| Materials for OBZh lessons for grade 11 | Academic Year Plan | First aid for acute heart failure and stroke

Life Safety Basics
Grade 11

Lesson 14
First aid
in acute heart failure and stroke

Acute heart failure

In most cases, it occurs with a weakening of the activity of the heart muscle (myocardium), less often - with heart rhythm disturbances.

The causes of acute heart failure   there may be rheumatic damage to the heart muscle, heart defects (congenital or acquired), myocardial infarction, cardiac arrhythmias when injecting large amounts of fluid. Heart failure can occur in a healthy person with physical stress, with metabolic disorders and vitamin deficiencies.

Acute heart failure   usually develops within 5-10 minutes. All pathological phenomena increase rapidly, and if the patient is not provided with urgent care, this can result in death. Acute heart failure usually develops unexpectedly, more often in the middle of the night. The patient suddenly wakes up from a nightmare, a feeling of suffocation and lack of air. When the patient sits down, it becomes easier for him to breathe. Sometimes this does not help, and then shortness of breath increases, a cough appears with the release of viscous sputum with an admixture of blood, breathing becomes bubbling. If the patient is not immediately provided with emergency medical care (Scheme 23), he may die.

Stroke

Stroke occurs with a sharp decrease in blood flow to one of the areas of the brain. Without proper blood supply, the brain does not receive enough oxygen, brain cells are quickly damaged and die.

Although for the most part, strokes occur in older people, they can happen at any age. More common in men than in women.

The causes of a stroke can be a blockage of a blood vessel by a blood clot or cerebral hemorrhage.

A blood clot causing a stroke usually occurs with atherosclerosis of the artery supplying the brain and blocks the blood flow, interrupting the flow of blood to the brain tissue supplied with this vessel.

The risk of clot formation increases with age, since diseases such as atherosclerosis, diabetes, hypertension are more common in older people. Improper nutrition, smoking also increase the predisposition to stroke.

Chronically elevated blood pressure or a swollen part of an artery (aneurysm) can cause a sudden rupture of the cerebral artery. As a result, part of the brain stops receiving the oxygen it needs for life. Moreover, blood accumulates deep in the brain. This compresses the brain tissue even more and causes even more damage to brain cells. A stroke from cerebral hemorrhage can happen unexpectedly at any age.

Symptoms of a stroke: severe headache, nausea, dizziness, loss of sensitivity on one side of the body, lowering of the corner of the mouth on one side, speech confusion, blurred vision, asymmetry of the pupils, loss of consciousness.

In a stroke, do not give the victim food or drink: he may be unable to swallow.

Questions and Tasks

1. In what cases does acute heart failure occur?

2. What are the causes of a stroke?

3. What complications in the body does a stroke cause and what consequences can there be from it?

4. What are the symptoms of a stroke?

5. In what sequence should I provide first aid for acute heart failure and stroke?

Task 39

For first aid in acute heart failure you need:

a) overlay the victim with heating pads;
b) give the victim validol, nitroglycerin or corvalol;
c) call an ambulance;
g) spray on the face and neck of the victim with cool water and let him smell cotton wool moistened with ammonia;
d) give the victim a comfortable semi-sitting position in bed and ensure an influx of fresh air.

Place the indicated actions in the necessary logical sequence.

Task 40

One of your friends has a severe headache, nausea, dizziness, one side of the body has become less sensitive, there is an asymmetry of the pupils. Define:

a) what happened to your friend;
b) how to provide him first aid.

Summary of the lesson on life safety class 11FIRST AID MEASURES FOR ACUTE HEART FAILURE ANDSTROKE

The purpose of the lesson: To familiarize students with the general rules for the provision of PHC in acute heart failure and stroke.
  Lesson 6

Time: 45 minutes

Lesson Type: Combined

Educational visual
  complex: OBZh textbook grade 11, projector, PC, presentation on the topic, video on the topic of the lesson

DURING THE CLASSES

I. Introductory part *
  Organizing time

* Student knowledge control:

• What are the conditions and procedure for marriage in the Russian Federation?
• How does the Family Code of the Russian Federation determine the personal rights and obligations of spouses?
• How does the Family Code of the Russian Federation determine the property rights of spouses?
• How does the Family Code of the Russian Federation determine the rights and obligations of parents?

  II. Main part

• announcement of the topic and purpose of the lesson
• explanation of the new
    Material: § 15, pp. 74-77

Heart failure is a pathological condition characterized by failure
  blood circulation due to a decrease in the pumping function of the heart.

A stroke is an acute circulatory disturbance in the brain that causes brain tissue to die.

FIRST AID MEASURES IN ACUTE HEART FAILURE

The main causes of heart failure can be heart diseases: rheumatic diseases, heart attacks, myocarditis (myocardial inflammation in various diseases), as well as prolonged overload of the heart muscle, leading to overwork. The speed of manifestation distinguishes acute heart failure, which occurs almost suddenly or within a few hours, and chronic, developing within weeks, months, years. Acute heart failure most often appears in patients with acute myocardial infarction (heart disease caused by insufficiency of its blood supply), after physical overload in people with certain heart defects, with hypertension, with myocardium.

Chronic heart failure in the early stages of development is characterized by rapid fatigue, muscle weakness, a feeling of lack of air, and chilliness. Heart failure can occur with overload of the left departments (left ventricular failure) or with overload and damage to the right heart (right stomach failure).

Left ventricular malnutrition manifests itself as a decrease in cerebral circulation (dizziness, darkening in the eyes, fainting). With right pancreatic insufficiency, the cervical veins swell, cyanosis of the fingers, tip of the nose, ears, chin appears, slight jaundice and swelling of various degrees appear.

First aid for acute heart failure is provided according to its clinical manifestations and causes. AT general case   it is necessary to lay the patient on his back, turn his head to one side, provide him with air access and be sure to call a doctor.

First aid for a stroke The main causes of a stroke can be:

• hypertension (a disease characterized by an increase in blood pressure);
• atherosclerosis (a disease characterized by a decrease in the extensibility (elasticity) of large and medium arteries and a narrowing of the lumen between them, as a result - deterioration of the cardiovascular system;
• blood disease.

Stroke is divided into hemorrhagic (hemorrhage in the brain, under the membranes and ventricles of the brain) and ischemic (cerebral vascular thrombosis, non-thrombotic softening of the brain in the pathology of the carotid and vertebral arteries).

Hemorrhagic stroke occurs as a result of rupture of a pathologically altered blood vessel of the brain. It usually develops suddenly, often during the day after a mental or physical strain. There is a sudden loss of consciousness, down to a coma (a state of deep depression of the central nervous system, characterized by loss of consciousness and reaction to external stimuli, a dysregulation of vital functions of the body), the patient falls. There is an influx of blood to the face (hyperemia of the face), sweat on the forehead, increased pulsation of blood vessels in the neck, hoarse, loud, bubbling breathing; blood pressure rises, the pulse is sharp, sometimes there is vomiting. Eyeballs are often deflected to the side. Paralysis of the upper and lower extremities is determined on the side opposite to the center of hemorrhage in the brain, and speech impairment. Ischemic stroke (cerebral infarction) occurs more often with cerebral arteriosclerosis, lowering blood pressure, increased blood coagulation, as a result of blockage of the brain vessel by a blood clot.

Ischemic stroke is often preceded by cerebrovascular accident. Headache, dizziness, numbness of the extremities, fainting, and sometimes pain in the heart area appear. Limb paralysis develops gradually.

The course of a stroke has three options:

1. Favorable when impaired body functions are gradually restored.
2. Moving when the condition periodically worsens.
3. Progressive, with gradual deterioration and death.

First of all, the patient must be conveniently laid on the bed and unfasten clothing that makes breathing difficult. Turn your head to one side so that your tongue does not sink. Put a heating pad at your feet. Urgently call an ambulance. Evacuation of the patient is allowed only in the supine position and only with the paramedic.

Findings:

1. Any disease is a violation of health.
2. Circulatory disorders can lead to a stroke.
3. And acute cardiovascular failure, and stroke, if you do not provide first aid in time, can lead to death. Stroke is hemorrhagic and ischemic.

The structure of the cardiovascular system can be found in supplementary materials to this section, on page 77.

III. Material fastening:

• What is understood as heart failure?
• What is a stroke?
• What are the main causes of stroke?

IV. Lesson summary.

VI. Homework: § 15, pp. 74-77. Task: To study the procedure for the provision of PHC in stroke.

What is acute heart failure?

A complex of pathological changes occurring in the body as a result of a sudden inability of the heart to perform its pumping function is called acute heart failure and emergency care in this condition should be provided immediately, otherwise the probability of a fatal outcome is very high.

Acute failure often develops within a few minutes. It can form on the background of an existing cardiovascular pathology, as well as on the background of other diseases. There are not a few reasons leading to AOS, I want to give only the most common ones.

First aid for acute heart failure

Call an ambulance.

Emotionally calm the patient.

Provide oxygen access.

Before the arrival of doctors, the patient must ensure a semi-sitting position in bed with pillows. The goal is the outflow of blood to the lower extremities and to the organs of the abdominal cavity, to reduce intrathoracic blood volume.

