Sudden decompensation of cardiac function

Introduction Cardiac decompensation occurs when heart disease becomes more severe and heart function declines beyond its compensatory function. (Heart failure is a group of syndromes caused by various cardiac structures or functional diseases leading to ventricular filling and/or impaired ejection ability. Due to decreased ventricular systolic function, impaired ejection function, cardiac output The quantity can not meet the needs of the body's metabolism, the blood perfusion of organs and tissues is insufficient, and the pulmonary circulation and/or systemic circulation congestion occurs at the same time. The clinical manifestations are mainly dyspnea, weakness and physical activity limitation and edema. The treatment of the disease should include prevention and prevention. Delay the onset of heart failure, relieve symptoms of clinical heart failure, improve long-term prognosis and reduce mortality.

Cause

Heart disease is getting worse and worse, and heart function is declining beyond its compensatory function. Almost all types of heart and macrovascular diseases can cause heart failure. Heart failure reflects the pumping dysfunction of the heart, which is the systolic and insufficiency of the heart muscle. From the perspective of pathophysiology, myocardial systolic dysfunction can be roughly divided into primary myocardial damage and due to long-term cardiac capacity and/or stress overload, resulting in the final development of myocardial function from decompensation to decompensation. Two major categories:

1. Primary myocardial damage: coronary heart disease myocardial ischemia, myocardial infarction, myocarditis, cardiomyopathy, etc. can lead to heart failure.

2. Cardiac overload: seen in hypertension, aortic stenosis, pulmonary hypertension, pulmonary stenosis; valvular insufficiency, left and right heart or arteriovenous shunt congenital cardiovascular disease such as septal defect, patent ductus arteriosus Wait.

an examination

Related inspection

ECG dynamic electrocardiogram (Holter monitoring)

(1) The heart rate is accelerated, and the blood output of the heart is reduced:

Early in heart failure, heart rate compensatory speeding, although it helps to increase cardiac output to or near normal levels, however, increased heart rate also increases myocardial oxygen consumption, and coronary blood supply and ventricular filling time is shortened, and The blood output per heart drop is reduced by the amount of blood per stroke.

(2) Water, sodium and sputum slip:

A decrease in cardiac output causes redistribution of blood and a decrease in renal blood flow. A decrease in renal blood flow may result in a decrease in glomerular filtration rate or an increase in renin secretion, which in turn acts on angiotensinogen produced by the liver to form angiotensin I. Angiotensin I undergoes pulmonary and renal circulation, and under the action of invertase, it forms angiotensin II, which in addition to causing systemic and renal arterioles to aggravate renal ischemia, also promotes the secretion of more aldosterone from the adrenal cortex. Increases sodium retention, increases plasma osmotic pressure, stimulates osmotic receptors near the suprachiasmatic nucleus of the hypothalamus, and reflexively increases secretion of antidiuretic hormone in the posterior pituitary, causing sodium, water retention, increased blood volume, veins and capillaries Congestion and increased pressure.

(C) increased ventricular end diastolic pressure:

In heart failure, myocardial contractility is reduced, cardiac output is reduced, residual blood volume in the ventricular chamber is increased, ventricular end-diastolic pressure is increased, venous return is blocked, causing an increase in venous stasis and venous pressure, when capillary hydronephrosis When the pressure increases beyond the plasma osmotic pressure and tissue pressure, the capillary fluid is extravasated and the tissue is edematous.

Differential diagnosis

Cardiac decompensation: When heart disease becomes worse and heart function declines beyond its compensatory function, cardiac decompensation occurs.

Atrial-to-ventricular contraction of auxiliary pump loss: common in atrioventricular block, impulsive is blocked during atrioventricular conduction. Divided into two categories of incompleteness and completeness. The former includes first- and second-degree atrioventricular block, the latter also known as third-degree atrioventricular block, and the block can be in the atria, atrioventricular node, His bundle and double bundle. At the time of complete atrioventricular block, the temporal relationship between the atrium and the ventricle is separated, and the atrial pumping of the ventricular contraction is lost, resulting in a decrease in cardiac output. According to typical ECG changes combined with clinical manifestations, it is not difficult to make a diagnosis. In order to estimate the prognosis and determine treatment, it is necessary to distinguish between physiological and pathological atrioventricular block, atrioventricular bundle block and three-branch block, and the degree of block.

Sudden left heart failure: 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. The main manifestations are: sudden breathing difficulties, especially paroxysmal dyspnea at night, the patient can not sit flat, 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.

Sudden right heart failure: acute right heart failure refers to a sudden decrease in right ventricular myocardial contractility or a sudden increase in right and left ventricular load due to some reasons, resulting in a sharp decrease in right heart discharge. Clinical syndrome. Acute right heart failure is more common in acute massive pulmonary infarction and acute right ventricular infarction.

Sudden cardiac death: refers to the unexpected sudden death caused by various heart diseases. The World Health Organization (WHO) stipulates that death within 6 hours after onset is sudden death, and most authors claim to be within 1 hour.

Cardiac arrest: refers to the sudden termination of the heart's ejection function, the aortic pulsation and heart sound disappear, important organs such as severe brain ischemia, hypoxia, leading to life termination. This unexpected sudden death is medically known as sudden death. The most common cause of cardiac arrest is ventricular fibrillation. If the patient is called without a response, the patient will be in a coma if there is no response to the pressure and the armpit. Then pay attention to observe the patient's chest and abdomen with or without undulating breathing. If there is no pulsation of the carotid artery and the femoral artery, the heartbeat can not hear the heartbeat, and the patient can be judged to have a cardiac arrest.

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