done so that the patient and other doctors know about the critical condition of the patient. This disease progresses quite quickly, so there is no need to delay the start of treatment and ignore the appeal to a medical institution.

In our century, edema has become a common problem and modern medicine can cope with most of these cases, especially if the victim asked for help in a timely manner.

Anasarca symptoms

Without knowing the exact cause of swelling, treatment should not be taken. However, there are common symptoms for all cases that are present in this disease:

• Actually, edema, which is often localized in the lower part of the body (feet, legs, stomach). To see the difference between such a swelling and, for example, adipose tissue is quite simple. Press on the problem area, if a hole has formed - this is exactly the swelling. The deeper and longer it levels out, the worse the situation;
• Dyspnea. It appears in the last stages. This is due to the fact that in the pleural region (the space between the pleurae in the lungs) fluid begins to accumulate, and this leads to oxygen deficiency;
• The heartbeat is disturbed (since the organ itself increases in size). Some pain is possible.

Since anasarca is an accumulation of fluid in not only subcutaneous areas, ultrasound is often performed in its diagnosis, on which it is possible to observe whether the internal organs have been affected.

More detailed symptoms and treatment in general depends only on what caused the swelling in the patient.

The reasons

Alas, it is impossible to consider all the options due to which this or that disease has arisen, anasarca can appear for a variety of reasons. However, among this multitude, there are several main sources of such a problem.

kidney failure

There is dysfunction of the urinary system. The normal filtration of the fluid is disrupted, so it is not excreted from the body, but rather remains in it. The volume of circulating blood increases, which leads to a decrease in oncotic pressure. In this case, anasarca has specific symptoms, which include:

• Bags under the eyes in the morning (several hours after getting up);
• General swelling of the face;
• Pain in the lumbar region;
• Swelling of the upper and lower extremities;

An additional inconvenience is that with nephrotic syndrome, the development of the disease will accelerate, and if we talk about the later stages, only systemic hemodialysis can help the patient (temporarily shifting the duties of the kidneys to a special drug).

Diseases of the cardiovascular system

It is anasarca with heart failure that becomes the diagnosis in a greater degree of cases when a person has extensive edema. With violations in the work of the cardiovascular system, the development of the disease begins with the lower extremities, and then this disease evolves throughout the body.

The more complex the case, the higher the overall level of swelling rises. Often it affects the genitals, lower back, part of the chest. It is with insufficient treatment of this disease that complications appear in the form of ascites (accumulation of excess fluid in the abdominal cavity) and hydrothorax (swelling of the lungs).

Other possible causes of anasarca

Naturally, these are not the only reasons for the occurrence of such a painful condition as anasarca, the following problems may be to blame:

• Allergy. This is also one of the most common causes of anasarca, often it has a huge rate of development and turns into Quincke's edema. This is a dangerous disease, because such internal organs as the lungs, throat begin to swell;
• Hypothyroidism. This is a lack of protein in plasma, its critical form is called myxedema. Because of this, fluid begins to seep into the tissues;
• Changes in hormone levels. Quite often, sodium ions accumulate against the background of this condition. They, in turn, have such a function as fluid retention;
• Blood clots.

In addition to the fact that all people who suffer from heart and kidney problems fall into the risk group, a number of such factors can complicate the situation:

• Physical injury (vascular damage);
• Disturbed metabolism;
• High blood pressure due to stress, loads, etc.;
• Blood stasis. Sedentary lifestyle.

Treatment

Most often, any severe form of swelling is easier to prevent than to take more serious measures later. This is done with diets that exclude excess fluid and sodium, and potassium and protein, on the contrary, become a priority.

However, if anasarca is diagnosed, the stage of preventive measures must be skipped, since it is already ineffective, a new regimen and a different course of treatment are required.

The main help in this case is the intake of diuretic drugs. Often used:

• Torasemide;
• Furosemide;
• Lasix;
• Triphas.

Important! Although the use of these medicines is mandatory for any underlying causes of anasarca, only a doctor can prescribe them. This is a big load on the kidneys, you should not injure them unnecessarily. Especially if this was the cause of the edema.

When problems are caused by heart ailments, this particular system is strengthened with the help of such drugs:

• Digoxin;
• Korglikon;
• Strofantin;
• Metamax;
• Mildronate.

In cases of allergies, use:

• Dexamethasone;
• Tavegil;
• Suprastin;
• Methylprednisolone.

