In heart failure, the contractility of the heart muscle decreases, which is accompanied by the appearance of stagnation in the pulmonary or systemic circulation. There are mixed, left ventricular and right ventricular heart failure. Right ventricular failure provokes congestion in the systemic circulation, thus limiting the release of blood into the pulmonary circulation.
Right ventricular heart failure can manifest itself in acute and chronic forms. However, the symptoms may vary.
Changes in myocardial function in the chronic form of the disease long time may be covered by compensatory mechanisms. At the same time, the strength and frequency of contractions increases, and due to the expansion of the diameter of the capillaries, diastolic pressure decreases.
However, compensatory abilities are limited. Subsequently, there is a decrease in the volume of ejected blood, an increase in the accumulating blood in the ventricles, and overflow of the ventricles at the time of diastole. This leads to stretching of the heart fibers. Thus, pathological myocardial hypertrophy develops.
After compensation, the stage of decompensation begins, accompanied by the processes of degeneration and sclerosis. The heart lacks nutrition because it does not receive sufficient volume blood.
On initial stage Right ventricular failure manifests itself as follows:
- Increased contractions;
- The occurrence of edema;
- Decreased temperature in the extremities.
The swelling gradually increases and becomes more persistent. Initially, it occurs in the lower extremities of those who spend a lot of time on their feet, and in bedridden patients it is observed in the sacral area. As heart failure develops, swelling can rise higher, spreading to the thighs, abdominal wall, and lumbar region. The consequence of a long-term pathology can be ascites - the accumulation of fluid in abdominal cavity.
The disease also manifests itself as hypothermia of the extremities and swelling of the veins in the neck. Initially, varicose veins are observed only in a lying position, but as symptoms increase, this also occurs in a sitting position, as the pressure in the veins increases more and more.
When diagnosed, an enlarged liver is detected. Palpation of the liver is accompanied by pain. With rapidly developing heart failure, there may be sharp pains, localized under the ribs. They are associated with stretching of the liver capsule. As a rule, these changes do not affect the functioning of the organ. In severe forms of the pathology, liver fibrosis may develop, accompanied by thickening of the edge of the organ.
Right ventricular failure can develop against the background of mitral heart defects, pulmonary ephysema, etc.
Acute form of the disease
The acute form of the disease is accompanied by the appearance pulmonary hypertension, resulting in a decrease in the volume of blood ejected by the ventricle.
Acute right ventricular failure often occurs against the background of thromboembolism pulmonary artery. Stagnation of blood is manifested by the same symptoms:
- Pain under the ribs with right side sternum;
- Decreased blood pressure;
- Pulsating veins in the neck;
- Shortness of breath;
- Blue discoloration of the skin.
Compared to left ventricular heart failure, decompensation occurs earlier, since the compensatory mechanisms of the right ventricle are smaller. This is due to the fact that the left ventricle is the most powerful part of the heart. At the same time, with left ventricular failure, all pathological processes proceed much faster.
Emergency care for acute right ventricular failure
If signs of an attack occur, you must immediately call an ambulance. Before she arrives, the upper half of the body should be raised. It is important to ensure access to oxygen: open the windows, and also untie your tie and unbutton your collar. The person should be provided with complete rest. Venous tourniquets are applied to the lower extremities for 30 minutes.
Diagnostic methods
Heart failure is a consequence of other heart diseases, therefore, when diagnosing, attention is paid to the data available in the anamnesis, as well as to identifying existing disorders.
At the earliest stage, the development of pathology may be indicated fast fatiguability and shortness of breath.
Such patients often have a history of ischemic disease heart disease, myocardial infarction, pathologies of unknown etiology, rheumatic attacks.
TO specific signs, indicating the development of heart failure, include: swelling in the area ankle joint, ascites, listening to 3 heart sounds, as well as blurred boundaries of the heart.
An electrocardiogram can reveal hypertrophic changes, poor blood supply and arrhythmias. The state of myocardial activity is determined not only at rest, but also with load. Such examinations, which involve a gradual increase in load, make it possible to identify the reserve potential of the heart muscle.
Echocardiography allows you to determine the cause of the pathology and assess to what extent the heart performs its function of pumping blood.
Magnetic resonance imaging makes it possible to identify coronary heart disease, existing defects (both congenital and acquired) and other problems.
