Swelling of propaedeutics

1. Classification of heart failure

Classification of heart failure by GF Lang, ND Strazhesko, V. Kh. Vasilenko.

This classification was created in 1953. According to her, heart failure is divided into acute and chronic. Acute circulatory insufficiency consists of three stages:

1) acute right ventricular failure - marked stagnation of blood in a large range of blood circulation;

2) acute left ventricular failure - an attack of cardiac asthma, pulmonary edema;

3) acute vascular insufficiency - collapse.

The first stage is the absence of subjective andobjective symptoms at rest. Physical exercise is accompanied by the appearance of dyspnea, weakness, rapid fatigue, palpitations. In rest these symptoms quickly stop.

The second stage is divided into two sub-stages:

1) symptoms of dyspnea, weakness appear at rest, but are moderately expressed. During physical exertion, they increase significantly, and therefore the volume of performed loads decreases;

2) signs of heart failure, stagnationblood on a small and large circle of blood circulation are expressed and at rest. Patients complain of shortness of breath, which increases with little physical stress. An objective study confirms changes in the body: there are ascites, sometimes significant, swelling of the legs, diffuse cyanosis.

The third stage is terminal, final, in this stage, all violations in organs and systems reach a maximum. These changes are irreversible.

Classification of heart failure of the New York Association of Cardiologists. According to this classification, cardiacInsufficiency is divided into four functional classes depending on the load that the patient can perform. This classification determines the patient's ability to work, his ability to perform certain activities without the appearance of complaints characterizing heart failure. The functional class does not necessarily correspond to the stage of chronic heart failure. If, according to the stage, heart failure usually progresses, then the functional class can either increase or decrease (depending on the therapy).

The 1st functional class includes patients withdiagnosis of heart disease, but not having physical activity limitations. Since there are no subjective complaints, the diagnosis is based on the characteristic changes in the stress tests.

The 2nd functional class is characterized bymoderate restriction of physical activity. This means that patients do not present complaints at rest. But the daily, habitual load leads to the appearance of shortness of breath, palpitation, fatigue.

3-rd functional class. Physical activity is limited significantly, despite the absence of symptoms at rest, even moderate daily exercise leads to shortness of breath, fatigue, and palpitations.

4-th functional class. Restriction of physical activity reaches a maximum, even at rest there are symptoms of heart failure, with minor physical exertion they are aggravated. Patients tend to minimize daily activity.

2. Clinical forms of heart failure. Acute and chronic insufficiency of the right heart. Subjective, objective symptoms

Heart failure When the heart can not be deliveredorgans and tissues then the amount of blood that corresponds to their needs. Right ventricular failure is a condition where the right ventricle is unable to perform its function and blood stagnation occurs over a large range of blood circulation. Right ventricular heart failure can be acute and chronic.

Acute right ventricular failure. The cause of acute right ventricularInsufficiency may be pulmonary embolism, myocardial infarction with interventricular septal rupture, myocarditis. Often, acute right ventricular failure results in a fatal outcome.

Clinical picture characterized by a sudden appearance in the patientcomplaints of chest pain or discomfort, shortness of breath, dizziness, weakness. On examination, diffuse pallid cyanosis, swelling of the cervical veins. Percussively determined increase in liver size, relative cardiac dullness due to the displacement of the lateral right border of the heart. Arterial pressure is reduced, with a pulse, tachycardia is noted.

Chronic right ventricular failure develops gradually. The cause of its occurrence may be heart defects, accompanied by increased pressure in the right ventricle. When the volume of blood flowing into the right ventricle increases, its myocardium is not able to compensate for a long time such a condition, and then chronic right ventricular failure develops.

This is characteristic of the final stage of such defects,as a mitral valve insufficiency, mitral stenosis, stenosis of the aortic aorta, tricuspid insufficiency, myocarditis. Increased stress on the right ventricle occurs in the final stage of the development of chronic obstructive bronchitis. Chronic heart failure is the main cause of death of these patients.

Clinical manifestations develop gradually. Appear complaints of patients for shortness of breath, palpitations- First, with physical exertion, and then at rest, a feeling of heaviness in the right hypochondrium, weakness, fatigue, sleep disturbance, sometimes note dyspeptic complaints (nausea, flatulence, constipation). On examination, the patients look thin, have a cyanotic skin tone, swelling of the cervical veins, increased in the horizontal position of the body, edema. Edema in heart failure is initially localized on the lower limbs and occurs toward the end of the day, decreasing after a night's sleep. With the progression of the process, edema can spread to the body cavity, ascites, hydrothorax. Percussively determine the increase in liver size, widening the boundaries of relative cardiac dullness to the right. Auscultation reveals muffled heart tones, a rapid heart rate, and sometimes a three-member rhythm of the canter is heard.

3. Acute and chronic insufficiency of the left heart. Subjective, objective symptoms

Acute left ventricular failure - a condition characterized by stagnation of blood bya small circle of blood circulation. It arises as a result of the inability of myocardium of the left ventricle to carry out the load assigned to it. The cause of this condition are myocardial infarction, severe myocarditis, acute intoxication, hypertension. Manifestations of acute left ventricular failure are cardiac asthma and pulmonary edema. The left ventricle is not able to cope with the burden imposed on it, as a result of this stagnation of blood on a small circle of blood circulation. Hydrostatic pressure in the pulmonary capillaries increases. The equilibrium between hydrostatic and oncotic blood pressure in the capillaries of the lungs is disturbed, and this leads to the exit of the liquid part of the blood into the interstitial tissue of the lung. The liquid can not be completely removed from the interstitial tissue of the lung and begins to enter the alveoli. There comes the alveolar pulmonary edema. Clinically stagnant blood in the lungs and developmentInterstitial edema is manifested by cardiac asthma. Cardiac asthma is accompanied by complaints about a feeling of severe shortage of air, shortness of breath, cough may appear.

Upon examination, the patient assumes the position of orthopnea with legs lowered (blood vessels are deposited in the vessels of the lower extremities, and the patient's condition is facilitated). Acrocyanosis is noted.

When auscultation over the lungs are listened tohard breathing, an abundance of dry wheezes. Auscultation of the heart: heart sounds are muffled, tachycardia, accent of tone II over the pulmonary artery. With the progression of the condition and the adhesion of the pulmonary edema, there is an abundant separation of pink foamy sputum. With auscultation, an abundance of moist wheezing is noted during this period, especially in the lower parts of the lungs, tachycardia persists, and a three-member rhythm of the canter can be heard.

Swelling of the lung is often the cause of death.

The causes of its occurrence may be defectsHeart, characterized by an increase in the volume of blood entering the left ventricle. However, myocardium is quite powerful and can compensate for such violations for a long time, so left ventricular failure develops after a long time after the onset of the disease. This is a deficiency of the aortic valve, mitral valve. In addition, chronic left ventricular failure often develops at the end of ischemic heart disease, hypertensive disease.

Patients complain of a cough, usually dry (sometimeswith blood, blood flow can be noted - hemoptysis), weakness, the appearance of dyspnea and palpitations with exercise or rest, increased weakness, fatigue. Examination of patients reveals cyanosis of the skin. At auscultation, hard breathing and dry wheezing in the lower calves of the lungs are noted. With percussion, decrease the mobility of the lower edge of the lungs.