Wheezing in the lungs with heart failure treatment. Heart failure. Congestive changes in the internal organs

Heart failure- a condition in which the cardiovascular system is not able to provide sufficient blood circulation. Violations develop due to the fact that the heart does not contract strongly enough and pushes less blood into the arteries than is necessary to meet the needs of the body.

Signs of heart failure: increased fatigue, intolerance to physical activity, shortness of breath, edema. People live with this disease for decades, but without proper treatment, heart failure can lead to life-threatening consequences: pulmonary edema and cardiogenic shock.

Reasons for the development of heart failure associated with prolonged overload of the heart and cardiovascular diseases: coronary heart disease, hypertension, heart disease.

Prevalence. Heart failure is one of the most common pathologies. In this regard, it competes with the most common infectious diseases. Of the entire population, 2-3% suffer from chronic heart failure, and among people over 65 years old, this figure reaches 6-10%. The cost of treating heart failure is twice the amount of money spent on treating all forms of cancer.

Anatomy of the heart

A heart- This is a hollow four-chamber organ, which consists of 2 atria and 2 ventricles. The atria (upper parts of the heart) are separated from the ventricles by septa with valves (bicuspid and tricuspid) that let blood into the ventricles and close to prevent backflow.

The right half is tightly separated from the left, so venous and arterial blood do not mix.

Functions of the heart:

Contractility. The heart muscle contracts, the cavities decrease in volume, pushing blood into the arteries. The heart pumps blood around the body, acting as a pump.
Automatism. The heart is capable of producing electrical impulses on its own, causing it to contract. This function is provided by the sinus node.
Conductivity. In special ways, impulses from the sinus node are conducted to the contractile myocardium.
Excitability- the ability of the heart muscle to be excited under the influence of impulses.

Circles of blood circulation.

The heart pumps blood through two circles of blood circulation: large and small.

Systemic circulation- from the left ventricle, blood enters the aorta, and from it through the arteries to all tissues and organs. Here it gives off oxygen and nutrients, after which it returns through the veins to the right half of the heart - to the right atrium.
Small circle of blood circulation- Blood flows from the right ventricle to the lungs. Here, in the small capillaries that entangle the pulmonary alveoli, the blood loses carbon dioxide and is again saturated with oxygen. After that, it returns through the pulmonary veins to the heart, to the left atrium.

The structure of the heart.

The heart consists of three membranes and a pericardial sac.

Pericardial sac - pericardium. The outer fibrous layer of the pericardial sac loosely surrounds the heart. It is attached to the diaphragm and sternum and fixes the heart in the chest.
The outer shell is the epicardium. This is a thin transparent film of connective tissue, which is tightly fused with the muscular membrane. Together with the pericardial sac, it provides unhindered sliding of the heart during expansion.
The muscular layer is the myocardium. The powerful heart muscle occupies most of the heart wall. In the atria, 2 layers are distinguished deep and superficial. There are 3 layers in the muscular membrane of the stomachs: deep, middle and outer. Thinning or growth and coarsening of the myocardium causes heart failure.
The inner lining is the endocardium. It consists of collagen and elastic fibers that provide smoothness to the cavities of the heart. This is necessary for blood to slide inside the chambers, otherwise parietal blood clots may form.

The mechanism of development of heart failure

It develops slowly over several weeks or months. There are several phases in the development of chronic heart failure:

Myocardial damage develops as a result of heart disease or prolonged overload.

Violation of the contractile function left ventricle. It contracts weakly and sends insufficient blood into the arteries.

stage of compensation. Compensation mechanisms are activated to ensure the normal functioning of the heart in the prevailing conditions. The muscular layer of the left ventricle hypertrophies due to an increase in the size of viable cardiomyocytes. The release of adrenaline increases, which makes the heart beat harder and faster. The pituitary gland secretes antidiuretic hormone, which increases the water content in the blood. Thus, the volume of pumped blood increases.

depletion of reserves. The heart exhausts its ability to supply cardiomyocytes with oxygen and nutrients. They are deficient in oxygen and energy.

Stage of decompensation– circulatory disorders can no longer be compensated. The muscular layer of the heart is not able to function normally. Contractions and relaxations become weak and slow.

Heart failure develops. The heart beats weaker and slower. All organs and tissues receive insufficient oxygen and nutrients.

Acute heart failure develops within a few minutes and does not go through the stages characteristic of CHF. Heart attack, acute myocarditis, or severe arrhythmias cause the heart's contractions to become sluggish. At the same time, the volume of blood entering the arterial system drops sharply.

Types of heart failure

Chronic heart failure is a consequence of cardiovascular disease. It develops gradually and slowly progresses. The wall of the heart thickens due to the growth of the muscle layer. The formation of capillaries that provide nutrition to the heart lags behind the growth of muscle mass. The nutrition of the heart muscle is disturbed, and it becomes stiff and less elastic. The heart is unable to pump blood.

Disease severity. Mortality in people with chronic heart failure is 4-8 times higher than in their peers. Without proper and timely treatment in the stage of decompensation, the survival rate for a year is 50%, which is comparable to some cancers.

The mechanism of development of CHF:

The throughput (pumping) capacity of the heart decreases - the first symptoms of the disease appear: intolerance to physical exertion, shortness of breath.
Compensatory mechanisms are activated, aimed at maintaining the normal functioning of the heart: strengthening the heart muscle, increasing the level of adrenaline, increasing blood volume due to fluid retention.
Malnutrition of the heart: muscle cells became much larger, and the number of blood vessels increased slightly.
Compensatory mechanisms are exhausted. The work of the heart deteriorates significantly - with each push it pushes out insufficient blood.

Types of chronic heart failure

Depending on the phase of cardiac contraction in which the violation occurs:

systolic heart failure (systole - contraction of the heart). The chambers of the heart contract weakly.
diastolic heart failure (diastole - the relaxation phase of the heart) the heart muscle is not elastic, it does not relax and stretch well. Therefore, during diastole, the ventricles are not sufficiently filled with blood.

Depending on the cause of the disease:

Myocardial heart failure - heart disease weakens the muscle layer of the heart: myocarditis, heart defects, ischemic disease.
reloading heart failure - the myocardium is weakened as a result of overload: increased blood viscosity, mechanical obstruction of the outflow of blood from the heart, hypertension.

Acute heart failure (AHF)- a life-threatening condition associated with a rapid and progressive violation of the pumping function of the heart.

DOS Development Mechanism:

The myocardium does not contract strongly enough.
The amount of blood ejected into the arteries decreases sharply.
Slow passage of blood through body tissues.
Increased blood pressure in the capillaries of the lungs.
Stagnation of blood and the development of edema in the tissues.

The severity of the disease. Any manifestation of acute heart failure is life-threatening and can quickly lead to death.

There are two types of OSS:

Right ventricular failure.
It develops when the right ventricle is damaged as a result of blockage of the terminal branches of the pulmonary artery (pulmonary embolism) and infarction of the right half of the heart. This reduces the volume of blood pumped by the right ventricle from the vena cava, which carry blood from the organs to the lungs.
Left ventricular failure caused by impaired blood flow in the coronary vessels of the left ventricle.
Development mechanism: the right ventricle continues to pump blood into the vessels of the lungs, the outflow from which is impaired. The pulmonary vessels are congested. At the same time, the left atrium is not able to accept the increased volume of blood and stagnation develops in the pulmonary circulation.

Options for the course of acute heart failure:

Cardiogenic shock- a significant decrease in cardiac output, systolic pressure less than 90 mm. rt. st, cold skin, lethargy, lethargy.
Pulmonary edema- filling of the alveoli with fluid that has seeped through the walls of the capillaries, accompanied by severe respiratory failure.
Hypertensive crisis- against the background of high pressure, pulmonary edema develops, the function of the right ventricle is preserved.
Heart failure with high cardiac output- warm skin, tachycardia, congestion in the lungs, sometimes high pressure(with sepsis).
Acute decompensation of chronic heart failure - symptoms of AHF are moderate.

Causes of heart failure

Causes of chronic heart failure

Diseases of the heart valves- lead to the flow of excess blood into the ventricles and their hemodynamic overload.
Arterial hypertension(hypertension) - the outflow of blood from the heart is disturbed, the volume of blood in it increases. Working in an enhanced mode leads to overwork of the heart and stretching of its chambers.
Aortic stenosis Narrowing of the aortic lumen causes blood to pool in the left ventricle. The pressure in it rises, the ventricle is stretched, its myocardium is weakened.
Dilated cardiomyopathy- a heart disease characterized by stretching of the heart wall without thickening it. In this case, the ejection of blood from the heart into the arteries is reduced by half.
Myocarditis- Inflammation of the heart muscle. They are accompanied by impaired conduction and contractility of the heart, as well as stretching of its walls.
Ischemic heart disease, myocardial infarction- these diseases lead to disruption of the myocardial blood supply.
Tachyarrhythmias- the filling of the heart with blood during diastole is disturbed.
Hypertrophic cardiomyopathy- there is a thickening of the walls of the ventricles, their internal volume decreases.
Pericarditis- Inflammation of the pericardium creates mechanical obstacles to filling the atria and ventricles.
Basedow's disease- the blood contains a large amount of hormones thyroid gland which are toxic to the heart.

These diseases weaken the heart and lead to the activation of compensation mechanisms that are aimed at restoring normal blood circulation. For a while, blood circulation improves, but soon the reserve capacity ends and the symptoms of heart failure appear with renewed vigor.

Causes of acute heart failure

Disorders in the work of the heart:

Complication of chronic heart failure with strong psycho-emotional and physical stress.
Pulmonary embolism(its small branches). An increase in pressure in the pulmonary vessels leads to an excessive load on the right ventricle.
Hypertensive crisis. A sharp increase in pressure leads to a spasm of small arteries that feed the heart - ischemia develops. At the same time, the number of heartbeats increases sharply and an overload of the heart occurs.
Acute cardiac arrhythmias- an accelerated heartbeat causes an overload of the heart.
Acute disturbance of blood flow within the heart can be caused by damage to the valve, rupture of the chord holding the valve leaflets, perforation of the valve leaflets, infarction of the interventricular septum, avulsion of the papillary muscle responsible for the operation of the valve.
Acute severe myocarditis- inflammation of the myocardium leads to the fact that the pumping function is sharply reduced, the heart rhythm and conduction are disturbed.
Cardiac tamponade- accumulation of fluid between the heart and the pericardial sac. In this case, the cavities of the heart are compressed, and it cannot fully contract.
Acute onset arrhythmia(tachycardia and bradycardia). Severe arrhythmias disrupt myocardial contractility.
myocardial infarction- this is an acute violation of blood circulation in the heart, which leads to the death of myocardial cells.
Aortic dissection- disrupts the outflow of blood from the left ventricle and the activity of the heart as a whole.

Non-cardiac causes of acute heart failure:

Severe stroke. The brain carries out neurohumoral regulation of the activity of the heart, with a stroke, these mechanisms go astray.
Alcohol abuse disrupts conduction in the myocardium and leads to severe arrhythmias - atrial flutter.
Asthma attack nervous excitement and an acute lack of oxygen lead to rhythm disturbances.
Poisoning by bacterial toxins, which have a toxic effect on the cells of the heart and inhibit its activity. The most common causes: pneumonia, septicemia, sepsis.
The wrong treatment heart disease or self-medication abuse.

Risk factors for developing heart failure:

smoking, alcohol abuse
diseases of the pituitary gland and thyroid gland, accompanied by an increase in pressure
any heart disease
taking medications: anticancer, tricyclic antidepressants, glucocorticoid hormones, calcium antagonists.

Symptoms of right ventricular acute heart failure are caused by stagnation of blood in the veins of the systemic circulation:

Increased heartbeat- the result of a deterioration in blood circulation in the coronary vessels of the heart. Patients have increasing tachycardia, which is accompanied by dizziness, shortness of breath and heaviness in the chest.
swelling of the neck veins, which increases on inspiration, due to an increase in intrathoracic pressure and difficulty in blood flow to the heart.
Edema. Their appearance is facilitated by a number of factors: a slowdown in blood circulation, an increase in the permeability of capillary walls, interstitial fluid retention, and a violation of water-salt metabolism. As a result, fluid accumulates in the cavities and in the extremities.
Lowering blood pressure associated with a decrease in cardiac output. Manifestations: weakness, pallor, excessive sweating.
There is no congestion in the lungs

Symptoms of left ventricular acute heart failure associated with stagnation of blood in the pulmonary circulation - in the vessels of the lungs. Manifested by cardiac asthma and pulmonary edema:

An attack of cardiac asthma occurs at night or after exercise, when blood congestion in the lungs increases. There is a feeling of acute lack of air, shortness of breath is growing rapidly. The patient breathes through the mouth to provide more air flow.
Forced sitting position(with lowered legs) in which the outflow of blood from the vessels of the lungs improves. Excess blood flows into the lower extremities.
Cough at first dry, later with pinkish sputum. The discharge of sputum does not bring relief.
Development of pulmonary edema. An increase in pressure in the pulmonary capillaries leads to leakage of fluid and blood cells into the alveoli and the space around the lungs. This impairs gas exchange, and the blood is not sufficiently saturated with oxygen. Moist coarse rales appear over the entire surface of the lungs. From the side you can hear the gurgling breath. The number of breaths increases to 30-40 per minute. Breathing is difficult, the respiratory muscles (diaphragm and intercostal muscles) are noticeably tense.
Formation of foam in the lungs. With each breath, the fluid that has leaked into the alveoli foams, further disrupting the expansion of the lungs. There is a cough with foamy sputum, foam from the nose and mouth.
Confusion and mental agitation. Left ventricular failure entails a violation of cerebral circulation. Dizziness, fear of death, fainting are signs of oxygen starvation of the brain.
Heartache . The pain is felt in the chest. Can give in the shoulder blade, neck, elbow.