Harnesses should be applied to the thigh area after 10-15 minutes. after the patient is brought into a semi-sitting position. This will exclude some of the circulating blood from the total volume.

Under the tongue, nitroglycerin 1-2 tablets., Every 10 minutes with mandatory control of blood pressure. Nitroglycerin can lower blood pressure. Sometimes such a timely approach to providing first aid to patients with acute heart failure gives positive results and after 5-15 minutes there is an improvement in the condition of patients.

In case of cardiac arrest, an artificial heart massage is required before the ambulance arrives.

All other measures to stop the signs of acute heart failure should be carried out only by medical personnel with the mandatory treatment of the underlying disease leading to AHF. The task of relatives is to provide first medical first aid.

A stroke is an acute violation of cerebral circulation, caused by either blockage of blood vessels and the termination of blood supply, or cerebral hemorrhage. Hemorrhage, as a rule, develops with high blood pressure.

Symptoms of a stroke are acute headache, dizziness, numbness and distortion of the face, weakness, impaired coordination and speech, blurred vision, loss of consciousness.

First aid for stroke

To make sure this is a stroke, ask the person to smile, clearly pronounce a word or raise both hands. If he doesn’t succeed, urgently call an ambulance. Accurately describe to the dispatcher everything that happened so that the specialized neurological team arrived.

The most effective treatment is possible in the first 3 hours from the moment of cerebrovascular accident. This is the so-called therapeutic window, when it is still possible to avoid the development of irreversible changes in the brain.

Patients with acute stroke should be hospitalized in a hospital equipped with equipment for computed tomography or magnetic resonance imaging. Only with its help is it possible to finalize the diagnosis, and, consequently, conduct adequate treatment.

Waiting for an ambulance - put a person to bed, giving him a comfortable half-sitting or lying position (as he is more comfortable). Do not let him get up, walk - this can cause complications.

Measure the pressure. If it is high, immediately give the patient the medicine that he usually takes to lower his blood pressure.

It is necessary to provide the patient with access to fresh air, at least open the window.

If a person faints, check breathing and pulse. If they are absent, do artificial respiration and heart massage. If there is breathing, turn your head to the side so that the person does not suffocate.

Ambulance doctors will give the patient stronger drugs to normalize blood pressure, heart function and blood composition.

Heart disease is one of the most dangerous conditions that require an immediate response. This is the only way to avoid extremely negative health consequences and eliminate the possibility of their rapid aggravation. Acute heart failure emergency care, which can be provided before the arrival of the ambulance team, requires quick action to stabilize the patient's condition, the elimination of the most severe manifestations of this pathological condition.

First aid for acute vascular insufficiency should contain a set of measures that can remove the dangerous manifestations of deterioration in the work of the heart, since it is they that can not only cause negative changes in the state of health of the victim, but also become a real danger to his life. After all, it is cardiological problems, according to medical statistics, that are the number one cause in terms of the number of deaths. And the acute form of such lesions is the most dangerous, especially in the presence of concomitant heart lesions.

Indicators of Acute Heart Failure

To assist, you must first establish the cause of the specific symptoms. And since the acute form of heart failure has quite characteristic manifestations, making a preliminary diagnosis will be simple. And knowledge of the basic methods for quickly stabilizing the patient's condition will allow you to wait for the arrival of the ambulance team and take the person out of the critical phase of the disease.

The following symptoms should be considered characteristic signs of acute insufficiency in the work of the heart:

• lowering blood pressure with an increased venous pressure;
• the occurrence of shortness of breath;
• arrhythmia or tachycardia;
• an increase in the size of the liver, which can be palpated even with palpation of the hands;
• swelling of the tissues, mainly the lower extremities;
• ascites or hydrothorax;
• low filling of the pulse, it is significantly reduced;
• increased epigastric pulsation;
• taking a half-sitting position in bed for patients.

Such manifestations can be added to such manifestations as swelling of veins in the neck and lower part of the head, their pulsation, which is noticeable even with the naked eye. An electrocardiogram shows the predominance of the work of the right side of the heart muscle. Assistance with the listed manifestations is a prerequisite for stabilizing the condition of the victim.

The fastest possible arrival of an ambulance or the delivery of a patient to a medical institution to provide him with the necessary assistance should be considered a prerequisite for eliminating the most dangerous manifestations of heart failure in acute form. When providing first aid, it is recommended first of all to place the victim in the most comfortable position for him (usually a sitting or half-sitting position with his legs down from the bed) and providing the necessary amount of fresh air by opening a window or window leaves and eliminating breathing obstruction (tightening clothes) .

Tasks of immediate assistance in acute heart failure

Since acute heart failure is a real danger not only to the health of the victim, but also to his life, first aid should be considered the main direction in the first hours after the detection of this condition.

The most important goals when performing certain manipulations to provide emergency care for heart failure include:

• increased intensity of the contractility of the heart muscle;
• a decrease in the hydrostatic pressure determined in the blood vessels of the pulmonary circulation;
• decrease in the degree of permeability of blood vessels and arteries;
• reduced circulating blood volume to facilitate heart function;
• elimination of the causes of hypoxia and its main consequences;
• decrease in the degree of impact of disturbed acid-base balance.

The above tasks should ideally be performed at a time, while both methods of drug exposure and physiotherapeutic manipulations can be used. Acute heart failure is accompanied by conditions in which emergency care can prevent both a significant deterioration in the patient’s health and negative consequences in the form of a pronounced violation of the basic functions of systems and individual organs (primarily the cardiovascular system).

The sooner emergency measures are taken for a person who has manifestations of acute heart failure, the more his health is preserved. However, an understanding of the mechanism of action of actions taken is necessary for a more objective assessment of the current state of the victim.

The sequence of therapeutic actions

A sharp decrease in myocardial contractility leads to a violation in the nutrition of heart cells. This is due to a change in the rhythm of the contractile movements of the heart muscle, as a result of which there is a decrease in the intensity of the intake of necessary amount of nutrients into the cells of cells for their normal functioning, as well as oxygen. As a result, a malfunction is noted in the work, first of all, of the heart, then of many internal organs. The initial signs of oxygen starvation are manifested - hypoxia.

If the first signs of acute heart failure are identified, the following steps should be taken:

1. Correctly place the victim. The best position is considered to be half-sitting in bed, legs lowered to the floor. In this case, a pronounced outflow of blood from the heart occurs, the process of myocardial work is facilitated - the patient ultimately feels better.
2. Since the development of heart failure primarily affects the contractility of the heart muscle, it is necessary to restore this process with the help of medications. For this, the following medicines can be used:

• any of the strongly acting cardiac glycosides is injected intravenously, which will normalize the functioning of the heart and maintain its necessary rhythm. Such agents with a pronounced and rapid cardiotonic effect include a 0.05% solution of strophanthin and a 0.06% solution of corglycon. A solution of strophanthin is administered at a rate of 0.5-0.75 ml intravenously, a solution of korglikon - 1 ml, previously dissolved in an isotonic sodium chloride solution;
• with extreme caution, a solution of fentanyl (0.002%) is also administered intravenously. The introduction (2 ml) is carried out with the lowest possible speed to prevent the negative impact on the state of the heart muscle;
• the introduction of a solution (0.25%) of droperzdol into the vein is used, which can also be used in combination with a solution of fentanyl to increase the intensity of the action;
• solutions of fentanyl and droperzdol can be administered in combination with diphenhydramine or suprastin to relieve a pronounced decrease in cardiac activity and provide some calming effect on the patient, since in acute heart failure the victim often experiences panic attacks.

1. The use of diuretic drugs allows you to slightly reduce the volume of circulating blood, which facilitates the myocardial work process. Such drugs with a diuretic effect can be used:

• furosemide in the form of a solution in a volume of 40-120 mg;
• ethacrylic acid - 65-150 ml.

1. To reduce the manifestations of lung dehydration, reduce the hydrostatic pressure and eliminate the manifestations of a reduction in venous return, antihistamines and antipsychotics are used in combination with ganglion blockers.
2. In order to reduce the degree of permeability of the walls of blood vessels, the use of osmotic diuretics, which can stabilize the state and functioning of the vessels, is connected to the treatment. These drugs include:

• mannitol solution (30 g of the substance are dissolved in 200 ml of glucose solution);
• glucocorticoids - prednisone, hydrocortisone.

Since the formation of pulmonary edema with the accumulation of fluid in the lungs is often accompanied by acute heart failure, it is necessary to aspirate the accumulating fluid during first aid. After this procedure, it is recommended to use antifoam agents - inhalation of a solution of ethanol or a 10% alcohol solution of antifomsilan.

The listed sequence of actions in providing emergency care to the patient allows you to eliminate the most obvious manifestations of the pathological condition, to prevent further aggravation of the current period of heart failure. The application of a tourniquet on the limbs should be considered as an additional method of therapeutic effect - this measure allows to reduce the speed of venous inflow.

Fainting in acute heart failure

A syncope in the situation under consideration is accompanied by a successive change in the following three stages in the patient's condition:

1. The harbinger of fainting, when there is a lack of air, the tendency to loss of consciousness prevails.
2. Directly fainting himself with loss of consciousness.
3. The recovery period, characterized by a gradual return of consciousness, is often observed slight muscle weakness, uncertainty in orientation.