In severe cases, they are carried out additional research, allowing to identify disorders that affected other internal organs.
Principles of treatment
Treatment involves eliminating the following problems:
- Prevention of heart overload;
- Elimination of symptoms;
- Elimination of consequences.
Primary treatment should be aimed at eliminating the underlying cause. This could be coronary heart disease, hypertension, myocarditis, etc.
In case of thromboembolism, emergency removal of the thrombus is necessary, which is performed surgically or by dissolution.
- Eufillin and ganglion blockers are necessary to reduce pulmonary hypertension.
- The state of shock is relieved with sympathomimetics.
- Treatment of a heart attack involves restoring normal blood supply to the coronary vessels.
- Antibacterial drugs are prescribed for pneumonia.
Often the problem can be solved only with the help surgical intervention. This is relevant for heart defects and cardiac aneurysm.
Acute right ventricular failure, as well as the chronic form in severe cases, require bed rest, lack of physical activity and mental stress. In other cases, loads that will not disturb normal well-being are acceptable.
You should limit your fluid intake, as drinking too much will cause even more swelling. You should drink no more than 500-600 ml per day, and you should also avoid salt consumption. Food should be easily digestible and rich in vitamins.
Treatment chronic form may be supplemented with diuretic therapy. When symptoms join atrial fibrillation cardiac glycosides are prescribed.
Drug treatment includes the following drugs:
- Cardiac glycosides. These are drugs whose action is aimed at increasing contractility myocardium, they increase exercise tolerance.
- Vasodilators and ACE inhibitors. They allow you to reduce vascular tone, promote the dilation of arteries and veins, as a result of which vascular resistance decreases and the volume of ejected blood increases.
- Nitrates. Under their influence, the filling of the ventricles with blood improves, the arteries dilate, and the release of blood increases.
- Diuretic drugs. Stimulate the removal of fluid from the body, reducing swelling.
- Beta blockers. They lead to a decrease in the frequency of contractions, normalize blood supply to the heart muscle, and increase the volume of ejection.
- Anticoagulants. Prevents the formation of blood clots in blood vessels.
- Drugs aimed at improving metabolic processes in the myocardium.
For patients diagnosed with heart failure, it is important to change their lifestyle:
- Bring your weight back to normal. Excess body weight complicates the patient's condition, increasing the load on the heart.
- Dieting.
- Required physical exercise regulated by a doctor.
- Getting rid of bad habits.
You may also be interested in:
Nursing care for acute cardiovascular failure 
How to recognize and treat acute heart failure
Right ventricular heart failure is a condition in which there is an isolated decrease in the function of the right ventricle, resulting from damage to the heart muscle of the right side of the heart and/or due to severe bronchopulmonary pathology (the so-called).
typical development of right ventricular myocardial failure due to pulmonary causes
Mechanism of development of right ventricular dysfunction
Usually, the coordinated work of the heart chambers is ensured by their alternate contraction, while blood from all internal organs moves to the right parts of the heart and further to the lungs, and, receiving oxygen from the alveoli, is sent to the left parts.
With the development of pathogenetic processes in the arteries of the lungs, in the most lung tissue or in the myocardium of the right ventricle, blood cannot be completely expelled into the pulmonary artery, and therefore the wall of the right atrium is stretched, and the chamber itself is filled with blood. The pathogenesis in this case is due to the fact that first in small pulmonary vessels, then in large ones, and then in the pulmonary artery extending from the right atrium. In other words, the heart is trying to push blood into the pulmonary artery with high intravascular pressure, and it is failing. Therefore, venous blood stagnates in the internal organs (brain, liver, kidneys, subcutaneous fat).
The pathogenesis of right ventricular dysfunction can be depicted in the form of a diagram:
Variants of right ventricular failure
Depending on the reasons that caused this state, acute and chronic right ventricular failure are distinguished.
- Acute condition usually develops within a few hours, less often days, and is characterized by the patient’s general serious condition, requiring emergency measures.
- Chronization of the process With this type of failure, it occurs in cases where the patient has had chronic diseases of the lungs and bronchi for many years, as well as signs of previous heart disease.
