Sudden left heart failure

Introduction Acute left heart failure refers to a sudden decrease in left ventricular discharge due to various reasons, resulting in severe left ventricular and left atrial diastolic blood pressure, acute pulmonary blood stasis.

Cause

Causes of sudden left heart failure:

1. Myocardial infarction associated with coronary heart disease, especially acute extensive anterior myocardial infarction, papillary muscle and chordae rupture, ventricular septal rupture and perforation;

2. Inflammatory endocarditis caused by valvular perforation and chordae rupture caused by valvular acute reflux;

3, other: high blood pressure of hypertension increased rapidly, the original heart disease based on rapid arrhythmia or severe slow arrhythmia; blood transfusion, excessive infusion, too fast.

an examination

Related inspection

Two-dimensional echocardiography Doppler echocardiography M-mode echocardiography (ME) ECG

Diagnosis of sudden left heart failure:

Acute left heart failure mainly manifests as sudden dyspnea, especially at night with paroxysmal dyspnea. The patient cannot lie flat and can only sit and breathe. Shortness of breath, frequent, up to 30 to 40 beats / min, while the patient has a feeling of suffocation, pale complexion, cyanosis, irritability, sweating, cold skin, coughing, coughing out of serous foam, severe coughing Red foam sputum, and even respiratory depression, suffocation, mental disorders, shock, sudden death, etc. According to the typical symptoms and signs of the patient, it is not difficult to make a diagnosis if the sudden difficulty of breathing, coughing pink foam, and the lungs are covered with wet rales.

Differential diagnosis

Differential diagnosis of sudden left heart failure:

1, bronchial asthma: Cardiac asthma and bronchial asthma have sudden onset, cough, dyspnea, asthma and other symptoms, the two principles of treatment are very different. Bronchial asthma is a reversible obstructive pulmonary disease with increased airway resistance. Patients often have a history of repeated asthma or a history of allergies. Young people are more common. Bronchial asthma cough is often no sputum or sticky white sputum, combined with infection cough and jaundice, often signs of emphysema, unless pneumonia or atelectasis, generally no wet voice, cardiac examination is normal. Pulmonary function tests have increased airway resistance and increased blood eosinophils (eosophilic cell counts often >250 to 400/l).

2, adult respiratory distress syndrome (ARDS) ARDS also known as shock lung, wet lung, pump lung, adult hyaline membrane disease. Difficulties in breathing, cyanosis, wet rales of the lungs, wheezing sounds, etc. are easily confused with acute left heart failure. ARDS generally has no history of lung disease, and the disease process that can directly or indirectly cause acute lung injury can cause the syndrome. Common diseases are lung trauma, drowning, shock, cardiopulmonary bypass, bacterial or viral pneumonia, and toxic pancreatitis. Often on the basis of the primary disease, or 24 to 48 hours after the onset of the disease, dyspnea is severe but less forced to sit breathing, hypoxemia is progressively worse, ordinary oxygen therapy is ineffective or poor. Although there is asthma with lung wet sound, cardiac examination has no galloping and heart enlargement and cardiac organic murmur. The treatment of cardiogenic asthma often has no significant effect, and the floating catheter shows the pulmonary wedge compression pressure <15mmHg (1.99kPa). End-expiratory positive pressure ventilation is effective. ARDS often combines multiple organ failure.

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