The first stage, characterized as a harbinger of fainting, lasts for several seconds, subjective manifestations may occur in the form of blanching of the skin, muscle weakness and trembling, an unstable rhythm of heart contraction.

At the second stage, loss of consciousness is noted, the depth of this state is individual. With fainting, an even greater blanching of the skin occurs, which occurs due to a deterioration in the blood circulation process. The eyes are closed at this moment, the pupils are dilated, and the reaction to light is significantly slowed down. During the recovery period, normalization of the circulatory process, stabilization of the general condition of the patient occurs. The duration of this period can vary from a few seconds to several hours - a lot depends on the depth of the fainting that has occurred.

When cardiac collapse occurs and the above symptoms appear, first aid should be immediately provided to the victim. For the quickest withdrawal from a fainting state, it is recommended to use ammonia vapors, which contributes to the enlightenment of consciousness.

Heart failure: signs, forms, treatment, relief of exacerbation

Today, almost every person experiences chronic fatigue syndrome, expressed in rapid fatigue. Many are familiar with a rapid heartbeat or dizziness that occurs for no apparent reason; shortness of breath that occurs when walking fast or while climbing stairs on foot to the desired floor; swelling on the legs at the end of the day. But few people realize that these are all symptoms of heart failure. Moreover, in one manifestation or another, they accompany almost all pathological conditions of the heart and diseases of the vascular system. Therefore, it is necessary to determine what heart failure is and how it differs from other heart diseases.

What is heart failure?

With many heart diseases caused by pathologies of its development and other causes, there is a violation of blood circulation. In most cases, there is a decrease in blood flow to the aorta. This leads to the fact that stagnation of venous blood occurs in various organs, which violates their functionality. Heart failure leads to an increase in circulating blood, but the speed of blood movement slows down. This process can occur suddenly (acute course) or be chronic.

Video: heart failure - medical animation

Acute heart failure

All heart activity is carried out by the heart muscle (myocardium). Her work is affected by the condition of the atria and ventricles. When one of them stops working in normal mode, myocardial overstrain occurs. This can be caused by damage to the heart by various diseases or abnormalities that occur outside the heart. It can happen all of a sudden. This process is called acute heart failure.

Etiology of acute form

To its occurrence can lead to:

1. Pericarditis;
2. Coronary insufficiency;
3. Valvular malformations (prolapse, calcification);
4. Myocarditis;
5. Myodystrophy;
6. Chronic and acute processes in the lungs;
7. Increased blood pressure in the systems of small and large blood circulation.

Symptoms

Clinically acute heart failure manifests itself in different ways. It depends on in which ventricle (right (RV) or left (LV)) muscle strain occurred.

• In acute LV failure (it is also called "cardiac asthma"), seizures generally catch up at night. A man wakes up from the fact that he has nothing to breathe. He is forced to take a sitting position (orthopnea). Sometimes this does not help and the patient has to get up and walk around the room. He develops rapid (tachypnea) breathing, like a driven animal. His face takes on a cyanotic gray color, marked acrocyanosis is noted. The skin becomes moisturized and cold. Gradually, the patient's breathing from the rapid changes to bubbling, which is heard even at a great distance. There is a cough with foamy sputum of pink color. HELL - low. Cardiac asthma requires immediate medical attention.
• In acute right ventricular failure in the vena cava (lower and upper), as well as in the veins of a large circle, blood stasis occurs. There is a swelling of the veins of the neck, stagnation of blood in the liver (it becomes painful). Shortness of breath and cyanosis occur. The attack is sometimes accompanied by bubbling breath of Chain-Stokes.

Acute heart failure can lead to pulmonary edema (alveolar or interstitial), and cause cardiogenic shock. Sudden weakness of the heart muscle leads to instant death.

Pathogenesis

Cardiac asthma (the so-called interstitial swelling) occurs with the infiltration of serous contents into the perivascular and peribronchial chambers. As a result, metabolic processes in the lungs are disrupted. With the further development of the process, liquid penetrates into the lumen of the alveoli from the bed of the blood vessel. Interstitial pulmonary edema passes into the alveolar. This is a severe form of heart failure.

Alveolar edema can develop independently of cardiac asthma. It can be caused by prolapse of AK (aortic valve), LV aneurysm, heart attack and diffuse cardiosclerosis. Clinical trials provide an opportunity to describe the picture of what is happening.

1. At the time of acute failure, in the circulatory system in a small circle, there is a rapid increase in static pressure to significant values \u200b\u200b(above 30 mm Hg), which causes blood plasma to enter the lung alveoli from the capillaries. In this case, the permeability of the walls of the capillaries increases, and the oncotic pressure of the plasma decreases. In addition, the formation of lymph in the tissues of the lung increases and its movement in them is disturbed. Most often this is facilitated by an increased concentration of prostaglandin and mediators, caused by an increase in the activity of the sympathoadrenal system.
2. The retention of blood flow in the pulmonary circle and accumulation in the left atrial chamber contributes to a sharp decrease in the ventricular foramen. It is not able to miss the bloodstream in the LV in full. As a result, the pumping function of the pancreas increases, creating an additional portion of blood entering the small circle and increasing venous pressure in it. This is what causes pulmonary edema.

Diagnostics

Diagnosis at the doctor's office shows the following:

• When conducting percussion (tapping to determine the configuration of the heart, its position and size) in the lungs (its lower sections), a blunt, boxy sound is heard, indicating stagnation of blood. Swelling of the mucous membranes of the bronchi is detected during auscultation. Dry wheezing and noisy breathing in the lungs indicate this.
• In connection with the developing emphysema of the lung border of the heart, it is difficult to determine, although they are enlarged. Heart rate is disturbed. Tachyarrhythmia develops (pulse alternation, gallop rhythm may occur). Cardiac murmurs, characteristic for pathologies of valve mechanisms, are heard, bifurcation and amplification of the II tone above the main artery of the lung.
• Blood pressure varies over a wide range. Increased and central pressure in the veins.

Symptoms of cardiac and bronchial asthma are similar. For an accurate diagnosis of heart failure requires a comprehensive examination, including methods of functional diagnostics.

• On x-rays, horizontal shadows are visible on the lower sections of the lungs (Curly line), indicating swelling of the partitions between its segments. The compression of the gap between the lobes is differentiated, the pattern of the lung is strengthened, the structure of its roots is vague. The main bronchi without visible clearance.
• When conducting an ECG, LV overload is detected.

The treatment of acute heart failure requires emergency medical therapy. It is aimed at reducing myocardial overstrain and increasing its contractile function, which will remove edema and chronic fatigue syndrome, reduce shortness of breath and other clinical manifestations. An important role in this is played by the observance of a sparing regime. The patient needs rest for several days, eliminating overvoltage. He should get enough sleep at night (night sleep for at least 8 hours), rest during the day (reclining up to two hours). Mandatory transition to diet with restriction of fluid and salt. You can use the Carrel diet. In severe cases, the patient requires hospitalization for treatment in a hospital.

Drug therapy

Video: how to treat heart failure?

Acute coronary insufficiency

With the complete cessation of blood flow in the coronary vessels, the myocardium lacks nutrients and lacks oxygen. Coronary insufficiency develops. It can have an acute (with a sudden onset) and chronic course. Acute coronary insufficiency can be caused by intense excitement (joy, stress, or negative emotions). Often it causes increased physical activity.

The cause of this pathology is most often vascular spasm, caused by the fact that in the myocardium due to impaired hemodynamics and metabolic processes, products with partial oxidation begin to accumulate, which lead to irritation of the receptors of the heart muscle. The mechanism for the development of coronary insufficiency is as follows:

• The heart is surrounded on all sides by blood vessels. They resemble a crown (crown). Hence their name - coronary (coronary). They fully satisfy the need of the heart muscle for nutrients and oxygen, creating favorable conditions for its work.
• When a person is engaged in physical work or simply moving, there is an increase in cardiac activity. At the same time, myocardial demand for oxygen and nutrients increases.
• Normally, the coronary arteries at the same time expand, increasing blood flow and providing the heart with everything necessary in full.
• During a spasm, the bed of the coronary vessels remains the same size. The amount of blood entering the heart also remains at the same level, and it begins to experience oxygen starvation (hypoxia). This is acute coronary artery insufficiency.

Signs of heart failure caused by coronary spasm are manifested by the appearance of angina pectoris symptoms (angina pectoris). A sharp pain compresses the heart, preventing it from moving. It can give to the neck, shoulder blade or arm on the left side. The attack most often occurs suddenly during physical activity. But sometimes it can come and at rest. At the same time, a person instinctively tries to take the most comfortable position to relieve pain. An attack usually lasts no more than 20 minutes (sometimes it lasts only one or two minutes). If an attack of angina pectoris lasts longer, it is likely that coronary insufficiency has gone into one of the forms of myocardial infarction: transient (focal dystrophy), small-heart attack or myocardial necrosis.

In some cases, acute coronary insufficiency is considered a type of clinical manifestation of coronary heart disease (coronary heart disease), which can occur without severe symptoms. They can be repeated several times, and a person does not even realize that he has a severe pathology. Accordingly, the necessary treatment is not carried out. And this leads to the fact that the condition of the coronary vessels is gradually worsening, and at a certain moment the next attack takes a severe form of acute coronary insufficiency. If medical assistance is not provided to the patient, myocardial infarction and sudden death can occur in a matter of hours.