If acute right ventricular failure sharply leads to hemodynamic disturbances and destabilizes the patient’s condition, then the chronic process gradually undermines the body’s strength, leading to the formation of hypertrophy of the right ventricle, then the right atrium, and then to stagnation of blood in the left parts of the heart. Severe disease develops with damage to all cardiac chambers. At the same time, the patient’s normal well-being and condition can rarely be maintained even with the help of constant medication, therefore delay treatment of right ventricular failure, including early stages absolutely not possible. Otherwise, severe heart failure coupled with a severe underlying disease will inevitably lead to the death of the patient, but the question of the time during which this will happen is individual for each individual patient.
development of right ventricular hypertrophy due to chronic pulmonary hypertension
Causes of development of acute right ventricular failure
Acute cor pulmonale never occurs just like that, by itself; this condition is always a complication of any of the diseases listed below.
1. Spicyemerging conditions or exacerbations chronic diseases bronchial tree and lung tissue, in which already existing hypoxia ( oxygen starvation), caused by respiratory failure, aggravates the condition of the right ventricle:
- An increase in severity during a prolonged attack of bronchial asthma, status asthmaticus, causes a sharp overload of the right ventricle with volume and pressure, stretching of its walls, which, together with hypoxia, causes severe hemodynamic disturbances.
- Severe progression of chronic obstructive pulmonary disease (COPD), leading to acute attack bronchial obstruction.
- Severe pneumonia, causing severe respiratory failure.
- Compression of the lung pleural cavity air or liquid (pneumo- or hydrothorax, respectively). As a result, indicators increase blood pressure in the lumen of the pulmonary arteries healthy lung, and the load on the right side of the heart increases with a decrease in its contractility.
2. Acute cardiovascular diseases:
- Sharp blockage of the lumen of the pulmonary artery by thrombotic masses (), especially massive damage to it with a sharp, sudden development of pulmonary hypertension.
- Acute (inflammation) with predominant damage to the heart muscle of the right ventricle.
- Transmural myocardial damage in acute, localized mainly in the right ventricle.
Manifestations of acute form
Appearance of signs acute condition in a patient it is measured several minutes, hours or days from the onset of the underlying disease. In addition to symptoms from the bronchopulmonary system (suffocation due to a cough with heavy sputum, dry whistling when breathing, etc.), the patient experiences a sharp and rapid increase in shortness of breath with increased frequency breathing movements up to 30-40 per minute or more, dry hacking cough with hemoptysis. With venous stagnation in the system hepatic vein There is pain in the right hypochondrium and in the abdomen, caused by increased blood supply in the hepatic vessels. The patient's skin quickly acquires a bluish color, especially in the area of the lips and nose, at the tips of the fingers and ears. Arterial pressure can decrease significantly, up to collapse and shock.
In case of heart diseases, pain syndrome is additionally noted in the projection of the heart on the right or left, elevated temperature bodies with myocarditis and other specific signs.
At pulmonary thromboembolism Along with rapid breathing, intense pain in the chest is noted, and with massive damage, bluish discoloration of the skin of the face, neck and chest, clearly along a conventional line drawn between the nipples.
Diagnostics
Despite the fact that the main clinical symptoms allow the doctor to almost immediately suspect a diagnosis; in most cases, further examination of the patient is required. In this case, diagnosis should be carried out in parallel with the patient’s admission to the hospital due to the need for emergency treatment.
Among the diagnostic methods that allow you to quickly confirm the diagnosis even at the level of the ambulance and hospital emergency department, the following are carried out:
- Electrocardiogram - allows you to determine signs of right ventricular overload ( negative teeth T in the right chest leads and/or bottom wall left ventricle), signs of complete or incomplete blockade right bundle branch, as well as thromboembolism criteria - “SIQIII syndrome” (deep S wave in lead I and deep Q wave in lead III). In addition, the cardiogram almost always reflects overload of the right atrium - P pulmonale (pulmonale) - a high, pointed P wave in all leads.
- X-ray of organs chest easily detects inflammatory processes, hydrothorax and pneumothorax, and during the formation acute failure in the right and left sections at the same time - pulmonary edema.
- Ultrasound of internal organs is informative in cases of blood stagnation in the liver, when pain under the ribs on the right may remain the only sign of impending acute right ventricular failure.
After the patient has been hospitalized in the cardiology or pulmonology department (depending on the underlying disease), and his condition has stabilized, daily monitoring Blood pressure and ECG, blood test for troponins, creatine phosphokinase and its fractions (CPK, CPK-MB for suspected acute heart attack), blood test for D-dimers (if thromboembolism is suspected), as well as a function test external respiration(FVD) for bronchial asthma or chronic obstructive bronchitis.