Dyspnea- This is a manifestation of oxygen starvation of the brain. She appears at physical activity, and in advanced cases even at rest.
exercise intolerance. During the load, the body needs active blood circulation, and the heart is not able to provide it. Therefore, under load, weakness, shortness of breath, pain behind the sternum quickly occur.
Cyanosis. The skin is pale with a bluish tint due to lack of oxygen in the blood. Cyanosis is most pronounced on the fingertips, nose, and earlobes.
Edema. First of all, swelling of the legs occurs. They are caused by overflow of the veins and the release of fluid into the intercellular space. Later, fluid accumulates in the cavities: abdominal and pleural.
Stagnation of blood in the vessels of internal organs causes them to fail:
- Digestive organs. Feeling of pulsation in the epigastric region, stomach pain, nausea, vomiting, constipation.
- Liver. Rapid enlargement and soreness of the liver associated with stagnation of blood in the organ. The liver enlarges and stretches the capsule. In motion and when probing, a person experiences pain in the right hypochondrium. Gradually, connective tissue develops in the liver.
- Kidneys. Reducing the amount of urine excreted, increasing its density. In the urine, cylinders, proteins, blood cells are found.
- Central nervous system. Dizziness, emotional arousal, sleep disturbance, irritability, fatigue.

Diagnosis of heart failure

Inspection. Examination reveals cyanosis (blanching of the lips, tip of the nose, and areas away from the heart). Pulse frequent weak filling. Arterial pressure in acute insufficiency is reduced by 20-30 mm Hg. compared to a worker. However, heart failure can occur against the background high blood pressure.

Listening to the heart. In acute heart failure, listening to the heart is difficult due to wheezing and breath sounds. However, you can find:

weakening of the I tone (the sound of contraction of the ventricles) due to the weakening of their walls and damage to the heart valves
splitting (bifurcation) of the II tone on the pulmonary artery indicates a later closure of the pulmonary valve
IV heart sound is detected with contraction of the hypertrophied right ventricle
diastolic murmur - the sound of blood filling during the relaxation phase - blood seeps through the pulmonary valve due to its expansion
heart rhythm disturbances (slow or fast)

Electrocardiography (ECG) It is mandatory for all violations of the heart. However, these signs are not specific to heart failure. They can also occur with other diseases:

signs of cicatricial lesions of the heart
signs of myocardial thickening
cardiac arrhythmias
conduction disorder of the heart

ECHO-KG with Dopplerography (ultrasound of the heart + Doppler) is the most informative method for diagnosing heart failure:

decrease in the amount of blood ejected from the ventricles is reduced by 50%
thickening of the walls of the ventricles (the thickness of the anterior wall exceeds 5 mm)
an increase in the volume of the chambers of the heart transverse dimension ventricles exceeds 30 mm)
reduced contractility of the ventricles
dilated pulmonary aorta
heart valve dysfunction
insufficient collapse of the inferior vena cava on inspiration (less than 50%) indicates stagnation of blood in the veins of the systemic circulation
increased pressure in the pulmonary artery

X-ray examination confirms an increase in the right heart and an increase in blood pressure in the vessels of the lungs:

bulging of the trunk and expansion of the branches of the pulmonary artery
fuzzy contours of large pulmonary vessels
enlargement of the heart
areas of increased density associated with swelling
the first edema appears around the bronchi. A characteristic "bat silhouette" is formed

Study of the level of natriuretic peptides in blood plasma- determination of the level of hormones secreted by myocardial cells.

Normal levels:

NT-proBNP - 200 pg/ml
BNP -25 pg/ml

The greater the deviation from the norm, the more severe the stage of the disease and the worse the prognosis. The normal content of these hormones indicates the absence of heart failure.
Treatment of acute heart failure

Is hospitalization necessary?

If symptoms of acute heart failure appear, an ambulance should be called. If the diagnosis is confirmed, then the patient must be hospitalized in the intensive care unit (with pulmonary edema) or intensive care and emergency care.

Stages of care for a patient with acute heart failure

The main goals of therapy for acute heart failure:

rapid restoration of blood circulation in vital organs
relief of disease symptoms
normalization of the heart rate
restoration of blood flow in the vessels supplying the heart

Depending on the type of acute heart failure and its manifestations, drugs are administered that improve heart function and normalize blood circulation. After it was possible to stop the attack, treatment of the underlying disease begins.

Group	A drug	Mechanism of therapeutic action	How is it prescribed
Pressor (sympathomimetic) amines	dopamine	Increases cardiac output, narrows the lumen of large veins, stimulating the promotion of venous blood.	Intravenous drip. The dose depends on the condition of the patient 2-10 mcg / kg.
Phosphodiesterase III inhibitors	Milrinone	Increases the tone of the heart, Reduces spasm of the pulmonary vessels.	Enter intravenously drip. First, a "loading dose" of 50 mcg/kg. In the future, 0.375-0.75 mcg / kg per minute.
Non-glycoside structure cardiotonic drugs	Levosimendan (Simdax)	Increases the sensitivity of contractile proteins (myofibrils) to calcium. Increases the strength of contractions of the ventricles, does not affect their relaxation.	Initial dose 6–12 mcg/kg. In the future, continuous intravenous administration at a rate of 0.1 μg / kg / min.
Vasodilators Nitrates	Sodium nitroprusside	Expand veins and arterioles, lowering blood pressure. Improves cardiac output. Often prescribed together with diuretics (diuretics) to reduce pulmonary edema.	Intravenous drip at 0.1-5 mcg / kg per minute.
Vasodilators Nitrates	Nitroglycerine		1 tablet under the tongue every 10 minutes or 20-200 mcg/min intravenously.
Diuretics	Furosemide	Helps to remove excess water in the urine. Reduce vascular resistance, reduce the load on the heart, relieve edema.	Loading dose 1 mg/kg. In the future, the dose is reduced.
Diuretics	Torasemide		Take wither in tablets of 5-20 mg.
Narcotic analgesics	Morphine	Eliminates pain, severe shortness of breath, has a calming effect. Reduces the heart rate during tachycardia.	Enter 3 mg intravenously.

Procedures that help stop an attack of acute heart failure:

bloodletting indicated for urgent unloading of pulmonary vessels, lowering blood pressure, eliminating venous congestion. With the help of a lancet, the doctor opens a large vein (usually on the limbs). 350-500 ml of blood is excreted from it.
The imposition of tourniquets on the limbs. If there are no vascular pathologies and other contraindications, then artificially create venous congestion in the periphery. Tourniquets are applied to the limbs below the groin and armpit for 15-30 minutes. Thus, it is possible to reduce the volume of circulating blood, unload the heart and blood vessels of the lungs. A hot foot bath can be used for the same purpose.
Breathing pure oxygen to eliminate hypoxia of tissues and organs. To do this, use an oxygen mask with a high gas flow rate. In severe cases, a ventilator may be needed.
Vapor oxygen inhalations ethyl alcohol used to extinguish the protein foam formed during pulmonary edema. Before carrying out inhalation, it is necessary to clear the upper respiratory tract of foam, otherwise the patient is threatened with suffocation. For these purposes, mechanical or electrical suction devices are used. Inhalation is carried out using nasal catheters or a mask.
Defibrillation necessary for heart failure with severe arrhythmias. Electrical impulse therapy depolarizes the entire myocardium (deprives it of dissociated pathological impulses) and restarts the sinus node responsible for heart rhythm.

Treatment of chronic heart failure

Treatment of CHF is a long process. It requires patience and significant financial costs. Mostly, the treatment is carried out at home. However, hospitalization is often required.

Goals of therapy for chronic heart failure:

minimization of manifestations of the disease: shortness of breath, edema, fatigue
protection of internal organs that suffer from insufficient blood circulation
reduced risk of developing acute heart failure

Is hospitalization necessary for the treatment of chronic heart failure?

Chronic heart failure is the most common cause of hospitalization in the elderly.

Indications for hospitalization:

failure of outpatient treatment
low cardiac output requiring treatment with inotropic drugs
pronounced edema in which intramuscular injection of diuretics is necessary
deterioration

cardiac arrhythmias

Treatment of pathology with medicines

Group	A drug	Mechanism of therapeutic action	How is it prescribed
Beta blockers	metoprolol	Eliminates heart pain and arrhythmia, reduces heart rate, makes the myocardium less susceptible to oxygen deficiency.	Take orally 50-200 mg per day for 2-3 doses. Dose adjustment is made individually.
Beta blockers	bisoprolol	It has an anti-ischemic effect and lowers blood pressure. Reduces cardiac output and heart rate.	Take orally 0.005-0.01 g 1 time per day during breakfast.
cardiac glycosides	Digoxin	Eliminates atrial fibrillation (uncoordinated contraction of muscle fibers). It has a vasodilating and diuretic effect.	On the first day, 1 tablet 4-5 times a day. In the future, 1-3 tablets per day.
Angiotensin II receptor blockers	Atakand	Relaxes blood vessels and helps reduce pressure in the capillaries of the lungs.	Take 1 time per day for 8 mg with food. If necessary, the dose can be increased to 32 mg.
Diuretics - aldosterone antagonists	Spironolactone	Removes excess water from the body, retaining potassium and magnesium.	100-200 mg for 5 days. With prolonged use, the dose is reduced to 25 mg.
Sympathomimetic agents	dopamine	Increases heart tone, pulse pressure. Expands the vessels that feed the heart. Has a diuretic effect.	It is used only in a hospital, intravenous drip at 100-250 mcg / min.
Nitrates	Nitroglycerine Glyceryl trinitrate	Assign with left ventricular failure. Expands the coronary vessels that feed the myocardium, redistributes blood flow to the heart in favor of the areas affected by ischemia. Improves metabolic processes in the heart muscle.	Solution, drops, capsules for resorption under the tongue. In a hospital, it is administered intravenously at 0.10 to 0.20 mcg / kg / min.

Nutrition and daily routine in heart failure.

Treatment of acute and chronic heart failure is carried out individually. The choice of drugs depends on the stage of the disease, the severity of the symptoms, and the characteristics of the heart lesion. Self-medication can lead to worsening of the condition and progression of the disease. Nutrition in heart failure has its own characteristics. Patients are recommended diet number 10, and in the second and third degree of circulatory disorders 10a.

Basic principles of therapeutic nutrition for heart failure:

The rate of fluid intake is 600 ml - 1.5 liters per day.
With obesity and overweight (> 25 kg / m²), it is necessary to limit the caloric intake of 1900-2500 kcal. Exclude fatty, fried foods and confectionery with cream.
Fats 50-70 g per day (25% vegetable oils)
Carbohydrates 300-400 g (80-90 g in the form of sugar and other confectionery)
Restriction of salt, which causes water retention in the body, an increase in the load on the heart and the appearance of edema. The norm of salt is reduced to 1-3 g per day. In severe heart failure, the salt is completely turned off.
The diet includes foods rich in potassium, the deficiency of which leads to myocardial dystrophy: dried apricots, raisins, sea kale.
Ingredients that have an alkaline reaction, since metabolic disorders in CH lead to acidosis (acidification of the body). Recommended: milk, wholemeal bread, cabbage, bananas, beets.
In case of pathological weight loss due to fat mass and muscles (> 5 kg in 6 months), a high-calorie diet 5 times a day in small portions is recommended. Since the overflow of the stomach causes the rise of the diaphragm and disruption of the heart.
Food should be high-calorie, easily digestible, rich in vitamins and proteins. Otherwise, the stage of decompensation develops.

Dishes and foods that are prohibited in heart failure:

strong fish and meat broths
bean and mushroom dishes
fresh bread, sweet and puff pastry products, pancakes
fatty meats: pork, lamb, goose, duck, liver, kidneys, sausages
fatty fish, smoked, salted and canned fish, canned food
fatty and salty cheeses
sorrel, radish, spinach, salted, pickled and pickled vegetables.
hot spices: horseradish, mustard
animals and cooking oils
coffee, cocoa
alcoholic drinks

Physical activity in heart failure:

In acute heart failure, rest is indicated. Moreover, if the patient is in a supine position, then the condition may worsen - pulmonary edema will increase. Therefore, it is desirable to be in the floor sitting position with legs down.

In chronic heart failure, rest is contraindicated. Lack of movement enhances congestion in the systemic and pulmonary circulation.

