Left heart failure

Introduction Left heart failure refers to a clinical syndrome caused by a significant decrease in myocardial contractility or a significant increase in cardiac load for a certain period of time, resulting in a sharp decrease in cardiac output and a sharp increase in pulmonary circulation pressure. The clinical manifestations are acute pulmonary edema, severe dyspnea, cyanosis, coughing pink foamy sputum, critical illness, rapid onset of cardiogenic shock, coma and death. Mainly due to pulmonary congestion caused by pulmonary congestion, decreased cardiac output and low organ perfusion.

Cause

1. Acute extensive anterior wall myocardial infarction and primary dilated cardiomyopathy associated with coronary heart disease.

2. Acute left ventricular preload is too heavy, senile valvular disease such as mitral regurgitation, aortic regurgitation. Complications of acute myocardial infarction in patients with coronary heart disease, papillary muscle infarction, ventricular septal perforation, etc.

3. Acute left ventricular afterload, hypertension, especially rapid or malignant hypertension, primary obstructive cardiomyopathy, severe aortic stenosis, excessive use of vasoconstrictors.

4. Left atrial failure: mainly seen in severe mitral stenosis, occasionally in the left atrial myxoma or huge thrombus obstruction of the mitral valve.

5. Severe arrhythmia: tachyarrhythmia (such as malignant ventricular arrhythmia) or significant bradycardia.

6. Congenital heart disease: patent ductus arteriosus, ventricular deficiencies, a large number of left-to-right shunts, etc., more common in children, the elderly are rare.

7. Others: such as low cardiac output after surgery, infection, etc.

an examination

Related inspection

Electrocardiogram, cardiac vascular ultrasonography, pulmonary capillary wedge pressure

1. General inspection

Including blood biochemistry, electrolytes, urine routines, electrocardiograms, etc.

2. X-ray inspection

The left ventricle is enlarged, the hilar shadow is enhanced, and the lungs have cloud-like shadows during pulmonary edema.

3. Ultrasound ECG

1 Evaluation of cardiac function: systolic function and diastolic function.

2 found basic heart disease and other conditions that have an impact on heart failure.

4. Other

Radionuclide examination, heart-lung oxygen exercise test, cardiac catheterization and coronary angiography.

Differential diagnosis

1, bronchial asthma: cardiogenic 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 often without phlegm 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. Difficulty in breathing, cyanosis, wet voice 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.

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