In every case additional examination to establish the cause is determined individually, but to confirm acute right ventricular failure as a syndromic diagnosis in most cases, a clinical examination and the first two diagnostic methods are sufficient.
Emergency care for acute right ventricular failure
Therapy of this disease will be successful only if, in addition to symptomatic treatment treatment of the underlying disease is carried out.
Before the brigade arrives emergency care the patient must be seated in a room with open window. If the patient is unconscious, you can put him in a supine position with his head raised high or place a couple of pillows under his head. If the patient is conscious and can answer what he was sick with before, he needs to take the medications that he receives constantly. For example, you should use inhalers during an attack of bronchial asthma (salbutamol, berodual, etc.).
After the team arrives, oxygen therapy begins (oxygen supply through a mask); for asthma, prednisolone and aminophylline are administered intravenously; for a heart attack, narcotic analgesics intravenously, sublingual nitroglycerin, for thromboembolism - administration of heparin and fibrinolytics (streptokinase, etc.).
In the intensive care unit, cardiology or pulmonology, treatment continues. Thus, for pneumonia, the administration of antibiotics is indicated, and for pneumo- or hydrothorax, it is often carried out pleural puncture– puncture of the skin and intercostal muscles to evacuate air or liquid. After stabilization of the patient’s condition, optimal therapy is selected in the future in order to prevent the development of severe stages chronic failure and prevention of the formation of cor pulmonale.
Etiological factors of chronic form of right ventricular failure
The pathogenesis of chronic right ventricular failure is slightly different from that of an acute condition. Thus, a long-existing chronic disease can lead to the long-term formation of cor pulmonale. obstructive disease lungs and bronchial asthma, frequent bronchitis, recurrent pneumonia, cystic fibrosis with lung damage, bronchiectasis, pulmonary sarcoidosis. On the part of the heart, the causative diseases are long-existing defects of the aortic and tricuspid valves, which are not susceptible to surgical correction, post-infarction cardiosclerosis, localized in the right ventricle, and post-myocardial.
But most common cause chronic pulmonary heart disease is the presence of systolic or diastolic, when as a result of chronic progression, blood stagnation increases in both circles of blood circulation (that is, blood stagnates in both the lungs and other internal organs). Clinically, this is assessed as the patient having complaints of both swelling and swelling in the body.
Thus, the clinic of the chronic process is characterized by edema on the legs, feet, and as it progresses - on the skin of the arms, thighs, external genitalia, face and subcutaneous fat of the abdomen.
In addition to the accumulation of fluid in the skin, an enlargement of the abdomen is determined - due to blood filling the liver and due to liquid effusion in the abdominal cavity (ascites). On severe stages failure, irreversible liver damage develops - cirrhosis, with all the ensuing symptoms, namely jaundice, weight loss, abdominal enlargement, bleeding of the skin and mucous membranes, dilated veins around the navel (“jellyfish head”), etc.
Due to high pressure in the tributaries of the superior vena cava, the patient has pulsating jugular veins on the neck, and are also characterized by decreased memory, intelligence and impaired cognitive function as a result of poor venous outflow from the brain and its oxygen starvation.
In terms of examination for chronic right ventricular dysfunction ECG, pulmonary radiography and echocardioscopy remain relevant. The latter method is more informative, because with the help of ultrasound it is determined not only structural features heart, but also the parameters of the contractile function of the right ventricle and its size are assessed. Based on this, as well as based on the results of ECHO-CS over time, the doctor will be able to determine the tentative prognosis for the patient.
In addition to the described diagnostic methods, in case of secondary damage to the kidneys and liver, ultrasound of internal organs is indicated in order to identify changes in their parenchyma, as well as assessment of their functional activity using biochemical analysis blood (study of urea, creatinine, liver tests and bilirubin levels).
Treatment of right ventricular failure
As with an acute condition, fundamental in the treatment of chronic failure is therapy of the underlying disease. Patients with bronchopulmonary pathology need to adjust therapy in such a way as to achieve as few exacerbations as possible per month or per year, and improve lung function in order to obtain a sufficient amount of oxygen to the lungs. internal organs, and above all, to the brain.