Sample list of exercises:

Lying on your back. The arms are extended along the body. Raise your arms on inhalation, lower them on exhalation.
Lying on your back. Bicycle exercise. Lying on your back, perform an imitation of cycling.
Move to a sitting position from a lying position.
Sitting on a chair. The arms are bent at the elbow joints, hands to the shoulders. Elbow rotation 5-6 times in each direction.
Sitting on a chair. On the inhale - hands up, torso tilt to the knees. As you exhale, return to the starting position.
Standing, in the hands of a gymnastic stick. While inhaling, lift the stick and turn the torso to the side. As you exhale, return to the starting position.
Walking in place. Gradually switch to walking on toes.

All exercises are repeated 4-6 times. If dizziness, shortness of breath and pain behind the sternum occur during physiotherapy exercises, then it is necessary to stop classes. If, when performing exercises, the pulse accelerates by 25-30 beats, and after 2 minutes returns to normal, then the exercises have a positive effect. Gradually, the load must be increased, expanding the list of exercises.

Contraindications to physical activity:

active myocarditis
constriction of the heart valves
severe cardiac arrhythmias
angina attacks in patients with decreased blood output

Deficiency is a violation of the function of the heart, when it is not able to provide full blood flow in organs and tissues. The cells of the body receive an insufficient amount of nutrients, experience oxygen starvation. Chronic heart failure is the result of almost all heart diseases.

Causes of chronic heart failure

The most common causes of heart failure are atherosclerosis, hypertension,. Due to vasoconstriction, the tension of the blood inside increases, it becomes more and more difficult for the heart to push it. Up to a certain point, this violation is compensated by an increase in the strength and frequency of heart contractions, but over time, the heart ceases to cope with increased loads.

Heart failure can be caused by dysfunction of the heart itself in myocarditis, myocardial dystrophy, heart valve defects, severe infections, poisoning, autoimmune diseases. Many lung diseases are accompanied by an increase in blood pressure in the pulmonary vessels. As a result, the workload on the heart increases, and this can also lead to heart failure. When kidney function is impaired, excess fluid is retained in the body, which contributes to an increase in the amount of blood and an increase in stress on the heart muscle.

Heart failure symptoms

In the initial stages, symptoms of heart failure occur only during exercise. Shortness of breath appears - breathing becomes too frequent and deep, does not correspond to the severity of work or exercise. If the pressure in the vessels of the lungs rises, the patient is worried, sometimes with blood impurities.

After physical exertion, heavy meals and in the supine position, an increased heartbeat occurs. The patient complains of increased fatigue, weakness.

Over time, these symptoms intensify, begin to disturb not only during physical work, but also at rest.

Many patients with heart failure have decreased urine output and go to the toilet mostly at night. In the evenings, swelling appears on the legs, at first only on the feet, and over time they “rise” higher. The skin of the feet, hands, earlobes and the tip of the nose acquires a bluish tint. If heart failure is accompanied by stagnation of blood in the vessels of the liver, there is a feeling of heaviness and pain under the right rib.

Over time, heart failure leads to impaired blood circulation in the brain. The patient becomes irritable, quickly gets tired during mental stress, often falls into depression. He does not sleep well at night, and during the day he is constantly sleepy.

What can you do?

If not treated, heart failure is constantly increasing and leads to more and more severe complications, the patient's condition worsens. The work of all organs is disrupted, since they no longer receive the necessary amount of nutrients and oxygen. Ultimately, this leads to disability and death.

Patients suffering from heart failure should be registered with a general practitioner and a cardiologist, regularly appear for examination and examination, and periodically undergo treatment in a hospital.

What can a doctor do?

If you have heart failure, your doctor may order the following tests and tests:

Heart failure is treated with medication. The patient receives appointments from a general practitioner and a cardiologist at a polyclinic at the place of residence. Periodically, hospitalization is required for examination and treatment. Common recommendations and prescriptions for heart failure include:

limitation of physical activity;
physiotherapy exercises;
diet: you need to limit the intake of salt, liquid, fatty foods;
drugs to lower blood pressure and unload the heart;
drugs that enhance heart contractions;
drugs that help remove excess fluid from the body and restore the water-salt balance;
, trace elements, vascular and other means that help restore normal metabolism in the heart muscle;
treatment of the underlying disease that led to the development of heart failure.

The prognosis for patients with heart failure depends on the underlying disease. If it can be cured, then the patient has a chance of recovery. Otherwise, the doctor can only slow down the further progression of the disease. In the initial stages, normal working capacity is maintained, but then it decreases, and in severe heart failure it is lost - the patient becomes disabled. If left untreated, heart failure eventually leads to death.

Prevention

To prevent heart failure, proper nutrition, sufficient physical activity, rejection of bad habits. All diseases of the cardiovascular system must be detected and treated in a timely manner.

- an acute or chronic condition caused by a weakening of myocardial contractility and congestion in the pulmonary or systemic circulation. Manifested by shortness of breath at rest or with slight exertion, fatigue, edema, cyanosis (cyanosis) of the nails and nasolabial triangle. Acute heart failure is dangerous for the development of pulmonary edema and cardiogenic shock, chronic heart failure leads to the development of organ hypoxia. Heart failure is one of the most common causes of human death.

General information

A decrease in the contractile (pumping) function of the heart in heart failure leads to the development of an imbalance between the hemodynamic needs of the body and the ability of the heart to fulfill them. This imbalance is manifested by the excess of venous inflow to the heart and the resistance that must be overcome by the myocardium to expel blood into the vascular bed, over the ability of the heart to move blood into the arterial system.

Not being an independent disease, heart failure develops as a complication of various vascular and heart pathologies: valvular heart disease, coronary artery disease, cardiomyopathy, arterial hypertension, etc.

In some diseases (for example, arterial hypertension), the increase in heart failure occurs gradually, over years, while in others (acute myocardial infarction), accompanied by the death of some functional cells, this time is reduced to days and hours. With a sharp progression of heart failure (within minutes, hours, days), they speak of its acute form. In other cases, heart failure is considered as chronic.

Chronic heart failure affects from 0.5 to 2% of the population, and after 75 years its prevalence is about 10%. The significance of the problem of the incidence of heart failure is determined by the steady increase in the number of patients suffering from it, the high rate of mortality and disability of patients.

Causes of heart failure

Among the most common causes of heart failure, occurring in 60-70% of patients, are myocardial infarction and coronary artery disease. They are followed by rheumatic heart disease (14%) and dilated cardiomyopathy (11%). In the age group over 60, in addition to IHD, heart failure is also caused by hypertension (4%). In elderly patients common cause heart failure is type 2 diabetes mellitus and its combination with arterial hypertension.

Risk factors

Factors provoking the development of heart failure cause its manifestation with a decrease in the compensatory mechanisms of the heart. Unlike causes, risk factors are potentially reversible, and reducing or eliminating them can delay worsening heart failure and even save a patient's life.

These include:

overstrain of physical and psycho-emotional capabilities
arrhythmias, PE, hypertensive crises, progression of coronary artery disease;
pneumonia, SARS, anemia, renal failure, hyperthyroidism
taking cardiotoxic drugs, drugs that promote fluid retention (NSAIDs, estrogens, corticosteroids), which increase blood pressure (isadrine, ephedrine, adrenaline)
severe and rapidly progressive weight gain, alcoholism
a sharp increase in BCC with massive infusion therapy
myocarditis, rheumatic fever, infective endocarditis
non-compliance with recommendations for the treatment of chronic heart failure.

Pathogenesis

The development of acute heart failure is often observed against the background of myocardial infarction, acute myocarditis, severe arrhythmias (ventricular fibrillation, paroxysmal tachycardia, etc.). In this case, there is a sharp drop in minute ejection and blood flow into the arterial system. Acute heart failure is clinically similar to acute circulatory failure and is sometimes referred to as acute cardiac collapse.

In chronic heart failure, changes that develop in the heart are compensated for a long time by its intensive work and adaptive mechanisms of the vascular system: an increase in the strength of heart contractions, an increase in rhythm, a decrease in pressure in diastole due to the expansion of capillaries and arterioles, which facilitates the emptying of the heart during systole, an increase in perfusion fabrics.

A further increase in the phenomena of heart failure is characterized by a decrease in the volume of cardiac output, an increase in the residual amount of blood in the ventricles, their overflow during diastole and overstretching of myocardial muscle fibers. The constant overstrain of the myocardium, which is trying to push blood into the vascular bed and maintain blood circulation, causes its compensatory hypertrophy. However, at a certain point, the stage of decompensation occurs, due to the weakening of the myocardium, the development of dystrophy and sclerosis processes in it. The myocardium itself begins to experience a lack of blood supply and energy supply.

At this stage, neurohumoral mechanisms are included in the pathological process. Activation of the mechanisms of the sympathetic-adrenal system causes vasoconstriction in the periphery, which contributes to the maintenance of stable blood pressure in the systemic circulation with a decrease in cardiac output. The resulting renal vasoconstriction leads to renal ischemia, which contributes to interstitial fluid retention.

An increase in the secretion of antidiuretic hormone by the pituitary gland increases the processes of water reabsorption, which leads to an increase in the volume of circulating blood, an increase in capillary and venous pressure, and increased fluid transudation into the tissues.

Thus, severe heart failure leads to severe hemodynamic disturbances in the body:

Gas exchange disorder

When the blood flow slows down, the absorption of oxygen from the capillaries by the tissues increases from 30% in the norm to 60-70%. The arteriovenous difference in blood oxygen saturation increases, which leads to the development of acidosis. The accumulation of underoxidized metabolites in the blood and increased work of the respiratory muscles cause activation of the basal metabolism.

A vicious circle arises: the body experiences an increased need for oxygen, and the circulatory system is unable to satisfy it. The development of the so-called oxygen debt leads to the appearance of cyanosis and shortness of breath. Cyanosis in heart failure can be central (with stagnation in the pulmonary circulation and impaired blood oxygenation) and peripheral (with slowing blood flow and increased oxygen utilization in tissues). Since circulatory failure is more pronounced in the periphery, acrocyanosis is observed in patients with heart failure: cyanosis of the extremities, ears, nose tip.

Edema

Edema develops as a result of a number of factors: interstitial fluid retention with an increase in capillary pressure and a slowdown in blood flow; water and sodium retention in violation of water-salt metabolism; violations of the oncotic pressure of the blood plasma in the disorder of protein metabolism; reducing the inactivation of aldosterone and antidiuretic hormone with a decrease in liver function.

Edema in heart failure is initially hidden, expressed rapid increase body weight and decreased urine output. The appearance of visible edema begins with the lower extremities, if the patient walks, or from the sacrum, if the patient is lying down. In the future, abdominal dropsy develops: ascites (abdominal cavity), hydrothorax (pleural cavity), hydropericardium (pericardial cavity).

stagnant changes in organs

Congestion in the lungs is associated with impaired hemodynamics of the pulmonary circulation. Characterized by rigidity of the lungs, a decrease in respiratory excursion of the chest, limited mobility of the lung edges. Manifested by congestive bronchitis, cardiogenic pneumosclerosis, hemoptysis. Stagnation of the systemic circulation causes hepatomegaly, manifested by heaviness and pain in the right hypochondrium, and then cardiac fibrosis of the liver with the development of connective tissue in it.

Expansion of the cavities of the ventricles and atria in heart failure can lead to relative insufficiency of the atrioventricular valves, which is manifested by swelling of the neck veins, tachycardia, and expansion of the boundaries of the heart. With the development of congestive gastritis, nausea, loss of appetite, vomiting, a tendency to constipation, flatulence, and weight loss appear. With progressive heart failure, a severe degree of exhaustion develops - cardiac cachexia.

Congestive processes in the kidneys cause oliguria, an increase in the relative density of urine, proteinuria, hematuria, cylindruria. Violation of the functions of the central nervous system in heart failure is characterized by rapid fatigue, a decrease in mental and physical activity, increased irritability, sleep disturbance, depressive states.

Classification

According to the rate of increase in signs of decompensation, acute and chronic heart failure are distinguished.

The development of acute heart failure can occur in two types:

according to the left type (acute left ventricular or left atrial insufficiency)
acute right ventricular failure

In the development of chronic heart failure, according to the classification of Vasilenko-Strazhesko, there are three stages:

I (initial) stage- hidden signs of circulatory insufficiency, manifested only during physical exertion by shortness of breath, palpitations, excessive fatigue; at rest hemodynamic disturbances are absent.

II (expressed) stage- signs of prolonged circulatory failure and hemodynamic disorders (stagnation of small and large circles of blood circulation) are expressed at rest; severe disability:

Period II A - moderate hemodynamic disturbances in one part of the heart (left or right ventricular failure). Shortness of breath develops during normal physical activity, performance is sharply reduced. Objective signs - cyanosis, swelling of the legs, initial signs of hepatomegaly, hard breathing.
Period II B - deep hemodynamic disorders involving the entire cardiovascular system (large and small circle). Objective signs - shortness of breath at rest, pronounced edema, cyanosis, ascites; complete disability.

III (dystrophic, final) stage- persistent circulatory and metabolic failure, morphologically irreversible damage to the structure of organs (liver, lungs, kidneys), exhaustion.