Treatment of acute coronary insufficiency consists in the relief of angina attacks. To do this, use:

1. Nitroglycerine. You can take it often, as this is a quick, but short-acting drug. (With myocardial infarction, Nitroglycerin does not have the necessary effect).
2. The rapid withdrawal of the attack is facilitated by the intravenous administration of Eufillin (Syntofillin, Diafillin).
3. A similar effect is exerted by No-spa and hydrochloric Papaverine (subcutaneous or intravenous injection).
4. You can stop attacks by intramuscular injection of Heparin.

Chronic heart failure

With weakening of the myocardium caused by cardiac hypertrophy, chronic heart failure (CHF) gradually develops. This is a pathological condition in which the cardiovascular system cannot supply the organs with the blood volume necessary for their natural functionality. The beginning of the development of CHF proceeds secretly. It can only be detected by testing:

• A two-stage breakdown of the MASTER, during which the patient must climb and go down the stairs with two steps, each height is 22.6 cm, with the mandatory removal of the ECG before testing, immediately after it and after a 6-minute rest;
• On the treadmill (it is recommended to carry out annually for people over 45 years old, in order to detect cardiac abnormalities)
• Holter monitoring.

Pathogenesis

The initial stage of heart failure is characterized by a violation of the correspondence between cardiac output per minute and the circulating volume of blood in a large circle. But they are still within the normal range. Hemodynamic disorders are not observed. With the further development of the disease, all indicators characterizing the processes of central hemodynamics are already changed. There is a decline. Disturbed blood distribution in the kidneys. Excess water begins to linger in the body.

Both left ventricular and right ventricular cardiovascular failure may be present. But sometimes it’s difficult to differentiate types. In a large and small circle, stagnation of blood is observed. In some cases, stagnation of only venous blood is observed, which overwhelms all organs. This significantly changes its microcirculation. The blood flow slows down, the partial pressure decreases sharply, the diffusion speed of oxygen in the cell tissue decreases. A decrease in lung volume causes shortness of breath. Aldosterone accumulates in the blood due to impaired functioning of the excretory pathways of the liver and kidneys.

With further progression of cardiovascular insufficiency, the synthesis of hormone-containing proteins decreases. Corticosteroids accumulate in the blood, which contributes to adrenal atrophy. The disease leads to severe hemodynamic disorders, a decrease in the functionality of the lungs, liver and kidneys of the liver and their gradual dystrophy. Water-salt metabolic processes are impaired.

Etiology

The development of heart failure is facilitated by various factors that affect myocardial tension:

• Overload of the heart muscle by pressure. This contributes to aortic insufficiency (AN), which may be of organic origin due to chest injury, aneurysm and atherosclerosis of the aorta, septic endocarditis. In rare cases, it develops due to the expansion of the aortic orifice. In AN, blood flow moves in the opposite direction (in the left ventricle). This contributes to an increase in the size of its cavity. The peculiarity of this pathology in a long asymptomatic course. As a result, LV weakness gradually develops, causing heart failure of the left ventricular type. The following symptoms accompany it:
  1. Shortness of breath during physical activity during the day and at night;
  2. Dizziness associated with abrupt rising or turning of the body;
  3. Palpitations and pains in the heart area with increased physical activity;
  4. Large arteries on the neck constantly pulsate (this is called "carotid dance");
  5. The pupils narrow and expand;
  6. A capillary pulse is clearly visible when pressing on the nail;
  7. Musse symptom (mild swaying of the head caused by pulsation of the aortic arch) is observed.
• An increased volume of residual blood in the atria. Mitral valve insufficiency leads to this factor. Pathology of MK can be caused by functional disorders of the valvular apparatus associated with the closure of the atrioventricular opening, as well as pathologies of organic origin, such as stretching of the chords or prolapse of the valves, rheumatic fever or atherosclerosis. Often, insufficiency of the MK leads to too much expansion of the circular muscles and fibrous ring of the atrioventricular opening, LV expansion caused by myocardial infarction, cardiosclerosis, cardiopathies, etc. Hemodynamic disorders in this pathology are caused by blood flow in the opposite direction (reflux) at the time of systole (back from the ventricle back in the atrium). This is due to the fact that the sash valves sag into the atrial chamber and do not close tightly. When more than 25 ml of blood enters the atrial chamber during reflux, its volume increases, which causes its tonogenic expansion. In the future, hypertrophy of the left atrial heart muscle occurs. In the LV, an amount of blood will begin to flow in excess of that which is required, as a result of which its walls hypertrophy. Gradually developing heart failure.
• Circulatory failure can develop due to the primary pathology of the heart muscle in the event of large focal heart attack, diffuse cardiosclerosis, cardiopathy and myocarditis.

It should be noted that most often the cause of the development of circulatory failure is a combination of several factors. A significant role in this is played by the biochemical factor, which is expressed in impaired ion transport (potassium-sodium and calcium) and adrenergic regulation of the function of myocardial contraction.

Stagnant form of heart failure

With circulatory disorders in the right atrium and ventricle, congestive heart failure of the right ventricular type develops. Its main symptoms are heaviness in the hypochondrium on the right side, decreased diuresis and constant thirst, swelling on the legs, and an enlarged liver. Further progression of heart failure contributes to the involvement of almost all internal organs in the process. This causes a sharp weight loss of the patient, the occurrence of ascites and impaired external respiration.

CHF therapy

The treatment of chronic heart failure is long. It includes:

1. Drug therapy aimed at combating the symptoms of the underlying disease and eliminating the causes that contribute to its development.
2. A rational regime, including the restriction of labor activity according to the stages of the disease. This does not mean that the patient should always be in bed. He can move around the room; exercise therapy is recommended.
3. Diet therapy. It is necessary to monitor the calorie content of food. It should correspond to the prescribed regimen of the patient. For fat people, the calorie content of food is reduced by 30%. And patients with exhaustion, on the contrary, are prescribed enhanced nutrition. If necessary, fasting days are held.
4. Cardiotonic therapy
5. Diuretic treatment aimed at restoring the water-salt and acid-base balance.

At the initial stage, treatment is carried out with vasolatators and alpha-blockers that improve hemodynamic parameters. But the main medications for treating chronic heart failure are heart glycosides. They increase the ability of the myocardium to contract, reduce the pulse rate and excitability of the heart muscle. The impulse patency is normalized. Glycosides increase cardiac output, thereby reducing diastolic pressure in the ventricles. At the same time, the oxygen demand of the heart muscle does not increase. An economical but powerful work of the heart is noted. The group of glycosides includes the following drugs: Korglikon, Digitoxin, Celanide, Digoxin, Strofantin.

Their treatment is carried out according to a special scheme:

• The first three days, in shock dosage to reduce tachycardia and relieve swelling.
• Further treatment is carried out with a gradual reduction in dosage. This is necessary so as not to cause intoxication of the body (glycosides tend to accumulate in it) and not lead to increased diuresis (they have a diuretic effect). With a decrease in dosage, the heart rate is constantly monitored, the degree of diuresis and shortness of breath is assessed.
• After the optimal dosage is established, at which all indicators are stable, maintenance therapy is carried out, which can last quite a long time.

Diuretics remove excess fluid from the body and eliminate leg swelling in heart failure. They are divided into four groups:

1. Ethacrylic acid and Furasemide - forced action;
2. Cyclomethaside, hydrochlorothiazide, clopamide - moderate;
3. Daytek (Triamteren), Spiranolactone, Amiloride, Veroshpiron - potassium-sparing diuretics intended for long-term use.

They are prescribed depending on the degree of imbalance of water-salt metabolism. In the initial stage for periodic intake, drugs of forced action are recommended. With prolonged, regular intake, it is necessary to alternate moderate-acting drugs with potassium-sparing. The maximum effect is achieved with the right combination and dosage of diuretic drugs.

For the treatment of congestive heart failure, which causes all types of metabolic disturbances, drugs that correct metabolic processes are used. These include:

• Isoptin, Fitoptin, Riboxin and others - calcium antagonists;
• Methandrostenolol, Retabolil - anabolic steroids that promote the formation of proteins and accumulate energy inside myocardial cells.

In the treatment of severe forms, plasmapheresis gives a good effect. With congestive heart failure, all types of massage are contraindicated.

For all types of heart failure, it is recommended to take disaggregants: Caviton, Stugeron, Agapurin or Trental. Treatment should be accompanied by mandatory prescription of multivitamin complexes: Pangexavit, Hexavit, etc.

Allowed treatment with alternative methods. It should complement the basic drug therapy, but not replace it in any way. Soothing remedies that normalize sleep and eliminate heart excitement are useful.

Strengthening of the heart muscle contribute to the infusion of flowers and berries of the hawthorn blood-red, rose hips. Fennel, caraway seeds, celery, parsley have diuretic properties. Using them fresh will help reduce the intake of diuretics. Excess fluid is well removed from the body by an infusion of birch buds, bearberry (bear's ear) and lingonberry leaves.