For patients with heart defects, it is advisable to undergo surgery to correct them, recognizing that fine line when surgery is already indicated, but not yet contraindicated. This optimal time is determined only by a cardiac surgeon when monitoring the patient over time.
In addition to etiological therapy, a patient with an established diagnosis of chronic cardiac right ventricular failure is indicated lifelong use of certain medications. Lifelong, because without their use decompensation quickly sets in, from which the patient can only be removed in a hospital, but deterioration in cardiac function will still remain. Of these drugs, the most optimal is to take (furosemide, veroshpiron, diuver, etc.), (verapamil, dialtiazem, amlodipine) and nitrates (nitrosorbide, monocinque). These drugs not only reduce blood flow to the right atrium, but also dilate peripheral vessels, including the blood vessels of the lungs, thereby reducing pulmonary hypertension.
Forecast
To the question of how long people with an established diagnosis of right ventricular failure live, one can answer - happily ever after, but only subject to timely delivery emergency care in case of an acute condition and pedantic implementation of all doctor’s recommendations for taking medications in case of a chronic process.
Certainly, the prognosis is largely determined by the nature of the underlying disease, its severity and duration. For example, with massive pulmonary embolism, the prognosis remains questionable, but with successful treatment further forecast favorable for life and health.
One of the most terrible diagnoses in cardiology is heart failure. The disease is chronic, so the patient must learn to live with his condition, avoiding relapses. There are left ventricular and right ventricular heart failure, but attention should be paid to damage to the right myocardium.
Given heart disease most often prevails in retirement age, but progresses against the background of existing myocardial diseases. There are no restrictions based on gender, so the characteristic form of heart failure progresses equally in female and male bodies.
If, with damage to the left part of the myocardium, blood stagnation is formed in the small circle, then with right ventricular heart failure this abnormal phenomenon predominates in the large circle of the general blood flow. As a result, irreversible changes occur in the lungs, fraught with swelling of this vital organ. The reasons for this pathological process not much, but doctors explain this by the fact that for certain reasons the overload of the right ventricle predominates.
If we study in detail the etiology of heart failure, then this form of the disease is caused by the presence of pulmonary hypertension in the affected body. Other diseases may also precede this diagnosis. cordially- vascular system represented by arterial hypertension, cardiac ischemia, atherosclerosis, myocardial infarction, stroke and vascular dystrophy. Accordingly, it is important to prevent detailed relapses, otherwise death patient.
Right ventricular chronic heart failure with obvious manifestations of dystrophy is considered the final stage of a characteristic pathological process, and prescribed resuscitation measures are not always able to stabilize the general condition. So it is important to know the symptoms of this diagnosis, otherwise the absence timely treatment may result in disability and mortality.
Symptoms
All heart diseases are characterized by relapses, which prompt alarming thoughts about the presence of problems with the functioning of the heart muscle and vascular system. Signs in such clinical pictures are clearly expressed, so it is simply impossible not to pay attention to them.
It all starts with a pressing sensation in the sternum, which increases almost every hour. A sick person besides such painful sensations experiences an acute lack of oxygen and an attack of dizziness. Vomiting is less common, fainting and instability of blood pressure predominate.
If we talk about eloquent signs of right ventricular heart failure, they are represented by swelling not only lower limbs, but also the arms, face, neck and upper chest.
Besides, skin change their color, becoming noticeably paler and becoming flabby. However, the first sign was attacks of suffocation, progressing mainly at night. Sometimes this condition can be confused with attacks of bronchial asthma, which is why right ventricular heart failure is also called “cardiac asthma.”
As for the blood pressure indicator, its value depends on the series additional signs diseases: during a hypertensive crisis it increases, and during myocardial infarction it rapidly decreases. Gradually, the progression of heart failure provokes pulmonary edema, which can be fatal.
Diagnostics
It is impossible to determine the disease on your own, but a doctor can do this after a detailed diagnosis. In this clinical picture, clinical examinations include ECG, ultrasound, MRI and chest x-ray, and laboratory research– general and biochemical blood tests, urine analysis.
Thus, an ECG demonstrates acute overload of the right side of the heart, ultrasound allows one to determine changes and neoplasms in the myocardium, and MRI is appropriate in difficult clinical situations. General analysis blood shows the number of leukocytes and, accordingly, the degree of progression inflammatory process; and biochemical - the state of hormonal levels and the presence of a potential threat to health.