Heart failure symptoms

Acute heart failure

Acute heart failure is caused by a weakening of the function of one of the parts of the heart: the left atrium or ventricle, the right ventricle. Acute left ventricular failure develops in diseases with a predominant load on the left ventricle (hypertension, aortic disease, myocardial infarction). With the weakening of the functions of the left ventricle, the pressure in the pulmonary veins, arterioles and capillaries increases, their permeability increases, which leads to sweating of the liquid part of the blood and the development of first interstitial and then alveolar edema.

Clinical manifestations of acute left ventricular failure are cardiac asthma and alveolar pulmonary edema. An attack of cardiac asthma is usually provoked by physical or neuropsychic stress. An attack of severe suffocation often occurs at night, forcing the patient to wake up in fear. Cardiac asthma is manifested by a feeling of lack of air, palpitations, cough with sputum difficult to discharge, severe weakness, cold sweat.

The patient takes the position of orthopnea - sitting with his legs down. On examination - the skin is pale with a grayish tinge, cold sweat, acrocyanosis, severe shortness of breath. A weak, frequent filling of an arrhythmic pulse is determined, the expansion of the boundaries of the heart to the left, muffled heart tones, a gallop rhythm; blood pressure tends to decrease. In the lungs, hard breathing with occasional dry rales.

A further increase in stagnation of the small circle contributes to the development of pulmonary edema. Acute suffocation is accompanied by a cough with the release of copious amounts of frothy pink sputum (due to the presence of an admixture of blood). In the distance, bubbling breathing with moist rales is heard (a symptom of a “boiling samovar”). The position of the patient is orthopnea, the face is cyanotic, the veins of the neck swell, the skin is covered with cold sweat. The pulse is threadlike, arrhythmic, frequent, blood pressure is reduced, in the lungs there are wet rales of various sizes. Pulmonary edema is an emergency requiring intensive care measures, as it can be fatal.

Acute left atrial heart failure occurs with mitral stenosis (left atrioventricular valve). Clinically manifested by the same conditions as acute left ventricular failure. Acute right ventricular failure often occurs with thromboembolism of large branches of the pulmonary artery. Stagnation develops in the vascular system of the systemic circulation, which is manifested by swelling of the legs, pain in the right hypochondrium, a feeling of fullness, swelling and pulsation of the cervical veins, shortness of breath, cyanosis, pain or pressure in the region of the heart. The peripheral pulse is weak and frequent, blood pressure is sharply reduced, CVP is increased, the heart is enlarged to the right.

In diseases that cause right ventricular decompensation, heart failure manifests itself earlier than in left ventricular failure. This is due to the large compensatory capabilities of the left ventricle, the most powerful part of the heart. However, with a decrease in the functions of the left ventricle, heart failure progresses at a catastrophic rate.

Chronic heart failure

The initial stages of chronic heart failure can develop according to the left and right ventricular, left and right atrial types. With aortic defect, mitral valve insufficiency, arterial hypertension, coronary insufficiency, congestion in the vessels of the small circle and chronic left ventricular failure develop. It is characterized by vascular and gas changes in the lungs. There is shortness of breath, asthma attacks (more often at night), cyanosis, palpitations, cough (dry, sometimes with hemoptysis), increased fatigue.

Even more pronounced congestion in the pulmonary circulation develops in chronic left atrial insufficiency in patients with mitral valve stenosis. Appear shortness of breath, cyanosis, cough, hemoptysis. With prolonged venous congestion in the vessels of the small circle, sclerosis of the lungs and blood vessels occurs. There is an additional, pulmonary obstruction to blood circulation in the small circle. Increased pressure in the pulmonary artery system causes an increased load on the right ventricle, causing its insufficiency.

With a predominant lesion of the right ventricle (right ventricular failure), congestion develops in the systemic circulation. Right ventricular failure may accompany mitral heart disease, pneumosclerosis, pulmonary emphysema, etc. There are complaints of pain and heaviness in the right hypochondrium, the appearance of edema, decreased diuresis, distention and enlargement of the abdomen, shortness of breath during movements. Cyanosis develops, sometimes with an icteric-cyanotic hue, ascites, cervical and peripheral veins swell, and the liver increases in size.

Functional insufficiency of one part of the heart cannot remain isolated for a long time, and over time, total chronic heart failure develops with venous congestion in line with the small and large circulations. Also, the development of chronic heart failure is noted with damage to the heart muscle: myocarditis, cardiomyopathy, coronary artery disease, intoxication.

Diagnostics

Since heart failure is a secondary syndrome that develops with known diseases, diagnostic measures should be aimed at its early detection, even in the absence of obvious signs.

When taking a clinical history, attention should be paid to fatigue and dyspnea as the most early signs heart failure; the patient has coronary artery disease, hypertension, myocardial infarction and rheumatic attack, cardiomyopathy. Identification of edema of the legs, ascites, rapid low-amplitude pulse, listening to the III heart sound and displacement of the boundaries of the heart are specific signs of heart failure.

If heart failure is suspected, the electrolyte and gas composition of the blood, acid-base balance, urea, creatinine, cardiospecific enzymes, and indicators of protein-carbohydrate metabolism are determined.

ECG for specific changes helps to detect hypertrophy and insufficiency of blood supply (ischemia) of the myocardium, as well as arrhythmias. Based on electrocardiography, various stress tests are widely used using an exercise bike (bicycle ergometry) and a treadmill (treadmill test). Such tests with a gradually increasing level of load make it possible to judge the reserve capacity of the heart function.

Heart failure treatment

In heart failure, treatment is carried out aimed at eliminating the primary cause (CHD, hypertension, rheumatism, myocarditis, etc.). With heart defects, cardiac aneurysm, adhesive pericarditis, which create a mechanical barrier in the work of the heart, they often resort to surgical intervention.

In acute or severe chronic heart failure, bed rest is prescribed, complete mental and physical rest. In other cases, you should adhere to moderate loads that do not violate well-being. Fluid intake is limited to 500-600 ml per day, salt - 1-2 g. Fortified, easily digestible diet food is prescribed.

Pharmacotherapy of heart failure can prolong and significantly improve the condition of patients and their quality of life.

In heart failure, the following groups of drugs are prescribed:

cardiac glycosides (digoxin, strophanthin, etc.) - increase myocardial contractility, increase its pumping function and diuresis, contribute to satisfactory exercise tolerance;
vasodilators and ACE inhibitors - angiotensin-converting enzyme (enalapril, captopril, lisinopril, perindopril, ramipril) - lower vascular tone, dilate veins and arteries, thereby reducing vascular resistance during heart contractions and contributing to an increase in cardiac output;
nitrates (nitroglycerin and its prolonged forms) - improve blood supply to the ventricles, increase cardiac output, dilate the coronary arteries;
diuretics (furosemide, spironolactone) - reduce the retention of excess fluid in the body;
β-blockers (carvedilol) - reduce heart rate, improve blood supply to the heart, increase cardiac output;
anticoagulants (acetylsalicylic acid, warfarin) - prevent thrombosis in the vessels;
drugs that improve myocardial metabolism (vitamins of group B, ascorbic acid, inosine, potassium preparations).

With the development of an attack of acute left ventricular failure (pulmonary edema), the patient is hospitalized and provided with emergency therapy: diuretics, nitroglycerin, drugs that increase cardiac output (dobutamine, dopamine), oxygen inhalations are administered. With the development of ascites, a puncture removal of fluid from the abdominal cavity is performed; if hydrothorax occurs, a pleural puncture is performed. Due to severe tissue hypoxia, patients with heart failure are prescribed oxygen therapy.

Forecast and prevention

The five-year survival threshold for patients with heart failure is 50%. The long-term prognosis is variable, it is influenced by the severity of heart failure, concomitant background, the effectiveness of therapy, lifestyle, etc. Treatment of heart failure on early stages can fully compensate for the condition of patients; the worst prognosis is observed in stage III heart failure.

Measures to prevent heart failure is to prevent the development of diseases that cause it (IHD, hypertension, heart defects, etc.), as well as factors contributing to its occurrence. In order to avoid the progression of already developed heart failure, it is necessary to comply with the optimal regimen of physical activity, taking prescribed drugs, and constant monitoring.

Most of us think that coughing is only due to allergic reactions and the common cold. But in practice this is far from the case. Cough is the first symptom indicating heart problems.

If this symptom occurs, do not delay a visit to the doctor. A heart cough has a number of features and characteristics with which you can distinguish it from other diseases. Heart failure can occur at any age and early detection will only make your life easier.

Coughing fits usually occur in the late afternoon. In children, this symptom may be due to congenital pathologies. So what is it - a cough with heart failure, the main types and distinctive features, as well as treatment methods. You will learn about all this in this material.

Cough is a defensive reaction of the body. The purpose of coughing is to clear the lungs and airways. It does not occur on its own, but is a symptom of a number of diseases: bronchitis, pneumonia, asthma, colds, etc.

Heart cough is not an official medical term, but rather a well-established code name for a cough caused by heart failure. But how does the work of the heart affect lung function and even more so cause a cough?

The fact is that a separate, small circle of blood circulation is engaged in the maintenance of the lungs. The full functioning of this system depends on the performance of the left ventricle and atrium - heart failure in them entails a failure of the entire system. Blood in the lungs begins to stagnate, causing edema.

This irritates the respiratory receptors and causes coughing. True, such a cough does not appear on initial stage diseases, and when the edema becomes large enough to cause irritation in the bronchi and alveoli.

At the stage of coughing, the patient is in a very serious condition and is not always able to get to the hospital on his own. Hospitalization and treatment should be carried out as soon as possible.

The mechanism of development of cough in various cardiovascular diseases is the same. Normally, the work of the right ventricle of the heart contributes to the filling of the lungs with blood, and the left ventricle pumps this blood out.

Violation of the heart, associated with insufficiency of the left ventricle, causes the following phenomena:

decreased contractility of the left ventricle;
deterioration of blood circulation, increased pressure in the lungs;
venous stasis of blood in the small (pulmonary) and systemic circulation;
swelling of the mucous membranes and accumulation in the lungs of fluid that irritates bronchial receptors;
cough reflex, which occurs in response to irritation of nerve endings.

Cardiac cough does not appear in all cardiologist patients. Much more often, these patients develop shortness of breath, causing coughing. But shortness of breath is not a symptom by which other diseases of the respiratory system can be excluded, because respiratory failure is also characteristic of pneumonia.

Cough symptoms appear when a person's cough reflex is activated. It is a protective mechanism that helps the respiratory tract clear of foreign bodies present in it, from sputum (mucus of the tracheobronchial tree).

Most often, coughing is associated with infectious diseases of the respiratory system, but it can also become one of the signs of cardiac pathologies. Often, a paroxysmal cough or a slight cough is a leading sign of heart disease, which one way or another leads to heart failure.

Sometimes it is generally the only symptom, and only a detailed examination can help establish the correct diagnosis in this case. Doctors call this symptom “heart cough” for a reason, and it can appear in two situations:

In diseases of the lungs, which are caused by their weakening against the background of damage to the pulmonary circulation.
With pathologies of the heart and coronary vessels, covering directly these organs.

As a rule, with the development of certain diseases of the cardiovascular system, pulmonary disorders sooner or later join. The pathogenesis of the appearance of cough in various cardiac disorders is approximately the same.

Pathological changes in the body that have arisen for one reason or another cause a decrease in the contractility of the left ventricle of the heart. As a result, the blood that returns through the vessels of the lungs is hardly pumped into the aorta.

Because of these processes in the pulmonary circulation, sooner or later there is an increase in pressure in the lungs and in the pulmonary artery. The blood flow slows down, congestion appears, tissue hypoxia is observed.

Edema occurs as blood is retained in the alveoli, and it leads to swelling of the mucous membrane and irritation of the alveolar receptors. This process causes a reflex cough.

Simply put, the main cause of a cough in a person with heart failure is blood stasis in the lung tissue, which provokes irritation of the cough center.

Cough that occurs with heart failure can be classified according to its accompanying symptoms. To date, experts distinguish seven types of SC.

Dry cough that occurs in the form of attacks. Sputum is not allocated with it. It occurs during an increase in load: when walking fast, lifting weights, etc. The appearance of such a cough may indicate the development of mitral stenosis.
Dry cough of short duration. It comes on quickly and goes away just as quickly. Accompanied by pain in the chest and heart. Similar signs occur with the development of heart failure, pericarditis and rheumatic myocardial damage.
Dry cough with reddish sputum. Definitely indicates stagnation of blood in the lungs. Blood may be coughed up in a coagulated form. Due to the brownish color, this selection is called "rusty".
Evening and nocturnal cough. Has a debilitating nature.

It begins at the moment when a person takes a horizontal position before going to bed. Sometimes accompanied by an increase in body temperature, which may indicate the development of septic endocarditis.

Wet cough with red discharge. Almost always accompanied by chest pain.

It indicates one of the last stages of the development of heart failure. May be associated with pulmonary infarction with existing thromboembolism in the pulmonary artery.

Wet cough with bloody froth. Such serious signs at least indicate pulmonary edema, and as a maximum - cardiac asthma.

During such a cough, a person begins to choke and wheeze. In order to weaken the attack, you should sit down and rest your hands on your knees. Going to the doctor when such a cough occurs is a matter of life and death.