With reduced oncotic pressure, it is increased by infusions of plasma and albumin. After that, therapy with L-thyroxine is prescribed.

It is worth remembering, despite the fact that some of these drugs can be bought without a prescription, they have a considerable number of contraindications, side effects and subtleties of use. Do not prescribe them to yourself without consulting a doctor.

Many are stunned by such an unknown term as anasarca. But it is worth remembering that modern medicine has developed a treatment for almost any ailment that can cause swelling of the body. The same complication develops quite quickly, so you should not ignore a timely visit to the doctor, as you are putting your health at risk.

Anasarca is the most severe degree of edematous syndrome and is accompanied by fluid retention in the tissues and internal organs of the human body:

• lower extremities (from foot to thigh);
• external genitalia;
• torso;
• upper limbs (shoulder to fingertips);
• neck and face;
• pleural cavity and lungs;
• abdomen;
• heart sac (pericardium).

The usual swelling of tissues does not pose a threat to the life of the patient, while anasarca is the accumulation of excess fluid in all cavities of the body and tissues, which leads to compression of the internal organs and disruption of their main function. A particular threat to the life of a sick person is edema of the pleural cavity and lungs, as it leads to insufficient gas exchange, increasing hypoxia and inhibition of the functioning of the brain with the nervous system.

Important! Anasarca is a consequence of decompensated pathologies and conditions of the body. The accumulation of fluid in organs and tissues is a protective reaction of the body, which works to unload the heart muscle and indicates a danger to human health and life.

The main reasons for the development of severe edematous syndrome of all organs and tissues of the human body are:

• congestion in the vascular bed;
• increased hydrostatic pressure of blood on the walls of blood vessels;
• increased vascular permeability and vascular fragility;
• decrease in osmotic pressure of blood plasma;
• retention of sodium ions in tissues.

Such conditions occur with various diseases of the internal organs in the stage of decompensation, namely:

1. cardiomyopathy, cardiac arrhythmias with symptoms of severe heart failure.
2. Diseases of the kidneys and organs of the urinary system, which are accompanied by renal failure, impaired excretion and outflow of urine - usually such conditions are observed with glomerulonephritis, severe pyelonephritis, and amyloidosis of the kidneys.
3. Hypothyroidism and other diseases of the endocrine system - with myxidema (a critical form of the course of hypothyroidism), the level of protein in the plasma rapidly decreases, which leads to fluid loss due to its seepage into the tissues of the internal organs.
4. Diseases of the adrenal cortex - all of them lead to a violation of the production of aldosterone and cause disturbances in the water and electrolyte balance of the blood. This leads to the retention of sodium salts and an increase in their concentration in the intercellular space, which entails an increase in osmotic pressure relative to blood plasma.
5. Quincke's edema and anaphylactic shock are severe manifestations of allergic reactions that can provoke a total swelling of tissues and body cavities. Especially often with a severe allergic reaction, swelling of the respiratory tract is observed, which can threaten the life of the patient.

Clinical manifestations of anasarca

The clinical symptoms of anasarca can develop slowly or rapidly progressively, depending on the underlying cause of the pathology.

The table shows the main symptoms that are characteristic of total edematous syndrome:

Anasarca treatment

Treatment of complicated edematous syndrome is necessarily complex and includes:

1. Dehydration therapy- Diuretics (Furosemide, Lasix) are administered intravenously in high doses to the patient in order to remove excess fluid from the body as soon as possible. This type of treatment is prescribed to absolutely all patients, regardless of the cause of anasarca.
2. Antihistamines- are prescribed for edematous syndrome of allergic origin. To achieve the fastest effect, antihistamines are injected directly into the bloodstream.
3. hormone therapy- prescribe drugs Dexamethasone, Prednisolone. Hormonal preparations are used as stabilizers of the permeability of the membrane wall of blood vessels.
4. Cardioprotectors- with anasarca, drugs that improve myocardial contractility are prescribed. These are cardiac glycosides (Korglikon) and metabolic drugs (ATP, Mildronate).
5. Carrying out hemodialysis- a mandatory measure for anasarca, which develops against the background of renal failure or severe kidney disease.
6. Injection intravenous drip of plasma and albumin to increase the plasma pressure.

What can not be done with anasarca?

Heart failure with congestion and the stage of decompensation is the most common and common cause of anasarca, so people with chronic heart disease should be registered with a cardiologist and regularly visit a doctor to monitor their condition.