When all the results of the tests and examination are in the hands of the specialist, after re-examination and examination of the patient’s complaints, it is possible to diagnose accurate diagnosis and prescribe an adequate treatment method. If there are difficulties in making a diagnosis, then X-rays and MRIs are also required.
Prevention
Of course, sometimes it is simply impossible to avoid heart disease, especially when it comes to genetic predisposition. However, once you find yourself in a risk group, it is important not to forget about preventive measures. As a rule, right ventricular heart failure progresses against the background of the underlying disease, which is why the task of prevention is to promptly prevent a relapse of a chronic pathological process and maintain a period of remission for as long as possible.
For these purposes, proper nutrition, emotional calm, an active lifestyle, cardio exercise, weight control and a regular course are required. drug therapy. In the latter case, you should not take unknown medications; in any case, it is important to first consult with your treating cardiologist.
Treatment
If we talk about intensive care, its task is to save the patient’s life and maintain his ability to work. For these purposes, drug and surgical treatment are specifically provided, and in the latter case, the testimony of a specialist is required to perform the operation.
Drug therapy should be timely and early, and be distinguished by its adequacy. That is why a patient in the relapse stage is immediately hospitalized, thereby providing round-the-clock clinical and laboratory-instrumental control.
Doctors set themselves the task of normalizing blood circulation, both in the small and large circles, while stabilizing it by normalizing the pumping function of the myocardium. In such clinical situations, beta blockers, anticoagulants, painkillers, vasodilators and restorative drugs are prescribed, but their daily dosage is determined on an individual basis.
If the disease is accompanied by complications, it is important to prevent pulmonary edema, arrhythmia, acidosis and restore tissue perfusion. It is sometimes very difficult to achieve a positive therapeutic effect, so cardiac surgeons have no choice but to perform the operation. This requires detailed diagnostics and doctor’s testimony, otherwise in the future medical error may become fatal.
Such surgical procedures are life-threatening and require high professionalism, and the rehabilitation period is very long. The consequences of a typical operation can be the most unpredictable, especially since they do not cure heart disease completely. The recovery period sometimes lasts more than one year, and it noticeably reduces overall performance.
Chronic right ventricular heart failure (CRHF) develops gradually, over several months, in chronic diseases that occur with a load on the right ventricle, and is characterized by venous stagnation in the systemic circulation. Most often, it is associated with left ventricular failure due to deep disturbances in the pulmonary circulation, increased pressure in the pulmonary artery and overload of the right side of the heart. Isolated chronic right ventricular failure can occur with chronic diseases of the respiratory system (cor pulmonale), with heart defects leading to overload of the right ventricle (tricuspid valve insufficiency, stenosis and insufficiency of the pulmonary artery valves) or the right atrium (tricuspid stenosis), with constrictive or effusion pericarditis, etc.
Question the patient.
An important sign of chronic right ventricular heart failure is edema. The main mechanism for the development of cardiac edema is an increase in hydrostatic pressure in the capillaries and a slowdown in blood flow, which causes extravasation of fluid into the tissue. Other factors also play a role in the origin of edema: disruption of the normal regulation of water-electrolyte metabolism due to activation of the aldosterone-antidiuretic hormone system, which leads to water and sodium retention; a disorder of liver function, accompanied by impaired albumin synthesis, which reduces oncotic pressure. Cardiac edema may initially be hidden. Fluid retention (sometimes up to 5 liters) does not immediately manifest itself as visible swelling, but is expressed in a rapid increase in body weight and a decrease in urine output. Visible swelling usually appears first on the feet and legs (by the end of the day), and as heart failure increases, it becomes more persistent and significant, spreading to the hips, lower back, abdominal wall. Cardiac edema tends to shift downwards, so in patients who sit or walk, the legs swell more, in those lying on their back - the sacral area, in those lying mainly on the right side - the right side.
With severe deficiency, fluid accumulates in the serous cavities. Hydrothorax (accumulation of fluid in the pleural cavity) can be right-sided or bilateral. Hydropericardium (fluid accumulation in the pericardial cavity) is rarely significant. Ascites (accumulation of fluid in the abdominal cavity) is usually observed with prolonged existence of right ventricular failure and venous stagnation in the liver.
Palpitations in right ventricular heart failure occur reflexively, due to increased pressure at the mouth of the vena cava (Bainbridge reflex).