Wet cough with pus. It indicates a progressive inflammation of the bronchi with the development of heart failure.

The patient may have an increase in body temperature, while coughing, he is usually sick. Treatment of bronchiectasis should not be delayed in any case, and at the first symptoms you should go to the hospital.

Causes

In many acute and chronic heart diseases, heart failure develops, resulting in a reflex cough.

The main causes of heart cough in adults are:

violations of the heart valves;
arterial hypertension;
cardiomyopathy;
myocarditis;
arrhythmias;
IHD (ischemic heart disease);
myocardial infarction;
heart attack;
cardiosclerosis;
vices;
diseases of the aorta (mesaortitis, aneurysm);
mediastinal lesions.

In children, the cough reflex may occur due to increased pressure in the pulmonary artery in congenital heart defects with enrichment of the pulmonary circulation.

Heart cough can also occur against the background of:

endocrine disorders;
anemia (usually severe);
alcohol abuse and smoking;
frequent or strong mental disorders, stress;
the use of certain medications (cough may be an adverse reaction).

Cough with heart failure - symptoms

Not paying due attention to their health, people very often trigger their condition. But the behavior of the organism clearly indicates that something unusual is happening to it.

Knowing the symptoms of the disease, you can make a proper diagnosis and proceed to timely and effective treatment. Experts identify the following cough symptoms in heart failure:

cough is manifested by sharp and painful attacks lasting from 2 minutes to half an hour;
it is dry, reminiscent of the barking of a dog;
most often, attacks occur in the evening and at night, while staying in a horizontal position;
during attacks, the patient's temperature rises, sweating increases, the heart rate quickens;
after the end of the attack, the patient has practically no strength;
after a prolonged attack, hemoptysis may occur;
often, along with a debilitating cough, there is also a sharp pain in the heart.

If such symptoms were observed at least once, then the trip to a specialized specialist should not be postponed. timely help and proper treatment help prevent further progression of the disease.

The symptoms of coughing in heart failure are pronounced and by paying attention to them in a timely manner, a serious exacerbation of the disease can be avoided.

It is possible to identify the most characteristic symptoms that most often accompany a cough in heart failure:

With such a disease, sputum is not secreted, that is, it is completely dry. In the event that such a contraction of the muscles of the respiratory tract becomes acute or protracted, then discharge with an admixture of blood may appear.
Coughing in heart failure often causes palpitations
The patient may experience symptoms of respiratory failure, which are expressed in constant shortness of breath and acute lack of oxygen.

In addition, breathing becomes hoarse and intermittent, and most often such problems occur with increased physical exertion on the body.

With further progression of the disease, such symptoms can occur even with normal walking and a long conversation.

With a hearty cough, the patient notices painful sensations, the place of occurrence of which is the area of \u200b\u200bthe heart and chest.
Heart failure is a disease that causes high blood pressure. Such a pathological condition is accompanied by a violation of blood flow to the heart and the result of this is frequent fainting.

Usually, cough symptoms in heart failure are often confused with other pathologies, however, in any case, when they appear, you should seek the advice of a specialist.

In addition to the above manifestations, people suffering from heart failure have a dry cough with sputum production:

"Rusty" - occurs with congestion in the pulmonary arteries. Such an unusual color appears due to erythrocytes entering the sputum from the alveolar sacs;
red - this manifestation goes in combination with sharp pains in the left side of the chest. Such pain indicates a pulmonary infarction or myocardial infarction (embolic form);
frothy pink - such a symptom is inherent if a person has acute heart failure. During an attack, a person has bubbling wheezing and suffocation, all this is accompanied by the release of foamy sputum. Most often, such attacks occur during physical exertion or during a night's rest;
mucopurulent - a cough with sputum production of this kind occurs when complications of cardiac pathology appear (bronchiectasia, inflammation of the bronchi). It is accompanied by a rise in temperature, fatigue, weakness, nausea.

Depending on the characteristics of the organism, the stage of the course of the disease and some accompanying symptoms, it is impossible to unambiguously determine which cough in heart failure.

Although several of its types should be distinguished in order to determine the likelihood of a disease.

Coughing attacks occur in the evening and at night. They are strong and exhausting.

As soon as a person takes a horizontal position, he begins to suffer from asthma attacks, followed by coughing.

Seizures can last up to half an hour. During the night, such symptoms can be observed up to 5-6 times.

A sudden onset of coughing. It is dry and short lived. Almost always accompanied by acute pain in the region of the heart.
There may be several long bouts of coughing throughout the day. In addition to severe exhaustion of the body, there is profuse hemoptysis, sweating, weakness, and sore throat.
Dry hearty cough with severe irritation of the mucous membranes, accompanied by copious sputum, rusty, and sometimes black. The attack occurs instantly and lasts up to 5 minutes.
Infrequent violent cough, always accompanied by copious hemoptysis.

Each specific type of cough indicates certain diseases of the heart and the stage of stagnation of fluid in the lungs.

After a full examination, the cardiologist will make an accurate diagnosis and be able to prescribe an adequate treatment for the disease. Depending on what kind of cough with heart failure symptoms it has, a number of certain diseases can be distinguished:

thromboembolic syndrome.
mitral stenosis.
Chronic left ventricular failure.
Complicated pericarditis.
Valve defects.
Postinfarction cardiosclerosis and others.

Unfortunately, there are many heart diseases that can accompany one of the above types of cough, and only a knowledgeable cardiologist can diagnose it accurately. In addition, in advanced stages of the disease, pulmonary edema or cardiac asthma may be added to heart disease.

If the first signs of the disease occur, you should immediately contact a specialist and begin treatment. Most often, a dry cough in heart failure occurs during the course of the following diseases.

Cough begins with sharp attacks and is accompanied by suffocation and lack of opportunities for normal breathing, accompanied by severe sweating and a sharp increase in temperature.

This symptomatology is characteristic with a significant increase in the left atrium, as a result of mitral stenosis.

Dry cough, accompanied by pain in the region of the heart with the release of copious brown sputum, indicates thromboembolic syndrome.
Sharp short attacks, accompanied by stabbing pains in the heart, can talk about stealing.

Dry cough in heart failure becomes a constant companion if its treatment is not properly approached. As a result of stagnation in the lungs, cardiac asthma with subsequent pulmonary edema can not be avoided.

Signs of a cough

Can be identified by the following features:

There are no highlights. With this type of cough, there is no sputum. It is dry and suffocating.

In the acute form, spotting may appear, which is a consequence of the fact that the blood is not completely pumped out of the lungs.

Increased heartbeat.
Breathlessness. Cardiac cough accompanied by shortness of breath. Breathing becomes hoarse and short.

In the initial stages of heart failure, respiratory problems occur during physical exertion, with the further development of the disease, even a long conversation or climbing stairs can cause shortness of breath.

Pain in the chest.
The veins in the neck swell.
Possible fainting. This can happen due to an increase in pressure in the chest and a decrease in the volume of blood reaching the heart.
In some cases, the skin becomes bluish in color.
There is a feeling of weakness, increased sweating, dizziness. With the further development of the disease, swelling of the ankle is possible.

A heart cough is often confused with a bronchial cough, but its nature can suggest the true causes of the problem. Each symptom may present differently. It depends on the severity of the heart disease.

If coughing attacks suddenly cause suffocation, which is accompanied by a strong feeling of tightness in the chest, it is necessary to call an ambulance and wait for her arrival in a sitting position.

Cardiac cough in children

Most often, cough manifests itself in children with congenital heart disease. Although not every defect is the cause of the development of this symptom. The appearance of cough in heart disease is provoked by the pathology of the left ventricle.

As a result of this, swelling of the bronchial mucosa is observed, which irritates the organ. Children's heart cough is very easy to confuse with bronchitis, so a thorough diagnosis of the child is required. Especially after a heart defect is detected.

It's important to know! When a heart cough occurs in a child, it is required to treat the cardiovascular system, and not cough! Such a drug effect will help eliminate coughing.

As for children in adolescence, the first malaise with a hearty cough is periodic shortness of breath even after light physical exertion. Compared to their peers, adolescents with this symptom are less resilient.

They have a constant weakness of the body, as well as rapid fatigue. Therefore, if a teenager has such ailments, then an urgent examination is necessary.

Timely treatment at this age is quite productive and will help to avoid chronic heart failure in the future.

Elderly people are often concerned about disorders of the cardiovascular system. Heart disease in the elderly is already chronic. Therefore, cough against their background is quite common. One of the first signs is a feeling of lack of air, especially at the time of an attack of dry cough.

There are many drugs that can help maintain the cardiovascular system in a normal state. Therefore, the timely intake of prescribed medications will help get rid of an unpleasant dry cough.

Important to remember! In the early stages of heart failure, it is much easier to get rid of a cough and bring the organ back to normal! Therefore, at the first ailments, you should consult a doctor.

If a woman already had any heart disease before conception, it is likely that during pregnancy it will worsen. The load on the body of a pregnant woman increases significantly, the load on the cardiovascular system also increases, so the likelihood of heart failure increases.

The most critical period is considered to be the period of 26-28 weeks of pregnancy, when the volume of circulating blood increases to the maximum. Childbirth and the postpartum period are also considered a dangerous period. Often, women with heart defects and other heart diseases are not allowed to give birth, but they do a planned caesarean section.

During pregnancy, heart failure manifests itself in severe weakness and fatigue, even if a woman is prescribed bed rest, periodic dry cough, especially at night, shortness of breath, cyanosis of the skin.

If a woman has already developed a heart cough, her condition should be constantly monitored and preferably in a hospital. The most dangerous are severe shortness of breath with a cough in the absence of exertion, as they can be harbingers of pulmonary edema.

Heart failure during pregnancy is dangerous not only for a woman, but also for a child, since if blood circulation is disturbed, fetal hypoxia begins, it lacks oxygen.

With severe hypoxia, a slowdown in growth and development can be observed. A woman with heart failure, but in the absence of serious complications, is admitted to the hospital three times during pregnancy: 8-10 weeks for examination and preservation of pregnancy, 26-30 weeks for monitoring fetal development and before childbirth to control labor activity.

During pregnancy, most drugs are prohibited, especially in the first trimester. Heart failure during this period is treated with acceptable drugs: diuretics, beta-blockers, agents to improve myocardial metabolism.

For severe coughing fits, safe antitussive drugs may be prescribed. A strong cough can be dangerous due to tension in the abdominal wall and increased uterine tone.

How to distinguish a cardiac cough from a non-cardiac one?

Cough in heart failure has distinctive features, the main of which is that it is unproductive and abrupt.

When coughing, mucous sputum is expectorated, sometimes even with bloody streaks. With secondary infection, the mucus increases in volume and begins to be purulent.

With diseases of the bronchi, due to prolonged stagnation of blood in the lung tissue, wheezing and moist rales develop. The sputum contains brown inclusions. A highly qualified doctor can easily determine stagnation in the lungs of a chronic type.

For differential diagnosis analyzes for the content of iron in sputum. If the disease proceeds for a long time, sputum is excreted with blood, which indicates a possible pulmonary infarction or bacterial inflammation of the endocardium.

In other cases, tumors and other pathological processes occurring in the mediastinum can be detected.

Making a diagnosis with severe manifestations of heart failure, accompanied by a cough, is not difficult. But to detect the disease in the early stages, a number of examinations are carried out:

Electrocardiography - shows the physical condition of the heart, reveals coronary disease, myocardial hypertrophy;
Ultrasound of the heart (Echo-KG) - allows you to view how the heart works in real time, shows the volume of the heart cavities and wall thickness;
X-ray - reveals signs of infections and tumors in the chest area;
Tomography - gives a detailed picture of the state of the heart muscle.

At the first suspicion of a cough with heart failure, seek help from a specialist! Folk remedies and self-diagnosis are not acceptable here. Only a qualified doctor will be able to correctly determine the cause of the disease and prescribe an effective treatment.

Cough in heart disease differs from any other cough in the absence of sputum. And if, with bronchitis or a cold, the treatment will be directed to expectoration, i.e. an increase in the amount of sputum and its dilution; then with a cough caused by heart failure, such treatment can be not only useless, but also harmful.

You can eliminate unpleasant symptoms only by coping with heart failure. This should be done by qualified professionals. For treatment, drugs are prescribed that facilitate the work of the cardiovascular system:

Diuretic. Due to their ability to remove fluid from the body, the work of the circulatory system is facilitated.
Drugs for vasodilatation.
Anesthetic or expectorant drugs.

If the cough is accompanied by bloody sputum, then the patient is prescribed an examination to identify its causes. If the bleeding is of cardiac origin, treatment can only be carried out in a hospital setting.

Drug therapy is not the only way to cure. Experts recommend lifestyle changes:

Make the right daily routine. Sleep at least 8 hours a day and avoid physical and nervous strain.
Stop drinking alcohol and cigarettes.
Eat right: limit the intake of fatty, salty and fried foods, do not overeat.
Walk outdoors more often.
Do not neglect physical activity, but in moderation. As you recover, physical activity can be increased.