Medicinal plants in combination with bromhexine and ambroxol effectively eliminate cough in heart failure. The cough of hyssop soothes. And inhalation with eucalyptus extracts helps to cleanse the bronchi and lungs with congestive heart failure.

During therapy and subsequent rehabilitation, it is recommended to constantly engage in physical therapy. The doctor selects the load individually. It is useful after each lesson to take a cold shower or douche with cold water, followed by rubbing the body until a slight redness. This helps to harden the body and strengthen the heart muscle.

Classification of CHF

Classification of heart failure is carried out according to the degree of tolerance of physical activity. There are two classification options. One of them was proposed by a group of cardiologists N.D. Strazhesko, V.Kh. Vasilenko and G.F. Lang, who divided the development of CHF into three main stages. Each of them includes characteristic manifestations during exercise (group A) and at rest (group B).

1. The initial stage (CHF I) - proceeds secretly, without pronounced symptoms, both at rest and during normal physical activity. Small shortness of breath and heart palpitations occur only when performing unusual, harder work or increasing the load during the training process for athletes before important competitions.
2. Severe stage (CHF II):
   • Group CHF II (A) - manifested by the occurrence of shortness of breath while performing even the usual work with moderate load. It is accompanied by heart palpitations, cough with bloody sputum, swelling in the legs and feet. Blood circulation is disturbed in a small circle. Partial decrease in disability.
   • Group CHF II (B) - characterized by dyspnea at rest. The main signs of CHF II (A) are added constant swelling of the legs (sometimes separate parts of the body swell), cirrhosis, cardiac, ascites. Complete reduction in disability.
3. The final stage (CHF III). It is accompanied by serious hemodynamic disturbances, the development of a stagnant kidney, cirrhosis of the liver, diffuse pneumosclerosis. Completely disrupted metabolic processes. The body is exhausted. The skin takes on the color of a light tan. Drug therapy is ineffective. Only surgery can save the patient.

The second option provides for the classification of heart failure on a Killip scale (degree of intolerance to physical activity) into 4 functional classes.

• I f.k. Asymptomatic CHF, mild. There are no restrictions on sports and work.
• II f.k. During physical activity, palpitations and a shortness of breath occur. Fatigue is noted. Physical activity is limited.
• III f.k. Shortness of breath and palpitations occur not only under the influence of physical activity, but also when moving around the room. A significant limitation of physical activity.
• IV f.k. Symptoms of heart failure occur even at rest, intensifying with the slightest physical activity. Absolute intolerance to physical exertion.

Video: lecture on the diagnosis and treatment of heart failure for doctors

Circulatory failure in childhood

In children, circulatory failure can occur, both in acute and in chronic form. In newborns, heart failure is associated with complex and combined heart defects. In infants, early and late myocarditis leads to heart failure. Sometimes the cause of its development are acquired heart defects associated with pathology of valve mechanisms.

Heart defects (congenital and acquired) can cause the development of heart failure in a child of any age. In children of primary school age (and older), heart failure is often caused by the formation of rheumatic heart disease or rheumatic pancreatitis. There are extracardiac causes of heart failure: for example, severe kidney disease, hyaline membrane disease in newborns and several others.

The treatment is similar to the drug therapy of chronic and acute heart failure in adults. But unlike adults, small patients are assigned a strict bed rest, when he performs all the necessary movements with the help of his parents. Relief regime (allowed to read in bed, draw, and do homework) with CHF II (B). You can start independent hygiene procedures, walk around the room (light mode) when you have CHF in stage II (A). Mandatory intake of magnesium preparations (Magnerot) is recommended.

First aid for heart failure

Many people are in no hurry to provide themselves with the necessary medication in case of attacks of heart failure. Someone simply does not know what to do in such cases, others simply neglect treatment. Still others fear that the frequent use of potent drugs can become addictive to them. Meanwhile, if symptoms of acute coronary insufficiency occur, if treatment is not started in time, death can occur very quickly.

First aid for acute attacks of heart failure is to take a comfortable position and take a fast-acting drug (Nitroglycerin with Validol under the tongue).

You can take these drugs repeatedly. They do not accumulate in the body and are not addictive, but you should always remember that Nitroglycerin is able to significantly (and quickly) lower blood pressure, and, in addition, some patients simply can’t tolerate it.

People who are diagnosed with mild heart failure (I f.k. or CHF stage I) are shown a spa treatment. It has a preventive value and is aimed at increasing the functionality of the cardiovascular system. Due to the systematic, correctly selected alternation of periods of physical activity and rest, the heart muscle is strengthened, which prevents the further development of heart failure. But when choosing a sanatorium, it is necessary to consider that patients with cardiovascular diseases are contraindicated:

• A sharp change in climatic conditions,
• Moving over long distances,
• Too high and low temperatures
• High solar radiation.

Spa treatment is strictly prohibited for patients with severe clinical manifestations of heart failure.

Each disease, even banal ARVI, can further have a detrimental effect on the body, and what can we say about myocardial infarction, stroke, and other serious diseases?

Myocardial infarction without the provision of professional medical care can result in death in a short period of time. But if medical care was provided and the patient began to recover, in this case he should be prepared for possible complications and even death in the first year after the attack. It is worth noting that complications of myocardial infarction can occur both in the early stages and months after a seizure.

Complications are classified according to the time of their onset from the time of the attack, and they are:

• early, formed in the acute period of the disease;
• later, which formed in the cicatricial period.

Early complications

Early complications are the consequences of a heart attack that occurred after the first 28 days. This period is the most dangerous. So, the early consequences of myocardial infarction can be divided into the following groups:

• heart rhythm disturbance;
• acute heart failure;
• mechanical damage to the heart;
• thromboebolitic complications.

The early consequences of myocardial infarction are the most dangerous and for this reason, one of the main tasks facing doctors during this period is to prevent the development of complications.

Heart rhythm disturbance

The following complications belong to the group associated with cardiac arrhythmias:

1. Bradyarrhythmia.
2. Ventricular fibrillation and flutter.
3. Supraventricular and ventricular arrhythmias.

Bradyarrhythmia is a fairly common consequence of myocardial infarction, in which a healthy heart rhythm is disturbed. The main sign of this complication is a heart rate of less than 60 beats per minute, less commonly dizziness or loss of consciousness.

Ventricular fibrillation and flutter is a chaotic and frequent reduction. Symptoms of ventricular fibrillation are:

• low blood pressure;
• pallor;
• loss of consciousness;
• cramps
• dilated pupils.

In the case of diagnosis, it is urgent to conduct cardiopulmonary resuscitation and defibrillation.

The most common complication of an early period is arrhythmia. Almost 90 percent of people who survived myocardial infarction suffer from it. The main signs of arrhythmia include:

• rapid pulse;
• shallow breathing;
• dizziness;
• fatigue;
• fainting state;
• chest pains.

In case of arrhythmia, the patient needs urgent medical attention, as it can cause cardiac arrest.

Acute heart failure

The group of complications associated with acute heart failure can include:

1. Cardiogenic shock.
2. Pulmonary edema.

The state of cardiogenic shock has a high mortality rate. Indeed, because of it, over the shortest period, the pumping function of the heart decreases, thereby lowering the level of blood pressure and suffering internal organs. It is worth paying attention that cardiogenic shock develops quickly and sometimes even outstrips pain.

Cardiogenic shock is of the following types:

• reflex;
• arrhythmic;
• true.

Reflex cardiogenic shock occurs against a background of pain irritation. Its symptoms are lethargy, lethargy, grayish skin tone, cold sweat and low blood pressure. Cardiogenic shock of an arrhythmic type occurs against the background of the fact that the heart rate goes astray. The most dangerous type is a true shock, with a fatal outcome in it occurs in 90 percent. It is based on a sudden violation of the ability of the myocardium to contract due to large injuries and leads to a sharp decrease in cardiac emissions.

Pulmonary edema occurs during the first week after an attack of myocardial infarction. The main reason for its occurrence is acute heart failure. When making a conclusion about pulmonary edema, urgent medical attention is needed.

Mechanical damage to the heart

The group associated with mechanical damage to the heart includes the following complications:

1. Rupture and dysfunction of the papillary muscle.
2. Rupture of the outer wall of the ventricle.
3. Rupture of the interventricular septum.
4. Pericarditis.
5. Acute aneurysm of the left ventricle.

Rupture and dysfunction of the papillary muscle is the most dangerous form of mitral regurgitation. Symptoms are unexplained stagnation of blood in a patient followed by a quick exit. This complication occurs on the second or seventh day after the attack and requires instant treatment.

The rupture of the outer wall of the ventricle occurs due to the fact that during the attack the strength of the affected area is lost, and this under certain conditions can cause a rupture. This type of complication is very dangerous, as it is accompanied by severe bleeding, and can also cause cardiogenic shock. Signs of a break:

• chest pain
• pressure drop;
• fainting state;
• dyspnea;
• bluish tint of the skin;
• wheezing
• the pulse is weakly felt.

Rupture of the interventricular septum occurs during the first five days after the attack, and mainly people of retirement age, women, as well as people with hypertension or anterior heart attack suffer from it. Signs of a break:

• dyspnea;
• increase in heart volume;
• swelling of veins on the neck;
• changes in the size of the liver;
• noise in the chest area;
• heart rhythm disturbances.