Patients also complain of heaviness, less often of pain in the right hypochondrium (due to venous stagnation in the liver, it enlarges and stretches the Glissonian capsule), enlargement of the abdomen due to ascites.
Fatigue, decreased physical and mental performance, increased irritability, sleep disturbance, and depression are caused by low cardiac output, decreased blood supply to the brain, and dysfunction of the central nervous system.
Changes in the gastrointestinal tract (nausea, sometimes vomiting, loss of appetite, flatulence, tendency to constipation, etc.) are associated with the development of congestive gastritis, as well as impaired liver function.
Oliguria (decrease in the daily amount of urine), nocturia (predominance of nighttime diuresis over daytime) develop due to venous stagnation in the kidneys.
Carry out a general examination of the patient,
With chronic heart failure the following are observed:
Acrocyanosis, sometimes a jaundiced tint of the skin, which is associated with impaired liver function due to coronary stasis;
Edema subcutaneous tissue cardiac origin, which should be differentiated from renal edema;
Swelling of the neck veins associated with stagnation of blood in the venous system of the systemic circulation;
Cardiac cachexia (severe exhaustion), developing with severe progressive chronic heart failure in late stage; caused by dyspeptic disorders and metabolic disorders (malabsorption due to the development of congestive gastritis, impaired liver function), which lead to weight loss;
Trophic ulcers of the legs (in the late stage of severe heart failure).
Conduct a cardiovascular study.
Signs of chronic heart failure detected during examination of the cardiovascular system:
Right border offset relative stupidity hearts outward;
Expansion of the diameter of the heart due to the right component;
Weakening of the first tone at the 4th point of auscultation;
Gallop rhythm at the 4th point of auscultation;
Systolic murmur at the 4th point of auscultation, increasing with inspiration (Rivero-Corvallo symptom);
Pulse is frequent, arrhythmic, weak filling, small;
Systolic blood pressure is low, diastolic blood pressure is normal or high, pulse blood pressure is low;
Venous pressure is increased.
Perform an examination of the abdominal organs.
Signs of chronic renal failure detected during examination of the abdominal organs:
The presence of free fluid in the abdominal cavity;
The liver is enlarged, painful, the edge of its soft-elastic consistency, smooth. When pressure is applied to the liver, the neck veins swell due to increased venous pressure (Plesch's symptom). Long-term and severe right ventricular heart failure leads to the development of liver fibrosis (cardiac cirrhosis). At the same time, its edge becomes dense, sharp, and its dimensions are more constant.
An ECG records:
Tachycardia, sometimes rhythm disturbance;
Signs of right atrium hypertrophy: sharpening and increase in the amplitude of the P wave in leads I, II, aVF, V 1-2;
Signs of right ventricular hypertrophy: deviation electrical axis heart to the right, increasing the amplitude of the R wave in leads V 1-2, deepening the S wave in V 5-6 , decrease in the amplitude of the T wave and the ST interval in V 1-2;
Changes characteristic of the underlying disease.
When performing echocardiography, the following are noted:
Dilatation of the cavities of the right ventricle and right atrium;
Decreased right ventricular stroke volume;
Echocardiography of the underlying disease.
Failure of both ventricles of the heart
Failure of both ventricles is characterized by signs of stagnation in the systemic and pulmonary circulation. If weakening of the right ventricle is preceded by left ventricular failure, then with the development of congestion in the systemic circle, shortness of breath decreases. In the late stage of heart failure, anatomical and functional changes occur in various organs and tissues due to their hypoxia. There is a significant enlargement of the heart, pneumofibrosis and cardiac cirrhosis, cachexia, etc. develop. Trophic ulcers of the legs, bedsores, and infection are often observed. Pneumonia often develops and has an atypical, asymptomatic course.
Modern classification of chronic heart failure
In Russia, the classification of chronic heart failure by V.Kh. Vasilenko and N.D. Strazhesko. This classification reflects the nature of the changes, the stages of the process and the manifestations of chronic heart failure (Table 6).
Acute right ventricular failure - a pathological condition caused by a sharp decrease in the propulsive ability of the right parts of the heart, leading to a redistribution of the volume of circulating blood mainly in the systemic circulation.
The most common causes of right ventricular failure include:
1. Cardiac pathology (pulmonary artery stenosis, pulmonary valve insufficiency, tricuspid valve atresia, Ebstein’s anomaly, right atrial myxoma, pericarditis of various etiologies).