With a heart cough, the doctor prescribes medications in combination. Thanks to diuretics, it is possible to eliminate excess fluid and lower blood pressure. Vasodilators dilate blood vessels, and coughing can be eliminated with the help of mucolytics.

Diuretics. And although these drugs are presented in a wide range, doctors most often prescribe the following options:

Indapamide. It is a long acting diuretic.

When using it, it is possible to prevent the penetration of sodium, chlorine, and hydrogen ions into the lymph. It has a slight vasoconstrictive effect. With pathologies of the heart, the drug is taken for 2-3 months in the morning, 1.25 mg.

Veroshpiron. It is a hormonal and potassium-sparing diuretic.

Its task is to stimulate the excretion of sodium and water from the body, reduce and flush out potassium ions, and reduce the level of urine acidity. With a heart attack of coughing, use it at 100 mg per day for 15 days.

Vasodilators This group of drugs should include the following:

Losartan. Its task is to lower the pressure in the pulmonary circulation in cardiac pathology.

Prevents sodium and water retention in the body. Reception to conduct for 6 weeks.

Atakand. This drug lowers blood pressure, inhibits the action of the hormone angiotensin. Reception is 8 mg once a day for 2-3 months.

Mucolytics To speed up the process of removing sputum and reduce the intensity of coughing, it is necessary to use the following medications:

Codeine. It has a narcotic effect, but it quickly stops the irritation of the cough center.

When used, it decreases pain syndrome. But it must be used with extreme caution, as drug dependence may occur. Apply the drug at 15-60 mg. The duration of the course can only be determined by a doctor.

Glaucine. It has a local anesthetic effect, effectively treats heart cough, has a calming effect on the autonomic nervous system, and lowers blood pressure.

Reception is carried out during the week, 50 g 3 times a day.

You can cure a heart cough with the help of alternative medicine. They cannot be used on their own, but only as adjunctive therapy. It is fashionable to consider such recipes as effective:

A decoction of oatmeal, which supports the work of the heart.

It is necessary to take raw materials in the amount of 100 g and pour 500 ml of water. Simmer on the fire, and place 1/3 cup of dried elecampane root to the cooled broth.

Again send to the stove, wait 2 hours, filter, add honey to improve the taste. Take 100 ml 3 times a day for 2 weeks.

Viburnum infusion. It treats heart pathologies and normalizes its work.

It is necessary to crush 20 g of ripe fruits, add 200 ml of boiling water. You can improve the taste of the medicine with the help of honey. Use within a month, 100 ml 2 times a day.

A decoction of herbs that soothes the heart and improves its work.

You need to mix 3 parts of yarrow and 1 part of lemon balm. Then add 1 part of valerian rhizome. For 20 g of raw materials there are 200 ml of boiling water. Wait 3 hours, filter and drink 200 ml throughout the day for 30 days.

Pumpkin pulp perfectly stops swelling and serves as a prophylactic. Grind 0.5 kg of pumpkin pulp and consume. If there is heart failure, then this remedy should be used constantly.
Garlic and lemon syrup effectively treats cough. Place 5 heads of garlic in a container, place 5 lemons and 500 g of honey. Close the jar tightly, wait 10 days, and then apply 10 g 4 times a day.

Heart cough is a very dangerous symptom that can indicate various pathologies of the heart. It is very important to be able to recognize it in time in order to immediately begin treatment. Moreover, therapy should be comprehensive, so as not only to stop coughing attacks, but also to normalize the work of the heart.

Healing elixir To treat a heart cough, prepare this potion.

Scald 10 large unpeeled lemons with boiling water and leave for 15 minutes. Squeeze the juice out of them, add 1 kg of linden honey and 10 crushed large heads (not cloves!) of garlic.

Mix thoroughly and pour into a jar. The medicine should be infused for 10 days in the refrigerator or in a cool, dark place. How to take: 1 teaspoon before meals 4 times a day.

Such treatment should be used for several months until all unpleasant symptoms go away. This drug relieves arrhythmia and other heart diseases at an early stage.

Additionally, you can use other folk remedies.

Herbal mixture with honey. For the treatment of heart cough, a recipe created by Carpathian healers is also suitable.

A full glass of dill seeds should be ground in a coffee grinder and mixed with 2 tbsp. grated valerian root.

Add 2 cups of liquid honey and mix again, pouring about 1 liter of boiling water into the product. Infuse the medicine for several days. How to take: 1 tablespoon 3 times a day before meals.

Continue treatment for 2-3 months. With arrhythmia, such a drug should be drunk for several years.

Herbal collection No. 1. You can treat a cough of the heart with the following herbal collection:

Hawthorn inflorescence - 50 g;
Melissa leaves - 50 g;
Grass broom crown - 50 g;
Yarrow grass - 50 g;
Valerian root - 50 g.

How to use: Pour 1 tablespoon of the mixture with a glass of boiling water and insist for 20-30 minutes. Drink 3 times a day, 1 glass after meals. Additionally, you can use other folk remedies to strengthen the heart.

Herbal Compound #2 If you are suffering from heart cough, try this treatment:

Melissa leaves - 50 g;
Potentilla grass goose - 50 g;
Motherwort herb - 50 g.

How to use: pour 1 teaspoon of the mixture with a glass of boiling water and insist for 20-30 minutes. The prepared drink should be drunk during the day in small portions.

Continue treatment until complete recovery and normalization of the heart.

Herbal collection No. 3. You can treat the disease with such a herbal drug:

Cumin seeds - 50 g;
Nettle leaves - 50 g;
Fucus vesicular leaves - 50 g;
Field horsetail herb - 50 g;
Knotweed grass - 50 g

How to use: Pour 2 tablespoons of the collection into 700 ml of boiling water and leave for 15 minutes, then strain. Drink warm drink 3 times a day 15 minutes before meals.

Herbal collection No. 4. If you have a cough due to heart disease, treatment with the following collection will give excellent results:

Motherwort herb - 50 g;
Hawthorn inflorescences - 50 g;
Hawthorn fruits - 50 g;
Grass lovage - 50 g;
Valerian root - 50 g;
Melissa leaves - 50 g;
Rose hips - 50 g;
Nettle leaves - 50 g;
Mistletoe grass - 50 g.

Pour 1 tablespoon of the mixture with a glass of boiling water, let it brew under the lid for 3 hours. Drink 3 times a day, 1 glass before meals.

To improve your condition, listen to a few simple tips:

Stop drinking and smoking to unload the cardiovascular system.
Regularly use moderate physical activity (swimming, easy running, aerobics).
Walk outdoors more often.
Try to sleep at least 8 hours a day.
Reduce the amount of salt you consume (this helps relieve swelling in the chest area).
Give up harmful products- smoked meats, fatty meats, pickles, fast food, carbonated drinks.
Learn relaxation techniques to reduce stress.
Eat 1 clove of garlic every day (it is very good for the cardiovascular system).

Cardiac pathologies require immediate therapeutic action, since if they worsen, there is a high probability of serious health consequences. One of the manifestations of heart failure can be the accumulation of fluid in the lungs, which is especially dangerous both for the health and life of the patient, since it entails disturbances in the functioning of the lungs, a danger in the possibility of serious damage to the respiratory tract of a person. Pulmonary edema in heart failure is accompanied by a number of characteristic manifestations, which makes it possible to timely detect the initial stage of the disease and begin its treatment.

According to medical statistics, the formation of fluid in the lungs can even lead to the death of the patient, since it interferes with normal gas exchange in the tissues, which is fraught with asphyxia (suffocation). And among the most dangerous cardiac diseases, it is pulmonary edema, which develops against the background of progressive changes in the work of the heart and in heart failure, is one of the leaders in the number of deaths. It can affect people of almost any age, of any gender. However, diseases are most often detected in the elderly, in those who are prone to bad habits in the form of excessively frequent use. alcoholic beverages smoking, drug use.

What is

With pronounced disturbances in the process of contraction of the heart muscle, a significant weakening of the overall cardiac activity occurs, which entails a decrease in the speed of all processes occurring during the work of the heart. There is a pronounced stagnation in the tissues of the heart, which leads to a congestive process in the lungs.

Accompanied by a constant deterioration in the movement of blood through the arteries of the capillaries of the heart muscle, heart failure also leads to stagnation in the tissues of the lungs. At the same time, there is a gradual accumulation of fluid in them. The structure of the lungs is such that with any negative changes, there is a violation of the process of oxygen supply to the alveoli, they swell over time, accumulating fluid in themselves.

The progression of this pathological process goes at a high speed, and given that the initial stage of the disease can be relatively asymptomatic, the detection of fluid accumulation in the lungs can occur at a more advanced stage, when treatment should be more active and intensive.

Since any damage to the heart muscle is often accompanied by some disturbances in the functioning of target organs (including the lungs), it is necessary to pay the necessary attention in a timely manner to any change in the condition and functioning of the heart. Insufficient attention to the functioning of the myocardium can result in irreversible consequences, therefore, knowledge of the most striking manifestations of this disease will help preserve the health, and in some cases, the life of the patient.

Characteristic symptoms

With the development of pulmonary edema, there is an increase in swelling of the tissues of the lungs, they cease to function normally, as a result of which there is a gradual development of suffocation. The lack of oxygen in the body is accompanied by a significant deterioration in the general condition of the patient, many current processes in the body change. But the most characteristic manifestation of this condition should be considered a pronounced lack of oxygen in the tissues, which causes asthma attacks.

Stagnation in the lungs leads to a gradual disruption of the processes of oxygen delivery to other organs and systems, while there is a pronounced division of the pathological process into several stages, which differ in their manifestations and depth.

Stages of pulmonary edema in heart failure

Today there is a certain technique for separating such a phenomenon as congestion in the lungs. At the same time, three stages are distinguished: the initial, more advanced and the last stage, in which the symptoms are more pronounced, but the treatment is already more effective, using more aggressive medications.

When stagnation is just beginning to form, the following manifestations are noted:

there is an unreasonable cough;
breathing quickens even without receiving a significant load (physical, emotional or psychological);
when listening to the chest, wheezing is noted, which gradually become audible even when breathing;
shortness of breath develops.

As the congestion progresses, the symptoms worsen, their intensity increases, and the frequency of manifestations becomes more frequent.

At a more advanced stage of the development of edema, there is an attachment to the above manifestations of deterioration in breathing - each breath is given to the patient with increasing difficulty, while there is a significant severity of lack of air. Also added is a gradual increased heartbeat, shortness of breath.

At the last stage, the symptoms already allow you not to confuse the current disease with anything:

wheezing is heard in the lungs even without special listening;
breathing becomes more and more difficult;
there is a pronounced lack of oxygen, even with the initial signs of suffocation;
the cough becomes more and more wetter.

Confusion, the appearance of fear (panic attacks), wheezing become more and more audible, there is a loss of consciousness during attacks of suffocation, the patient cannot take a horizontal position due to a noticeable complication of breathing: the semi-sitting position becomes the most convenient for him. With an increase in asthma attacks, the skin acquires a stinky shade, when coughing, a significant amount of mucus begins to be released, the patient's condition deteriorates sharply. Heavy breathing is accompanied by the appearance of cold sweat, swelling of the veins in the neck and face, as well as compression in the chest and loss of consciousness.

Mandatory hospitalization at a late stage of the development of the disease avoids the negative consequences of this cardiac lesion, and with a special neglect of the pathological process, the death of the patient, since more frequent asthma attacks can lead to irreversible consequences in the lungs and heart. Therefore, with any negative changes in the functioning of the heart and lungs, which are accompanied by any of the above symptoms, you should immediately consult a doctor for assistance. Self-treatment often does not bring tangible positive results and becomes the cause of death of the patient.

Causes of the disease

When the heart ceases to cope with its functions, there is a gradual imbalance of many systems in the body. As medical practice shows, cardiac diseases are most often accompanied by the formation of fluid in the lungs, which is due to the greatest susceptibility of lung tissue to negative changes in the functioning of the myocardium.

Therefore, it is precisely the negative changes in the process of the heart that cause the danger of pulmonary edema. The lungs, being one of the target organs, receive a large load when negative changes in the work of the heart are detected. In addition to heart failure, the following conditions should be attributed to the causes that can cause disturbances in the functioning of the lungs:

cardiosclerosis;
myocardial infarction;
insufficiency in the work of the left ventricle;
chronic disorders in the work of the myocardium;
noted violations in the functioning of the left atrium (systole);
systole dysfunction;
diastolic pathology.

The listed pathological conditions and diseases can lead to serious health problems, as well as in the functioning of the lungs, which provokes the accumulation of fluid in them, and this process has a high development rate. Therefore, the detection of violations at the earliest possible stage allows you to respond to diseases in a timely manner, to prevent its aggravation and the transition to a more advanced stage.

Provoking factors

However, there are still a number of conditions that can be attributed to provoking pulmonary edema. They may not be independent diseases, however, with a long course, and even more so with their chronic form, they can provoke the occurrence of pulmonary edema.

Provoking factors include:

kidney failure;
trauma of any nature of the brain;
bronchial asthma;
thrombosis of blood vessels;
atherosclerosis of blood vessels;
oncological processes in the lung;
poisoning the body with prolonged inhalation of toxic fumes;
tuberculosis.

