Effective treatment of heart failure
March 07, 2021Heart failure is the heart's inability to maintain adequate cardiac output to meet the body's metabolic needs.
Based on pathophysiology and differences in treatment methods, people are divided into:
Acute heart failure: acute pulmonary edema, cardiogenic shock, acute decompensation of chronic heart failure.
Chronic heart failure:
Systolic dysfunction occurs when the heart's ability to pump blood is reduced (ejection fraction (EF) is reduced).
Diastolic dysfunction occurs when the elasticity of the ventricular chamber is reduced, thereby receiving poor blood.
Clinical manifestations
Symptoms of reduced cardiac output: fatigue, poor exercise tolerance, reduced peripheral perfusion, severe heart failure with reduced perfusion of vital organs; Decreased renal perfusion, decreased cerebral perfusion eventually leading to shock.
Manifestations of pulmonary and systemic venous congestion: difficulty breathing when lying down, difficulty breathing on exertion, paroxysmal nocturnal dyspnea, peripheral edema, distended neck veins, pleural effusion, pericardial effusion, hepatic congestion, ascites.
In young children (£1 year old) and newborns, the clinical manifestations of heart failure are different from those of older children and adults. The usual manifestations are: the child refuses to breastfeed, does not gain weight and develop, breathes rapidly, sweats a lot, if the left atrium is too large, it can compress the left pulmonary bronchus, causing lung collapse, the child often has lung infections. Physical examination also shows an enlarged liver, often facial edema, rarely limb edema or ascites, and cold hands and feet.
Paraclinical
X-ray
Can show an enlarged heart, pulmonary congestion, and pleural effusion.
Electrocardiogram
Depending on the cause, ECG does not help assess heart function.
Echocardiogram
Measure the size of the heart chambers, examine the condition of the heart valves, regional disorders, and assess left ventricular function with reduced ejection fraction < 45 - 50% in cases of clear left ventricular systolic dysfunction.
BNP (brain natriuretic peptide)
Pre pro-BNP is formed in the ventricles, consisting of 2 components N-terminal-pro-BNP (NT-pro-BNP) and BNP. These hormones are highly reliable and specific in diagnosing and excluding heart failure. BNP is especially valuable in distinguishing cardiac dyspnea from dyspnea due to pulmonary diseases, especially useful in the emergency resuscitation department.