Sunday, October 14, 2012

Heart failure


Heart failure (HF) is a condition in which abnormal cardiac function is responsible for the inability of the heart to pump blood to the extent that they meet tissue metabolism, or it is achieved with the increased pressure load cardiac cavities.


The cause of

There are many possible causes for SI: myocardial diseases - coronary heart disease, cardiomyopathy, myocarditis, infiltrative myocardial disease, hypertension, aortic stenosis and pulmonary valve, aortic and mitral insufficiency, congenital heart defects, tireotoksokoza, anemia, pregnancy, beri-beri, then damage infarction drugs, ionizing radiation. As precipitating factors are: infection, anemia, pulmonary embolism, pregnancy, thyrotoxicosis, myocardial infarction, infective endocarditis, stress, increased salt intake.

Forms of heart failure
Most often encountered:

• SI with low and high volume minutnum
• Acute and chronic NE
• Failure of the left and right heart
• NE-type congestion and hypoperfusion
• Systolic and diastolic heart failure

The clinical picture

Dyspnea (breathing disorder) is definitely the first and foremost sign of SI, and occurs as a result of increased respiratory effort. In the initial phase occurs only during exercise, but later becomes present at rest.
Ortopnea - dyspnea in the supine position, caused by crossing the fluid from the abdomen and lower chest in ekstermiteta. Patients noted that in the course of the night, trying to sleep on a low pillow, with a feeling of being short of breath, coughing and shortness of breath.

Paroxysmal nocturnal dyspnea - short attacks of breathing and coughing that occur at night, be patient from sleep. While the sheer ortopnea lost when the patient sits down with his feet, in this case, coughing and wheezing persist in this position.

Acute pulmonary edema - a patient has severe dyspnea so that there is a sense of imminent threat to life and suffocation, anxious is abundant sweat, cough and sputum and blood-stained.The frothy sputum, and playing with audible rales in the chest.

Fatigue, weakness, reduced effort tolerance are common symptoms of SI. Also, there are anorexia, nausea, vomiting, dull pain in the liver. In elderly patients due to poor blood supply of the brain caused confusion, reduced concentration, memory, headache, insomnia. Contribute to insomnia and frequent nighttime urination.

Cardiac islands - around the ankles and lower legs, most pronounced in the evening, doughy, formed under the influence of gravity.

The liver is enlarged, painful, later becoming firmer, ascites (accumulation of fluid in the abdomen), jaundice caused by liver damage.

There may be other signs: pale, cold and damp ekstermiteti, decreased urination, low concentration of sodium in the urine, a positive albumin in the urine.


Diagnosis
It is based on history, physical examination, x-ray of the heart and lungs, ultrasound.


Treatment

The problem is the treatment of HF in the fact that a single rule for the treatment of these patients is not formulated because of varying etiology, hemodynamic images, clinical manifestations and severity of NE. The first measure is certainly decreased physical activity and reduce salt intake. If this is not enough, it begins drug therapy combination of diuretics, ACE inhibitors, and digitalis. The next step is a rigorous salt restriction and use of diuretics stronger. If no effect is applied the hospitalization, strict restrictions salts, intravenous vasodilators, positive inotropic agents, and others.

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