Pericarditis is an inflammatory process, and it occurs in only 10 percent of patients who survive an attack of myocardial infarction. It develops if the patient has been affected by all three layers of the heart, and inflammation has developed on the pericardium. Signs of this complication are constant throbbing pains in the chest area, which intensify with a sigh and movement. This consequence can occur in the first four days, and is treated with aspirin.

The occurrence of acute left ventricular aneurysm is caused by an extended and deep myocardial infarction, as well as a repeated attack of a heart attack, arterial hypertension and heart failure. It occurs with a transmural type of heart attack. Symptoms of acute aneurysm are increasing left gastric insufficiency, pulsation, and others. It is worth noting that when a patient is diagnosed with acute aneurysm, surgical treatment is necessary, since it leads to rupture and is fatal.

Thromboembolism Complications

The group of complications associated with thromboembolitic complications include:

1. The formation of blood clots in the left ventricle.
2. Arterial thromboembolism.

Blood clots may occur in the heart cavity. If blood clots are located in the cavity, then they do not pose a danger, but when they leave the heart, then arterial thrombosis of another organ may occur, and can also trigger a stroke attack. Symptoms of a blood clot are the following factors:

• dyspnea;
• low blood pressure;
• dizziness;
• tachycardia;
• fainting state;
• chest pain;
• suffocation;
• pallor.

Arterial thromboembolism is a complication caused by blockage of blood vessels by blood clots that were formed on their walls. After the cessation of blood flow, the patient begins to feel severe sharp pain. Arterial thromboembolism is often the cause of gangrene.

Late complications

Late complications are the consequences of myocardial infarction, which occur a month after an experienced attack. At a later stage, the following diseases may occur:

1. Postinfarction syndrome.
2. Chronic aneurysm.
3. Repeated heart attack.

Post-infarction syndrome is an immunological reaction of the body, as a result of which inflammation of the pleura, lungs, and pericardium can develop. Signs of post-infarction syndrome are:

• high temperature, about 40 degrees;
• chest and side pains;
• swelling in the sternoclavicular and sternocostal joints.

Post-infarction syndrome is also called Dessler syndrome. This complication does not appear earlier than two to six weeks after an experienced attack.

Chronic aneurysm can form in about one to two months due to a stretching of the scar that formed after a heart attack. The main signs include changes in the larger side of the size of the heart, a pulsation in the suprauscular region. Chronic aneurysm interferes with the normal functioning of the heart, and then goes into heart failure.

Complications of myocardial infarction can concern not only the cardiac activity, but also the genitourinary system, the gastrointestinal tract and the psyche.

Infusion therapy for hypertensive crises

Hypertensive crises - emergency conditions, manifested by a sudden significant increase in systolic and / or diastolic blood pressure (above 180/120 mm RT. Art.).

Complicated and uncomplicated hypertensive crises are distinguished depending on the occurrence of life-threatening complications from the so-called target organs (primarily the myocardium, brain, and kidneys).

Complicated hypertensive crisis

Hypertensive crisis is called complicated with a sharp increase in blood pressure with the development of:

• hypertensive encephalopathy;
• stroke (ischemic or hemorrhagic);
• acute coronary syndrome;
• pulmonary edema;
• aortic dissection;
• acute renal dysfunction;

as well as with:

• severe late gestosis;
• traumatic brain injury;
• taking amphetamines, cocaine, etc.

Patients with complicated hypertensive crisis need immediate hospitalization in specialized departments, where doctors must provide a quick (in the first minutes and hours) decrease in blood pressure (but not more than 25% of the initial) by intravenous drugs.

First-line drugs in complicated hypertensive crises in most cases, with the exception of suspected aortic dissection, are angiotensin-converting enzyme (ACE) inhibitors: captopril orally (by mouth) and enalaprilat 1.25-5 mg intravenously. They are also preferred in heart failure, including pulmonary edema in myocardial infarction. Contraindicated in preeclampsia / eclampsia of pregnant women.

If pheochromocytoma (a hormone-active adrenal tumor secreting adrenaline or norepinephrine) is suspected, the alpha-adrenoblocker phentolamine (5-15 mg by bolus) is the drug of choice. Representatives of this pharmacological group are also effective for low-corinine arterial hypertension.

Diuretics (furosemide - 20-120 mg intravenously bolus) are used for the obvious clinical picture of fluid retention in the body, as well as in patients with symptoms of heart failure, including pulmonary edema. The onset of action is 5 minutes, the duration is 2 hours.

Central-acting drugs (clonidine, clonidine - 0.075-0.15 intravenously slowly) are prescribed for drug withdrawal syndrome of this pharmaceutical group. At the same time, the use of such patients with the α- and β-blocker - labetalol (20 mg intravenously slowly or 50-200 mg intravenously) is allowed.

Peripheral vasodilator sodium nitroprusside is a first-line drug for acute hypertensive encephalopathy. It is characterized by an immediate effect. Dosage regimen - 0.25-10 mcg / kg / min intravenously drip. Keep in mind the toxicity of sodium nitroprusside, exacerbated in patients receiving diuretics.

Nitroglycerin (5-100 mcg / min intravenously) is preferred for myocardial infarction and pulmonary edema, providing a reliable decrease in blood pressure and anti-ischemic effect. In acute coronary syndrome, the administration of antipsychotics (droperidol 2.5-10 mg intravenously) is also justified.

If aortic dissection is suspected, the drugs of choice are β-blockers (esmolol, metoprolol) and / or ganglion blockers (pentamine). With insufficient effectiveness, sodium nitroprusside is introduced.

Effectively reduces blood pressure during pre-eclampsia / eclampsia of pregnant women by intravenous administration of magnesium sulfate, which also has an anticonvulsant effect.

In a stroke, the question of the need and degree of pressure reduction should be decided in conjunction with a neurologist, since a sharp drop in blood pressure can contribute to aggravation of cerebral ischemia. In hemorrhagic strokes, the intravenous administration of a calcium antagonist, nimodipine (5-15 mg / h), α- and β-adrenergic blocking agent, labetalol (fractionally, 10-20 mg intravenously, with repeated administration, if necessary, up to 60 mg / day), is justified. The use of sodium nitroprusside is not recommended. For ischemic stroke, a choice should be made in favor of ACE inhibitors (captopril / enalaprilat), α-blockers (phentolamine) and clonidine (clofelin) from the point of view of relative safety for blood circulation in the ischemic zone.

Uncomplicated hypertensive crisis

Uncomplicated hypertensive crisis is not accompanied by clinically significant dysfunction of target organs and, as a rule, is treated on an outpatient basis under the supervision of a specialist. Oral (inside) are prescribed β-blockers (metoprolol), calcium antagonists (nifedipine), drugs of the central mechanism of action (clofelin), ACE inhibitors (captopril), α-blockers (prazosin, terazosin). Reduce blood pressure gradually over a period of 1-2 days.

The article provides an overview of almost all modern drugs that are recommended for use if the patient has a hypertensive crisis.

Attention! This article describes only drugs that are used for hypertensive crisis, i.e., in emergency situations. For the "systematic" treatment of hypertension, the medicines are completely different, they are described in other articles. On our site you will find the most detailed information about the medicines for hypertension. All materials are written in a simple, understandable language. This knowledge will help you effectively collaborate with a doctor who will select pills for you.

• How to choose a cure for hypertension - general principles
• What medications for hypertension are prescribed for elderly patients
• Complicated Hypertension Medication

The pharmaceutical market is constantly replenished with new drugs, including those that are designed to help with hypertensive crisis. Our review includes not only new medicinal products, but also drugs that are already being discontinued in developed countries because our doctors are still widely using them: trimethafan camsylate (arfonad), clonidine (clonidine), pentamine, dibazole.

• The best way to cure hypertension (fast, easy, good for health, without the "chemical" drugs and dietary supplements)
• Hypertension is a folk way to recover from it at stages 1 and 2
• Causes of hypertension and how to eliminate them. Hypertension tests
• Effective treatment of hypertension without drugs

With complicated hypertensive crisis, any delay in treatment can cause irreversible consequences. The patient is hospitalized in the intensive care unit and immediately begin intravenous administration of one of the drugs listed in the table.