The appearance of swelling of lung tissues is usually provoked by existing heart lesions, therefore it is heart disease that should be considered the main cause of the development of pulmonary edema and the accumulation of fluid in them.

The gradual disruption of the functioning of the heart muscle leads to disturbances in the processes of blood circulation, the capillaries gradually lose their elasticity, an increase in the permeability of their walls begins to be noted. This leads to an increase in blood pressure inside the capillaries, and as a result of the aggravation of this process, there is a gradual accumulation of fluid in the tissues of the lungs - this is how edema is formed in them.

Therapeutic method for pulmonary edema

If a condition such as pulmonary edema is detected in the presence of chronic heart failure, the patient should be immediately hospitalized. The provision of first aid consists in giving him a semi-sitting position of the body, in which breathing becomes easier, as well as in providing free access to the lungs. This is achieved by removing any pinching resulting from tight clothing, and windows should also be opened to allow free access of air to the patient.

For elimination especially unpleasant symptoms the patient is given a nitroglycerin tablet for resorption under the tongue. However, this measure should not be applied when reduced level blood pressure or when the patient is unconscious. Next, the patient's legs are placed in a basin of moderately hot water for the speedy outflow of blood from the heart, diuretics are given, allowing to obtain approximately the same effect.

Further therapeutic therapy should be carried out in a complex manner, which makes it possible to obtain more pronounced results with less time.

Basic principles of inpatient therapy

During hospitalization, the patient undergoes the following therapeutic measures, which allow both to reduce the characteristic symptoms of the current disease and improve his general condition:

Carrying out inhalations to eliminate the appearance of foam during breathing - oxygen and alcohol are used.
With increased pain, narcotic drugs are used.
Diuretics (diuretic drugs) remove excess fluid from the body.
Antipsychotics are used to stabilize the psychological state of the patient.
With the manifestation of heart failure due to the introduction of infection into the body, an antibacterial effect is carried out.

These measures help to quickly eliminate the most acute manifestations of pulmonary edema in current heart failure, and traditional medicine methods can also be used to increase their effectiveness. However, treatment with folk remedies can only act as an additional treatment that will stabilize the general condition of the patient and quickly return his body to normal functioning.

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Causes of the disease

Depending on the condition that led to pathophysiological disorders in the lungs, cardiogenic, or cardiac, and its non-cardiogenic variants are distinguished.

Cardiac pulmonary edema(acute left ventricular failure), can complicate the course of diseases such as:

Acute myocardial infarction is the cause of pulmonary edema in 60% of cases.
Chronic heart failure - in 9%.
Acute cardiac arrhythmias - in 6%.
Heart defects (acquired and congenital) - in 3%.

Non-cardiogenic pulmonary edema occurs in 10% of cases of all emergency conditions and is due to any of the following reasons:

The development of non-cardiogenic pulmonary edema is carried out through several mechanisms at once - a damaging effect on the capillary-alveolar membrane of toxic agents, an increase in blood volume with a significant intake of fluid intravenously, protein metabolism disorders in diseases of the internal organs, dysfunction of the cardiovascular system, disorders of the nervous regulation of the function of external respiration in diseases of the central nervous system.

Unfortunately, not only people, but also pets are susceptible to the occurrence of this condition. The causes of pulmonary edema in cats and dogs are most often distemper, inhalation of hot air, overheating of the body and heat stroke, pneumonia, poisoning with toxic gases.

Symptoms of the disease

With a cardiogenic nature, an increase in symptoms is possible in a few days before the onset of pronounced signs of pulmonary edema. The patient is disturbed at night by episodes of cardiac asthma - shortness of breath (respiratory rate of 30 per minute or more), obsessive cough without sputum and difficulty in breathing. These are signs of interstitial edema, in which the liquid part of the blood accumulates in the lung tissue, but has not yet penetrated into the alveoli.

Further, the liquid is in the alveoli and foams under the stream of passing air. There is a cough with pink sputum of a frothy nature, accompanied by bubbling breathing and wheezing, audible to others.

The general condition is severe - there is a sharp weakness, cold sweat, severe pallor and coldness of the extremities, with further development, the bluish color of the skin rapidly increases - cyanosis. Arterial pressure decreases, pulse is frequent and weak. The patient experiences severe fear and anxiety, and breathing is possible only in a sitting position with emphasis on the hands (orthopnea).

Another variant of the development of edema is also possible, when, against the background of complete health, an already existing, asymptomatic heart disease makes its debut with the symptoms described above. For example, this variant occurs when asymptomatic myocardial ischemia leads to the development of a heart attack with acute left ventricular failure.

Non-cardiogenic pulmonary edema is clinically manifested by similar signs that suddenly developed, for example, after inhalation of a poisonous substance, against the background of high fever or during pneumonia.

In children initial signs of pulmonary edema are sometimes difficult to suspect if caused by bronchitis or pneumonia, due to the fact that the symptoms of the underlying disease are also manifested by coughing, wheezing and shortness of breath. In this case, parents should be alerted by such signs as sudden severe shortness of breath, sudden cyanosis of the skin of the face or extremities, bubbling breathing and the appearance of foamy sputum.

In some patients with cardiac pathology, left ventricular failure may develop several times, then it is called recurrent or chronic pulmonary edema. After successful relief of the previous edema in a hospital setting, after some time, the patient again develops signs of cardiac asthma, which, if the treatment is not corrected, turns into alveolar pulmonary edema. This option is prognostically unfavorable.

Diagnosis of the disease

You can suspect the diagnosis even at the stage of examining the patient on the basis of such signs:

typical complaints,
General serious condition
Indrawing of the intercostal spaces during breathing,
swelling of the neck veins,
Increased humidity, pallor and cyanosis of the skin.

Additional methods are used to confirm the diagnosis:

X-ray of the chest organs- diffuse darkening of the lung fields is determined, a decrease in the transparency of the lung pattern.

detects signs of myocardial infarction, rhythm disturbances and other heart diseases.
Chocardiography (ultrasound of the heart) visualizes internal cardiac structures, which is especially important for heart defects.
Insertion of a catheter into the pulmonary artery with the measurement of blood pressure in it is informative for the differential diagnosis of cardiogenic and non-cardiogenic pulmonary edema.

In the emergency department of the hospital, where the patient with pulmonary edema is delivered, it is sufficient to conduct an ECG and X-ray, since it is important for the patient to be taken to the intensive care unit as soon as possible, without wasting time on the examination. As the patient is removed from a serious condition, other diagnostic methods are prescribed.

At the prehospital stage it is important to distinguish pulmonary edema from bronchial asthma. The main differences are reflected in the table:

signs	Bronchial asthma
Dyspnea	Lengthened expiration	Lengthened breath
Breath	Whistling wheezes	Wet rales
Sputum	Lean, viscous, glassy	Abundant, pink, frothy character
Disease history	History of episodes of bronchial asthma, allergic diseases	History of cardiac disease
ECG signs	Right ventricular overload	Left ventricular overload

Treatment

Emergency care should be provided immediately, as soon as others notice signs of edema in the patient. The algorithm of actions is reduced to the following activities:

Calm the patient, give him a half-sitting position, lower his legs down,
Measure blood pressure and heart rate,
Call an ambulance, describing in detail the dangerous symptoms to the dispatcher,
Open window for fresh air
Reassure and explain to the patient that panic will aggravate his condition,
If blood pressure is within the normal range (110-120/70-80 mm Hg), take a nitroglycerin tablet under the tongue, if lower pressure - nitroglycerin is not recommended,
Place the patient's legs in a basin of hot water to reduce venous return to the heart,
If signs of clinical death appear (lack of consciousness, breathing and pulse on the carotid artery), proceed to chest compressions and artificial respiration with a ratio of 15:2 until the arrival of the medical team.

The actions of the emergency physician are as follows:

Removal and interpretation of the ECG,
Supply through a mask of humidified oxygen passed through a 96% solution of ethyl alcohol to reduce foaming,
The introduction of diuretics intravenously (furosemide), nitroglycerin (if blood pressure is reduced, then in combination with drugs that maintain its level - dopamine, dobutamine),
The use of drugs depending on the underlying disease - morphine or promedol in acute heart attack, antiallergic drugs (diphenhydramine, pipolfen, suprastin, prednisolone) in the allergic nature of the disease, glycosides (strophanthin, corglicon) in atrial fibrillation and other rhythm disturbances,
Immediate transport to a specialized hospital.

Treatment in a hospital is carried out in the intensive care unit. To stop pulmonary edema, intravenous infusions of nitroglycerin, diuretics, detoxification therapy are prescribed for the toxic nature of the disease. In diseases of the internal organs, appropriate treatment is indicated, for example, antibiotic therapy for purulent-septic processes, bronchitis, pneumonia, hemodialysis for renal failure, etc.

Prevention of pulmonary edema

Patients with cardiogenic pulmonary edema the underlying disease that caused such a dangerous condition should be treated. To do this, you must constantly take drugs prescribed by a doctor, for example, ACE inhibitors (enalapril, lisinopril, prestarium, etc.) and beta-blockers (propranolol, metoprolol, etc.). It has been reliably proven that these drugs significantly reduce the risk of complications and sudden death in heart disease. In addition to drug treatment, it is recommended to follow a diet with a decrease in the salt content in food up to 5 mg per day and with a volume of fluids consumed up to 2 liters per day.

With the non-cardiogenic nature of the disease, the prevention of re-edema is reduced to the treatment of diseases of the internal organs, the prevention of infectious diseases, the careful use of toxic drugs, the timely detection and treatment of allergic conditions, and the avoidance of contact with toxic chemicals.

Forecast

The prognosis for untimely seeking medical help is unfavorable, since respiratory failure is fatal.

The prognosis for emergency care provided on time is favorable, and for relapses of pulmonary edema, it is doubtful.

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Acute heart failure

This pathology is a severe, life-threatening condition. Characterized rapid development clinics as a result of a sudden drop in myocardial contractility and a decrease in cardiac output.

The causes leading to the development of acute insufficiency are:

inflammatory, dystrophic diseases of the heart;
bradyarrhythmias, tachyarrhythmias;
myocardial infarction (large focal transmural);
pulmonary embolism;
hypertensive crisis;
state of decompensation of chronic heart failure.

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There are the following clinical forms of acute insufficiency:

congestive - includes right ventricular and left ventricular failure, manifested by stagnation of circulating blood;
hypokinetic - accompanied by the development of cardiogenic shock.

Symptoms of acute heart failure:

Left ventricular heart failure leads to a delay in circulating blood in the area of the small circle. In this case, acute pulmonary edema develops, which is manifested by the following symptoms:

Increasing shortness of breath, up to suffocation.
Forced position of the body, sitting, as in a horizontal position there is a deterioration in ventilation of the lungs.
Cough with frothy sputum.
Distant moist rales in the lungs during breathing.
Cardiopalmus.
Cyanosis of the skin and mucous membranes.

With significantly pronounced hypertension in the vessels of the lungs, cardiopulmonary insufficiency develops. The main cause of this condition is pulmonary embolism. Symptoms of pathology are:

sudden onset of shortness of breath at rest;
cyanosis of the lips;
acute chest pain;
with pulmonary infarction - hemoptysis.

Right ventricular heart failure is manifested by stagnation of circulating blood in the area of the systemic circulation, which can be determined by the appearance of the following symptoms:

swelling of the neck veins;
pain in the right hypochondrium due to the development of portal hypertension, venous congestion and liver enlargement, which is accompanied by stretching of the capsule;
in case of acute necrosis of the hepatic parenchyma, jaundice may occur;
development of ascites (accumulation of fluid in the abdominal cavity).

The total form of the disease is characterized by combined signs of hemodynamic disturbances.

Cardiogenic shock is manifested by symptoms such as:

decrease in blood pressure, decrease in pulse pressure;
decreased urine output or complete absence of urination;
the appearance of sinus tachycardia;
coming out of cold, clammy sweat;
marbling of the skin.

Chronic heart failure (CHF)

It has a wider distribution and is the predominant form of the disease in clinical practice. The frequency of diagnosis increases with age. So, most often the symptoms of CHF are detected in the elderly (in the age group of 60-80 years).

Reasons for the formation of CHF

The factors leading to the development of pathology include the following diseases:

arterial hypertension;
myocarditis, dilated cardiomyopathy;
chronic ischemic heart disease: small focal infarction, postinfarction cardiosclerosis;
lung diseases (chronic obstructive pulmonary disease, pneumonia);
diabetes.

In men, the symptoms of the disease often develop after suffering an acute myocardial infarction. In women, the leading factor in the formation of chronic heart failure is arterial hypertension in combination with diabetes mellitus. In children, congenital anomalies in the development of the heart come to the fore as a cause.

Signs of CHF

With a long course of the disease, there are dysfunctions of all parts of the heart. IN clinical picture The main symptoms of heart failure can be identified:

fast fatiguability;
shortness of breath, cardiac asthma;
peripheral edema;
heartbeat.

Complaints of rapid fatigue are presented by the majority of patients. The presence of this symptom is due to the following factors:

low cardiac output;
insufficient peripheral blood flow;
state of tissue hypoxia;
development of muscle weakness.