Acute respiratory failure(respiratory distress syndrome in newborns, hydrothorax, foreign body bronchi, attack of bronchial asthma).
Chronic bronchopulmonary diseases with the development of cor pulmonale (chronic pneumonia, cystic fibrosis, diffuse interstitial pulmonary fibrosis).
Thromboembolism of the pulmonary artery and its branches (PE).
The clinical picture of acute right ventricular failure is characterized by an extremely serious condition of the child. The deterioration develops suddenly and is accompanied by the appearance of suffocation, pain or a feeling of tightness behind the sternum, and severe weakness. The skin is pale, cold, cyanotic, with PE - “cast iron” cyanosis. It is important that the severity of shortness of breath and cyanosis is determined by the underlying disease, and not by the severity of right ventricular dysfunction. A typical sign of impaired blood flow to the right side of the heart and stagnation in the systemic circulation is swelling of the veins of the neck, which increases in a horizontal position.
There is a rapid enlargement of the liver, which upon palpation is sharply painful and pulsates. When pressure is applied to the liver, the swelling of the neck veins increases (Plesch's symptom). The borders of the heart are often expanded to the right, the cardiac impulse is increased, pulsation is detected in the epigastrium and the second intercostal space to the left of the sternum. The second tone on the pulmonary artery is accentuated, the pulse is frequent and superficial, and blood pressure is reduced. An R-gram of the chest shows an enlargement of the right ventricle of the heart and an expansion of the pulmonary artery. The ECG reveals signs of overload of the right heart.
Emergency treatment :
Give the patient an elevated body position in bed.
Oxygen therapy.
Administer a 2% solution of Lasix at a dose of 2-3 mg/kg intravenously.
Administer a 3% solution of prednisolone at a dose of 3-5 mg/kg intravenously.
Introduce a 2.4% solution of aminophylline at a dose of 2-4 mg/kg IV slowly into 20-40 ml of saline. solution.
At pain syndrome and severe psychomotor agitation, administer a 1% solution of promedol at a dose of 0.1 ml/year or a 20% solution of GHB at a dose of 50-100 mg/kg.
For thrombosis of the pulmonary artery and its branches, heparin is needed at a dose of 200-400 units/kg per day IV 4-6 times a day under the control of a coagulogram; fibrinolysis activators (streptokinase at a dose of 100,000-250,000 IU intravenously over an hour; dipyridamole at a dose of 5-10 mg/kg intravenously).
8. In case of arterial hypotension, administer rheopolyglucin at a dose of 5-10 ml/kg intravenously in a slow stream or drip.
3.2. Hypertensive crisis
Hypertensive crisis (HC) is a sharp rise in blood pressure above the 95th centile, accompanied by symptoms of cerebrovascular accident, pronounced autonomic reactions.
In childhood, GC occurs mainly with secondary symptomatic arterial hypertension (renal, endocrine, cardiovascular, neurogenic). Hypertensive crises in primary arterial hypertension in children with sympathoadrenal reactions are much less common.
Clinical manifestations of GC in a child are characterized by the sudden appearance of a sharp, “piercing” headache mainly in the temporo-frontal and occipital regions, dizziness, “flushes” of blood to the face, lethargy, nausea, vomiting not associated with food intake, cardialgia, blurred vision, hearing, paresthesia, hand tremor. The pulse is tense and rapid.
Emergency treatment :
Lay the patient down with the head end elevated.
Introduce a 1% solution of dibazole at a dose of 0.1-0.2 ml/year of life or a 0.01% solution of clonidine at a dose of 0.3-0.5-1.0 ml IV slowly by 10-15 ml 0, 9% NaCl solution or prescribe nifedipine at a dose of 0.25-0.5 mg/kg/day or prazosin at a dose of 0.5-2 mg/day.
Administer a 2% Lasix solution at a dose of 1-3 mg/kg IV.
For crises caused by pheochromocytoma, prescribe phentolamine initially 0.25-1.0 mg IV bolus as a test, and then at a dose of 2-5 mg IV with repeated administration of the drug every 5 minutes until blood pressure decreases or tropafen at a dose 10-30 mg IM or 5-15 mg IV, or phenoxybenzamine chloride at a dose of 10 mg/day.