Medications for intravenous administration in complicated hypertensive crises

Drug name

Route of administration, dose

Action start

Action duration

Notes

Medicines relaxing blood vessels
Sodium Nitroprusside	Intravenously, drop 0.25-10 mcg / kg / min (50-100 ml in 250-500 ml of 5% glucose)	Right away	1-3 min	It is suitable for immediate pressure reduction in hypertensive crises of any type. Enter only using a special dispenser with continuous monitoring of blood pressure
Nitroglycerine	Intravenously, drip, 50-200 mcg / min	2-5 min	5-10 min	Nitroglycerin is especially effective in acute heart failure, myocardial infarction
Nicardipine	Intravenously, drip, 5-15 mg / hour	5-10 min	From 15 minutes to 12 hours, with prolonged administration	Effective in most hypertensive crises. Not suitable for patients with heart failure. Caution patients with coronary heart disease.
Verapamil	Intravenously 5-10 mg, intravenous drip can be continued, 3-25 mg / hour	1-5 min	30-60 min	Contraindicated in patients with heart failure and those taking beta blockers
Hydralazine	Intravenously, bolus (stream), 10-20 mg per 20 ml of isotonic solution, or intravenously drip 0.5 mg / min, or intramuscularly 10-50 mg	10-20 min	2-6 h	Mostly with eclampsia. You can repeat the introduction after 2-6 hours.
Enalaprilat	Intravenously, 1.25-5 mg	15-30 min	6-12 h	Effective in acute left ventricular failure
Nimodipine	Intravenously, drip, 15 mg / kg per 1 hour, then 30 mg / kg per 1 hour	10-20 min	2-4 h	With subarachnoid hemorrhage
Fenoldopam	Intravenously, drip, 0.1-0.3 mcg / kg / min	1-5 min	30 minutes	Effective in most hypertensive crises
Adrenergic blockers
Labetalol	Intravenously, bolus (jet), 20-80 mg at a rate of 2 mg / min or intramuscular injection of 50-300 mg	5-10 min	4-8 h	Effective in most hypertensive crises. Contraindicated in patients with heart failure.
Propranolol	Intravenous drip of 2-5 mg at a rate of 0.1 mg / min	10-20 min	2-4 h	Mostly with stratified aortic aneurysm and coronary syndrome
Esmolol	Intravenously drip 250-500 mcg / kg / min for 1 min, then 50-100 mcg / kg for 4 min	1-2 min	10-20 min	It is the drug of choice for stratified aortic aneurysm and postoperative hypertensive crisis
Trimethafan camphylate	Intravenous drip, 1-4 mg / min (1 ml of 0.05-0.1% solution in 250 ml of 5% solution of glucose or isotonic sodium chloride solution)	Right away	1-3 min	In crises with pulmonary or brain edema, stratified aortic aneurysm
Clonidine (clonidine)	Intravenously 0.5-1.0 ml or intramuscularly 0.5-2.0 ml 0.01% solution	5-15 min	2-6 h	Undesirable for a stroke
Azamethonium bromide	Intravenously 0.2-0.75 ml (increase the dose gradually until the effect is achieved) or intramuscularly 0.3-1 ml of 5% solution	5-15 min	2-4 h	Contraindicated in elderly patients. Causes orthostatic hypotension.
Phentolamine	Intravenously or intramuscularly, 5-15 mg (1-3 ml of a 0.5% solution)	1-2 min	3-10 min	Mostly with pheochromocytoma, clonidine withdrawal syndrome
Other drugs
Furosemide	Intravenously, bolus (jet), 40-200 mg	5-30 min	6-8 h	Mostly in hypertensive crisis with acute heart or kidney failure
Magnesium sulfate	Intravenously, bolus (jet), 5-20 ml of a 25% solution	30-40 min	3-4 h	With convulsions, eclampsia of pregnant women

If it is impossible to immediately administer intravenous drugs, use should be taken under the tongue of fast-acting drugs that lower blood pressure: nitrates, captopril, nifedipine, adrenergic blockers and / or intramuscular injection of clonidine, phentolamine or dibazole.

Preference should be given to short-acting drugs (sodium nitroprusside, nitroglycerin, trimethafan camsylate), since they give a controlled effect of lowering blood pressure. Long-acting drugs are dangerous for the possible development of uncontrolled hypotension. A sharp decrease in blood pressure increases the risk of complications: a decrease in cerebral circulation (up to the development of a coma), a lack of blood supply to the heart (angina attacks, arrhythmia, and sometimes myocardial infarction). The risk of complications is especially great with a sudden decrease in blood pressure in elderly patients with severe atherosclerosis of the cerebral vessels.

At the first stage of treatment, the goal is to partially reduce the pressure to a safe level - not necessarily to normal. Most often, blood pressure is reduced by 20-25%.

Provenly effective and cost-effective additives to normalize pressure:

• Magnesium + Vitamin B6 from Source Naturals;
• Taurine from Jarrow Formulas;
• Fish Oil from Now Foods.

Read more about the technique in the article "Treatment of hypertension without drugs." How to order hypertension supplements from the USA - download instructions. Bring your pressure back to normal without the harmful side effects that “chemical” pills cause. Improve heart function. Be calm, get rid of anxiety, sleep at night like a child. Magnesium with vitamin B6 works wonders for hypertension. You will have excellent health, the envy of peers.

Medications for the treatment of uncomplicated hypertensive crisis

In the case of uncomplicated hypertensive crisis, as a rule, there is no need for intravenous administration of drugs. Prescribe orally (through the mouth) drugs that lower blood pressure, with quick action or intramuscular injection.

Clonidine (clonidine)

Effective use of clonidine (clonidine), which does not cause tachycardia, does not increase cardiac output, so it can be recommended for angina pectoris. In addition, this drug can be prescribed to patients with renal failure. The effect of the use of clonidine occurs 5-15 minutes after intravenous administration and 30-60 minutes after oral administration. If necessary, the medication is repeated every hour until the effect is obtained.

The main side effects are due to a pronounced sedative (calming) effect, which is why the drug is contraindicated in patients with manifestations of a hypertensive crisis on the part of the central nervous system: a sedative effect can weaken the manifestation of symptoms and make it difficult to objectively assess the severity of the patient's condition. Clonidine (clonidine) should not be recommended for patients with impaired cardiac conduction, especially those who receive cardiac glycosides.

For details, see the article “Clonidine (clonidine).”

Nifedipine

Nifedipine is also used, which has the ability to relax blood vessels, increase cardiac output and renal blood flow. A decrease in blood pressure is observed already 15-30 minutes after its administration, the effect persists for 4-6 hours. The nifedipine capsule should be chewed and swallowed. 5-10 mg of nifedipine is usually sufficient. If there is no effect, after 30-60 minutes the administration is repeated.

Nifedipine in some patients can cause intense headache, as well as uncontrolled arterial hypotension (especially in combination with magnesium sulfate), so its use should be limited to cases where patients responded well to this drug earlier, during planned treatment.

It should be noted that the United National High Blood Pressure Committee of the United States considers it inappropriate to use nifedipine during a hypertensive crisis. The fact is that the speed and degree of lowering blood pressure when taking the drug under the tongue is difficult to control in order to avoid the risk of developing cerebral or coronary ischemia.

For more information see the article “Nifedipine - a calcium antagonist.”

Captopril

Captopril ACE inhibitor lowers blood pressure within 30-40 minutes after administration due to the rapid absorption in the stomach. If captopril is used, then after lowering blood pressure, cerebral blood flow does not deteriorate. Occasionally, this medicine causes an excessive decrease in blood pressure, especially in patients with renal failure or a decreased volume of circulating blood.

For more information, see the article "Captopril".

A positive therapeutic effect is also observed with intramuscular injections of clonidine (clonidine) or dibazole. In case of increased sweating, feelings of anxiety, fear - sedatives are indicated, in particular, benzodiazepine derivatives, which can be administered orally or as intramuscular injections, as well as droperidol. Combinations of 2 or 3 drugs are effective (for example, nifedipine + metoprolol or nifedipine + captopril).

Medicines for the Emergency Treatment of Hypertensive Crises - An Overview

Conventionally, two groups of drugs can be distinguished for the treatment of hypertensive crises using intravenous injection: the first is universal drugs suitable for stopping most crises, the second is specific drugs that have special indications.

The first group includes sodium nitroprusside, hydralazine, trimethafan camsylate, azamethonium bromide, labetalol, enalaprilat, nicardipine. To the second - nitroglycerin, esmolol, phentolamine.

Sodium Nitroprusside

Sodium nitroprusside has a quick and easily controlled effect on lowering blood pressure, which manifests itself immediately after the start of its administration and ends a few minutes after the cessation of administration. Obviously, the use of the drug should be carried out under close monitoring of blood pressure. Sodium nitroprusside is effective in all forms of hypertensive crises, especially in acute hypertensive encephalopathy, postoperative bleeding, or acute left ventricular failure. Contraindicated in eclampsia due to the risk of fetal poisoning with cyanides.

Sodium nitroprusside has in its composition a NO group (endothelium-dependent relaxing factor), which, by splitting off in the body, causes the expansion of arteries and veins. This leads to relaxation of blood vessels, a decrease in blood flow to the heart and a decrease in stroke volume. Heart rate is increasing. Due to significant relaxation of blood vessels, redistribution of blood flow occurs with its decrease in ischemic zones (robbery syndrome). In this regard, sodium nitroprusside can impair coronary blood flow in patients with coronary heart disease.

Due to the expansion of the large cerebral arteries, sodium nitroprusside increases cerebral blood flow and can increase intracranial pressure. However, a decrease in systemic blood pressure reduces this effect, due to which most patients with encephalopathy tolerate the drug well.

Sodium nitroprusside is destroyed by sulfhydryl groups of red blood cells to cyanide, and then - in the liver - to thiocyanate. High concentrations of the latter, if kept in the blood for several days, have a toxic effect in the form of nausea, weakness, sweating, disorientation, toxic psychosis. The risk of thiocyanate poisoning increases with prolonged use of the drug (more than 24 hours) and in high doses (more than 10 mcg / kg in 1 min). In case of intoxication, sodium nitrate (4-6 mg) and sodium thiosulfate (50 ml of a 25% solution) are used as antidotes.