Shortness of breath in heart failure increases gradually - at first it occurs during physical exertion, then it appears with minor movements and even at rest. With decompensation of cardiac activity, the so-called cardiac asthma develops - episodes of suffocation that occur at night.

Signs of cardiac asthma:

acute, sudden onset;
a feeling of lack of air, a violation of inspiration;
the appearance of suffocation;
at first dry cough, then there may be separation of frothy sputum.

Peripheral edema includes:

swelling of the legs (feet, shins) - symmetrical on both limbs, from barely noticeable in the form of a trace from the gum of socks, to pronounced;
accumulation of fluid between the sheets of the pleura, pericardium;
the appearance of ascites, anasarca.

The skin in the area of edema has a cyanotic color. Tachycardia is a compensation reaction due to the presence of chronic oxygen starvation of tissues. Often there are rhythm disturbances (permanent or paroxysmal form of atrial fibrillation, ventricular premature beats).

Classification of heart failure

Two complementary classifications have been widely used, reflecting the severity of the existing changes.

Domestic classification (Vasilenko-Strazhesko) implies a division into stages:

Stage 1 CHF - hemodynamic disturbances occur only during exercise.
Stage 2a - there are symptoms of hemodynamic disturbances in one circle of blood circulation, reduced exercise tolerance.
Stage 2b - severe, there are pronounced hemodynamic disturbances in both circles;
Stage 3 - terminal, significant hemodynamic disturbances, structural changes in organs.

The New York Heart Association distinguishes 4 functional classes depending on exercise tolerance:

I functional class (I FC) - physical activity is not limited.
II functional class - physical activity is moderately limited.
III FC - there is a pronounced limitation.
IV FC - the inability to make any movements without discomfort.

Causes of death in heart failure

Life-threatening conditions that require emergency care include:

the appearance of ventricular arrhythmias;
acute pulmonary edema;
exudative pericarditis, accompanied by cardiac tamponade.

Heart failure treatment

Indications for hospitalization are:

clinic of acute heart failure;
newly diagnosed heart failure in people of working age;
ineffectiveness of the therapy, decompensated chronic insufficiency.

Chronic heart failure in the stage of compensation is treated on an outpatient basis. At the prehospital stage, the following methods are used:

Compliance with the principles of nutrition - the diet is enriched with foods high in potassium, salt intake is significantly limited, and fluid intake is controlled.
Dosed physical activity - should be adequate to the patient's capabilities, breathing exercises, walking are useful.
Drug therapy - drugs with a proven positive effect on the prognosis and quality of life are used. These are drugs from the group of angiotensin-converting enzyme inhibitors, sartans, adrenoblockers, aldosterone antagonists, cardiac glycosides. With significant edema, diuretics are prescribed, diuretic herbs are additionally used. In addition, statins, nitrates, anticoagulants, antiarrhythmic drugs are used.
Surgical methods - installation of a pacemaker, an implantable cardioverter-defibrillator, myocardial revascularization operations.

Timely adequate treatment in the early stages of the development of the disease can slow down the progression of the disease, improve the prognosis and have a significant impact on the quality and life expectancy of such patients.

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Etiology

With changes in blood flow velocity, pulmonary edema is inevitable. Gas exchange is also disturbed in the system, which causes breathing problems. This is due to heart failure, which, in turn, develops against the background of the following diseases:

Clinical form of ischemic myocardial necrosis
Deformation of the heart muscle and valves due to the proliferation of connective tissue
Defects in the structures of large vessels and the heart
Disruption of the ventricles
Chronic pathologies of the heart
Extrasystolic arrhythmia
heart attack
Injuries
Thromboembolism
Arterial hypertension
Arrhythmia.

In addition to diseases against which heart failure develops, followed by pulmonary edema, there are a number of provoking factors that provoke congestion:

Frequent respiratory illnesses
Diabetes
Physical and psycho-emotional overstrain
kidney failure
Taking drugs that contribute to the retention of fluids in the body
Rapid weight gain leading to obesity
Alcoholism
Rheumatism
Increase in blood volume during infusions
Infectious pathologies
Thyroid dysfunction with high hormone levels
Hypervolemia
Anaphylactic or septic shock
Intoxication.

Pathogenesis

The respiratory system of a healthy person contains about 600 ml of blood. Under the influence of some factors, the volume may increase. To prevent this from happening, there is oncotic pressure. The walls of the capillaries are permeable to water and substances with a low molecular weight, but for protein compounds they are too dense. The rate of passage of fluids depends on hydrostatic pressure, which is a direct function of the heart. When certain pathologies cause a reduction in albumin synthesis, oncotic pressure decreases, which leads to the development of edema.

Vascular diseases often begin at an early age and are not always treated despite obvious symptoms. Over time, pathologies progress, with age, heart failure often occurs against their background. At the initial stage, fluid is filtered into the interstitial tissues. Due to impaired blood circulation, reabsorption into the vascular bed occurs at a reduced rate.

Further, conditions are formed when the walls become permeable, so surfactants and protein elements enter the alveolar tissues. There they combine with air, creating a foamy mass that prevents the access of oxygen. As a result, gas exchange is disrupted. Hypoxemia entails pulmonary edema and pressure, which provokes increased blood flow to the right ventricle. At the same time, osmotic pressure increases, microcirculation in the small circle is disturbed even more, exudate effusion into the alveolar regions increases. Thus, a cyclicity is obtained - pulmonary edema develops due to heart failure, but the reverse process also contributes to the progression of the pathology.

The pathogenesis of the disease is classified according to the following principle:

Myocardial infarction - as the cause of edema. In this case, the source of the disease is the right ventricle. When its ability to pump blood is reduced, capillary pressure increases dramatically. If there is also vasoconstriction due to hypotension or hypoxia, the disturbances that have arisen are maintained for a long time, which leads to pulmonary edema.
With hypertension, the process is similar, with the only difference being that the aortic valves suffering from insufficiency are involved in it.
Overexcitation of the nervous system, hypothermia, physical stress, fears lead to redistribution of blood flow with accumulation in the respiratory organs. This reduces osmosis, which causes pulmonary edema.
In patients with nephropathy, metabolite retention occurs. Accumulated substances increase capillary permeability, resulting in nephrosis. A large release of proteins entails massive edema and the accumulation of toxic substances in various organs.
After cranial and brain injuries, the right ventricle begins to work in an enhanced mode. This leads to impaired microcirculation, heart failure and pulmonary edema.

There are two main types. The first is patients suffering from hypertension, cardiac lesions against the background of high blood pressure, rheumatic pathologies, lesions of the cerebral vessels. Treatment is to reduce flow to the right heart valve.

The second type of patients are people with normal blood pressure or mild hypotension who have had a heart attack, stenosis, or gas poisoning. In such patients, the use of glycosides can lead to more pulmonary edema and exacerbate heart failure.

Symptoms

There are two forms of heart failure. The first is an acute type with dysfunction of one of the departments. The main clinical manifestations are edema and asthmatic symptoms, which are expressed in the following factors:

Acute choking at night
Feeling of fear
severe weakness
Arrhythmia
Increased sweating
Coughing fits with poor expectoration
Pale skin
Weak pulse.

If the symptoms increase, pulmonary edema, respiratory failure develops. The patient takes a characteristic posture, when coughing, foam with blood impurities is released along with the secret. The cervical veins swell, the patient complains of pain in the chest and cardiac region. This condition is critical and requires emergency care and immediate treatment.

Symptoms in chronic heart failure are similar, but there are some differences. The skin becomes yellowish. There is distension of the abdomen, the liver increases in size. Shortness of breath persists at rest. The cough is persistent and is accompanied by characteristic wheezing. A specific symptom is the retention of salt and water in the body. Because of this, both internal and external edema are formed. They are located mainly on the lower extremities, in the ankle area.

Diagnostics

The first principle of examination is a visual examination of the patient. In case of heart failure, pulmonary edema, the patient has symptoms by which the doctor can determine the pathology in order to provide emergency care even before the full diagnosis begins. On auscultation and percussion, wheezing and sounds are present. In addition, when listening, it turns out the localization of fluid accumulation and the spread of the process to the pleural region. For a more thorough examination, the patient undergoes a number of procedures already in the hospital:

Treatment methods

With symptoms of pulmonary edema in heart and respiratory failure, first of all, emergency care is required. Before the arrival of doctors, it is necessary to seat the patient in order to ensure the outflow of blood to the lower extremities. It is important to open windows for free access of oxygen. Nitroglycerin is given to a person if blood pressure is elevated, which is absolutely impossible to do at low rates and when the patient is unconscious. You can moisten gauze with an alcohol solution so that the essential vapors facilitate the breathing process. With a mild degree of flow, hot foot baths are made.

Ambulance doctors upon arrival proceed to urgent measures:

Two catheters are installed - to monitor arterial and pulmonary pressure.
To expand the vessels, morphine is administered intravenously at a dosage of 3-5 mg. The tool also helps to calm the patient, eliminate the feeling of fear.
To get rid of hypoxemia, artificial ventilation and forced delivery of 1005 oxygen are used.
Diuretics reduce edema and reduce venous backflow. For this, Furosemide is used parenterally in a dosage of 40-100 mg or Bumetadine in an amount of 1 mg.
Sodium nitropusside relieves the burden on the heart, it is administered by infusion at a dose of 30 mcg / min, provided that blood pressure indicators are not lower than 100 mm Hg.
To reduce bronchospasm, Aminophylline is used intravenously at a dosage of 300-400 mg. It also increases the ability of myocardial contractility.
Dopamine and Dobutamine inhibit the secretion of prolactin, they are often used in heart disease and shock in the amount of 1 mg / in.

After providing first aid, the patient is taken to the hospital for further treatment. In rare cases, the patient undergoes procedures on an outpatient basis. Pharmacological therapy can prolong and improve the quality of human life. For these purposes, the following drugs are prescribed:

Glycosides

Cardiotonics of plant origin with antiarrhythmic properties. They are able to normalize the work of the myocardium, inhibiting the synthesis of adenosine triphosphate enzymes. Means increase the concentration of calcium, regulate the interaction of actin-myosin compounds. The mechanism of their action is based on the solubility of glycosides and their binding to protein elements, which allows normalizing the permeability of arterial walls. As a result, the frequency of contractions decreases, the heart rate slows down.

The group includes cardiotonic drugs with an average and prolonged duration of action. These are Digoxin, Strofantin, Korgglikon. They are made on the basis of foxglove, lily of the valley, adonis. Contraindicated in allergies, blockade conditions of the cardiac system, impaired atrioventricular conduction.

Nitrate preparations

Drugs that dilate blood vessels and relax smooth muscles. The mechanism of action is the conversion of active substances into nitrogenous oxides, which implies relaxing properties. They easily penetrate all barriers, are well absorbed by mucous membranes, so they can be used in any pharmacological form. Along with a decrease in vascular resistance, drugs reduce the reverse venous course. Medicines reduce the need for oxygen and normalize metabolism. This helps to redistribute blood flow in favor of the ischemic lesion zone.

Conventionally, nitrates are divided into short-acting and long-acting formulations. The first includes Nitroglycerin and Isosorbide, which provides assistance in the first 60 minutes of an attack. Angibid, Trinitrol - representatives of the prolonged effect group. They are contraindicated in high intracranial pressure, hypotension.

Adrenoblockers

Category of drugs with cardiac effects. They act on the production of catecholamines, which have inotropic properties. Thus, they reduce the contraction of the heart, inhibit conduction, normalize tone respiratory organs. At high doses, drugs are able to stabilize membranes, preventing them from leaking. In patients with normal blood pressure, there is no effect, however, medications reduce elevated rates. Also, beta-blockers regulate metabolic processes, causing increased glycogenolysis.

There are non-selective agents - Timolol, Nadolol and compositions with selective properties - Atenolol, Metaprolol. Contraindications are cardiogenic shock, asthma, allergies. Be wary appoint in diabetes.

Diuretics

Means prevent the retention of excess fluid in the body. They quickly remove water and saline solutions, thereby helping to reduce swelling. Their use is possible with a positive sodium balance, but they are not used in the chronic form of pathology. In case of heart failure, powerful loop agents are prescribed. They create optimal concentrations within 2 hours and keep it for 18 hours. Act until the normalization of electrolyte balance.

The group includes Furosemide, Torasemide, Diuver, Mannitol. Medicines are used intravenously or infusionally. May cause adverse reactions in the form of dyspeptic disorders. Contraindicated in hypokalemia, hepatic cirrhosis. Control of administration is required for pathologies of the heart and insufficiency.

Prevention and prognosis

If untreated, complications may develop - atelectasis, secondary infections, ischemic lesions, hypoxia. If the swelling process is slow, there is every chance to stop the attack. Therapy in the early stages of the disease completely compensates for the condition. Further human health depends on the severity of the course, the accompanying background, the effectiveness of treatment. The prognosis is poor with rapidly developing edema. In this case, the risk of death is high.

Prevention of lesions of the cardiac and respiratory system consists in the prevention and timely treatment of diseases that can lead to insufficiency. People who are at risk, with a previously diagnosed pathology, should be constantly monitored by a cardiologist.

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Edema in heart failure treatment