Nitroglycerine

Nitroglycerin is administered intravenously to patients with myocardial ischemia, regardless of the presence or absence of hypertension. This is the drug of choice for hypertensive crisis, which is accompanied by angina pectoris, myocardial infarction or acute left ventricular failure, as well as after coronary artery bypass grafting. Nitroglycerin has the same advantages in stopping a hypertensive crisis as sodium nitroprusside: quick onset and rapid cessation of action, the possibility of a gradual increase in dose to obtain the desired effect on lowering blood pressure.

Like sodium nitroprusside, nitroglycerin causes vascular relaxation through the formation of NO. However, unlike sodium nitroprusside, nitroglycerin is an indirect NO donor. The latter is formed from nitroglycerin in the body through a series of enzymatic reactions.

The main therapeutic effect of nitroglycerin is vascular relaxation. At the same time, large arteries expand first, then medium-sized arteries, and with a further increase in the dose, arterioles.

The relaxation of large veins helps to reduce venous flow, stroke volume and the appearance of reflex tachycardia. In patients with heart failure, on the contrary, the administration of nitroglycerin contributes to an increase in stroke volume due to the normalization of the pressure / volume ratio in the heart cavities.

Unlike sodium nitroprusside, nitroglycerin does not cause a robbery syndrome: there is no increase in blood supply to non-ischemic sections of the heart muscle to the detriment of ischemic ones.

At higher doses, nitroglycerin dilates the small arteries, helps to reduce systemic blood pressure. The systemic response depends on the dose of the drug and individual sensitivity to it.

Diazoxide

Diazoxide dilates resistive arteries without affecting the capacitive veins. A decrease in blood pressure under the influence of diazoxide may be accompanied by fluid retention, facial flushing, dizziness. To minimize these phenomena, the drug is administered slowly drip or in low doses intravenously bolus (jet) every 5-10 minutes and combined with the introduction of diuretics. Currently, it is considered obsolete due to the emergence of a large number of new drugs that quickly lower blood pressure.

Hydralazine

Hydralazine (dihydralazine) - relaxes the arteries without affecting the capacitive veins. A decrease in the total peripheral vascular resistance under the influence of hydralazine causes tachycardia and an increase in cardiac output. The drug can also provoke a headache, due to increased intracranial pressure.

Hydralazine is administered intravenously in a bolus (jet) or drip; sometimes intramuscularly. To prevent tachycardia, a beta-blocker is added to it. Usually, a diuretic (furosemide) is also required, since hydralazine promotes fluid retention. A diuretic is not administered if there are signs of dehydration due to vomiting or excessive urine output caused by a sharp increase in blood pressure (“pressure diuresis”).

Hydralazine is the drug of choice for pregnant women with eclampsia. It improves blood circulation in the uterus and does not adversely affect the condition of the fetus. Contraindicated in acute myocardial ischemia and stratified aortic aneurysm. It is also not recommended for relief of crises accompanied by cerebrovascular complications, as it increases intracranial pressure and can worsen cerebral circulation due to the appearance of high and low pressure zones.

For details, see the article “Hydralazine - a vasodilator for hypertension.”

Trimethafan camphylate

Trimethafan camsylate is a ganglion-blocking drug with a short, easily controlled action. It is administered intravenously. It causes a blockade of the sympathetic and parasympathetic ganglia. Due to the risk of developing atony of the bladder and intestinal obstruction, it is not recommended to use it in the postoperative period.

Previously, trimethafan camsylate (in combination with a beta-blocker) was the drug of choice in acute stratified aortic aneurysm due to its ability to reduce heart rate and cardiac output. In today's clinical practice, more modern drugs are used more often, in particular the esterol short-acting beta-blocker esmolol, which is considered to be the most effective remedy for stratified aortic aneurysm (combined with sodium nitroprusside).

Trimethafan camsylate is more toxic than sodium nitroprusside, which is due to generalized blockade of the autonomic nervous system. With repeated use, its effectiveness decreases - tachyphylaxis develops.

Azamethonium bromide

Azamethonium bromide is used if more effective and safe drugs are not available. Being a ganglion blocker, azamethonium bromide relaxes the veins and arteries, thereby reducing the load on the heart. It is used to relieve hypertensive crises, accompanied by acute left ventricular failure. Enter intravenously in the form of repeated fractional injections (0.3-0.5-1 ml) very slowly.

Azamethonium bromide can also be used for other types of hypertensive crises (preferably intramuscular injection). The disadvantages of the drug are the same as that of trimethafan camsylate. In addition, it has a long-lasting effect (4-8 hours), which complicates the individual selection of an effective dose. It can cause a sharp decrease in blood pressure, up to the development of collapse.

Phentolamine

Phentolamine is used if the hypertensive crisis is caused by an excess of catecholamines (pheochromocytoma, sudden cancellation of clonidine (clonidine), etc.). Intravenous administration of phentolamine causes an effective, short-term blockade of alpha-1 and alpha-2 adrenergic receptors. The drug reduces blood pressure no more than 15 minutes after a bolus (jet) intravenous administration. Its action is accompanied by reflex tachycardia, which can aggravate myocardial ischemia (up to a heart attack) or cause the appearance of severe arrhythmias.

Labetalol

Labetalol - a blocker of beta-1, beta-2 and alpha-1-adrenergic receptors, is considered by many authors as the drug of choice for most hypertensive crises. It is effective and safe, has no toxic effects, does not cause tachycardia or increased intracranial pressure, like direct vasodilators. The action of labetalol with intravenous administration begins after 5 minutes and lasts 3-6 hours. Labetalol is effective for any type of hypertensive crisis, except for complicated by acute insufficiency of the left ventricle of the heart. In the latter case, the use of the drug is undesirable due to the pronounced effect of reducing the strength of the heart contractions due to the blockade of beta-adrenergic receptors.

For the properties and uses of labetalol, see also the article “Beta-blockers: a list of drugs.”

Esmolol

Esmolol is a cardioselective beta-blocker. It is rapidly destroyed by blood enzymes, as a result of which it has a very short (about 9 min) half-life and, accordingly, a short duration of action (about 30 min). It is especially indicated for anesthesia and exfoliating aortic aneurysm (in the latter case, it is used in combination with sodium nitroprusside or another drug that relaxes blood vessels).

Enalaprilat

Enalaprilat is used in cases where ACE inhibitors have an advantage over other antihypertensive agents, in particular with severe heart failure. Enalaprilat has a mild effect on cerebral blood flow, which is expressed in the absence of signs of a deficiency in the blood supply to the brain even with a significant decrease in blood pressure.

Nicardipine and other calcium agonists

Nicardipine is comparable in effectiveness with sodium nitroprusside, while it is better tolerated by patients. Another dihydropyridine calcium agonist - nimodipine - has a selective effect on the cerebral vessels, which is why it is used to eliminate the spasm of these vessels in patients with subarachnoid hemorrhage. Of the other calcium antagonists, verapamil is also used, which is administered intravenously for hypertensive crises.

Fenoldopam

Fenoldopam is a new selective dopamine receptor agonist. It has a direct effect on relaxing blood vessels and lowering blood pressure, similar to sodium nitroprusside, but with less frequent side effects. Along with lowering blood pressure, fenoldopam significantly improves urination, excretion of sodium from the body and increases creatinine clearance, which is why it is the drug of choice in patients with renal failure. It is indicated for any type of hypertensive crisis. The experience of its use to date is small.

Diuretics for stopping hypertensive crises

Diuretics, usually loopback - furosemide or bumetanide - are administered in cases where there are signs of fluid retention, especially in patients with congestive heart failure or when treated with drugs that relax blood vessels and cause fluid retention. Patients with a reduced volume of circulating blood due to vomiting or excessive diuresis are not recommended for diuretics. In these cases, lowering blood pressure, on the contrary, can be achieved by restoring the volume of circulating blood using intravenous administration of an isotonic solution.

For more details see the articles “Loop diuretics - general information” and “Furosemide”.

Magnesium sulfate

Magnesium sulfate is used for the prevention and relief of convulsive syndrome in patients with preeclampsia and eclampsia, as well as other clinical forms of hypertensive encephalopathy. Magnesium sulfate has an anticonvulsant, dehydrating, antispasmodic effect, inhibits the vasomotor center, which reduces blood pressure.

The drug is administered intravenously or intramuscularly. With intravenous administration, an increase in the concentration of magnesium ions in the blood can lead to inhibition of the respiratory center and respiratory arrest. The antidote of magnesium sulfate is calcium chloride, which is administered intravenously at the first signs of respiratory failure. Intramuscular administration can cause the formation of abscesses.

• Complicated and uncomplicated hypertensive crisis: how to distinguish
• When hypertension requires urgent hospitalization
• Stroke - a complication of hypertensive crisis - and how to treat it
• Complications of a hypertensive crisis: angina pectoris and heart attack
• Aortic aneurysm - a complication of hypertensive crisis
• How to treat hypertensive crisis in pregnant women, after surgery, with severe burns and with the abolition of clonidine