What Is Left-Sided Heart Failure?

Left heart failure refers to heart failure that occurs due to left ventricular insufficiency. It is extremely common clinically and is characterized by pulmonary circulation congestion. Left heart failure is divided into acute left heart failure and chronic left heart failure.

Basic Information

TCM disease name

Left heart failure

Visiting department

Cardiology

Common locations

heart

Main features

Pulmonary circulation congestion

Causes of left heart failure

Common causes

Ischemic myocardial injury, myocarditis and cardiomyopathy, myocardial metabolic disorders such as diabetes, stress overload such as hypertension, volume overload, etc.

Almost all types of heart and macrovascular diseases can cause heart failure. Heart failure responds to the heart's pumping dysfunction, which is the myocardial diastolic dysfunction, which eventually leads to the development of myocardial function from compensated to decompensated. The basic causes are as follows:

Primary myocardial damage

(1) Ischemic myocardial damage: Coronary heart disease myocardial ischemia and / or myocardial infarction is one of the most common causes of heart failure.

(2) Myocarditis and cardiomyopathy: Various types of myocarditis and cardiomyopathy can cause heart failure. Viral myocarditis and primary dilated cardiomyopathy are the most common.

(3) Myocardial metabolic disorders: diabetic cardiomyopathy is the most common, and others such as cardiomyopathy secondary to hyperthyroidism or reduction, myocardial amyloidosis, etc.

2. Heart overload

(1) Excessive pressure load (post-load): seen in diseases such as hypertension, increased aortic valve stenosis, pulmonary hypertension, pulmonary valve stenosis and other diseases of left and right ventricular systolic ejection resistance. To overcome the increased resistance, compensatory hypertrophy of the ventricular muscles to ensure ejection volume. If the load is persistent, the structure and function of the myocardium will inevitably change, eventually decompensating, and the cardiac output will decrease.

(2) Excessive volume load (preload): seen in the following two cases: heart valve insufficiency, blood reflux, such as aortic valve insufficiency, mitral valve insufficiency, etc .; left and right heart or arteriovenous Shunt congenital cardiovascular diseases such as septal defects and open arterial ducts. In addition, diseases such as chronic anemia, hyperthyroidism, etc. that are accompanied by an increase in systemic blood volume or increased circulating blood volume, inevitably increase the volume load of the heart. In the early stage of increasing the volume load, the ventricular cavity is compensatory enlarged, and the myocardial contractile function can still maintain normal, but the decompensation manifestation occurs when the myocardial structure and function are changed beyond a certain limit.

Common symptoms of left heart failure

Chronic is dyspnea, acute pulmonary edema, cough, expectoration, and hemoptysis; acute is sudden severe dyspnea, cyanosis, frequent cough, and pink foamy sputum

Clinical manifestations of left heart failure

1. Main clinical manifestations of chronic left heart failure

(1) Difficulty breathing

1) Labor dyspnea: Labor dyspnea is the earliest symptom of left heart failure. Exercise increases blood volume in the back, increases left atrial pressure, and aggravates pulmonary congestion.

2) Sit and breathe: Lung congestion reaches a certain level. When you lie supine, the amount of returning blood increases and the diaphragm is raised, making breathing more difficult.

3) Paroxysmal dyspnea at night: The patient suddenly wakes up due to belching after falling asleep and is forced to take a sitting position, which can be accompanied by shortness of breath, cough, foamy sputum, and wheezing, also known as "cardiogenic asthma" .

(2) Acute pulmonary edema

It is a further development of "cardiogenic asthma" and the most severe form of dyspnea in left heart failure.

(3) Cough, expectoration and hemoptysis

Sputum is caused by congestion of the alveolar and bronchial mucosa. It usually occurs at night and is relieved when sitting or standing. White serous foamy sputum is the main feature, and occasionally blood in the sputum can be seen.

(4) other

Symptoms of fatigue, fatigue, dizziness, and palpitation caused by insufficient cardiac output, insufficient perfusion of organs and tissues, and accelerated compensatory heart rate; with the decrease of peripheral circulating blood volume, renal blood flow will be significantly reduced, and patients may appear Oliguria or abnormal renal function.

2. Clinical manifestations of acute left heart failure

Acute left heart failure is mainly manifested as pulmonary circulation congestion, sudden severe breathing difficulties, breathing frequency up to 30-40 times / minute, forced posture, gray complexion, cyanosis, sweating, irritability, and frequent cough, sputum, slightly Pink foamy sputum. In severe cases, consciousness may be blurred due to hypoxia; blood pressure may transiently increase at the onset of the disease. If the condition does not ease, blood pressure may continue to decline or even shock.

Left heart failure examination

1. ECG: most commonly used, in addition to heart rate, it can diagnose whether arrhythmia is associated with heart failure patients, because patients with heart failure are often accompanied by arrhythmias such as pre-systole and atrial fibrillation; ECG can also determine whether the patient has a myocardial infarction There are also abnormalities in ECG in hypertrophy and pericardial effusion.

2. Chest radiograph: chest X-ray, the size and shape of the heart shadow can provide a reference for the diagnosis of the etiology of heart disease, and the degree and dynamic changes of the heart can also indirectly reflect the functional status of the heart. There is pulmonary congestion in left heart failure. The chest radiograph will show different degrees of change, and the hilar vascular shadow may be enhanced. The upper lung texture is similar to the lower lung texture density. In addition, we can see the presence of pleural effusion and thickening of leaf space.

3. Echocardiography: It is a non-invasive examination that can evaluate the size of the heart cavity, the thickness of the wall and the abnormal movement, the structure of the heart valve, and the pumping function of the heart. It is the most important examination for the diagnosis of heart failure. Estimating cardiac function, such as systolic function, left ventricular ejection fraction responds to systolic function. Although inaccurate, it is very convenient. Under normal circumstances, left ventricular ejection fraction> 50%, and left ventricular ejection fraction <or = 40% is contraction Criteria for the diagnosis of chronic heart failure.

4. Blood brain natriuretic peptide: BNP and NT-proBNP are commonly used in clinical practice, and their levels are helpful for the diagnosis of heart failure. When the level of BNP in the untreated is normal, the diagnosis of heart failure can be basically ruled out.

5. Others: Myocardial nuclide scans, coronary angiography, exercise tests, etc. can be used to understand the heart's blood supply.

Left heart failure treatment

(A) chronic left heart failure

The purpose of treatment is to slow or prevent the occurrence of heart failure, relieve the symptoms of patients with clinical heart failure, delay their long-term prognosis and reduce mortality.

Cause treatment

(1) Treatment of basic causes: treatment of all common causes that may cause heart damage, such as hypertension, coronary heart disease, diabetes, metabolic syndrome, etc.

(2) Incentive treatment: such as infection, various arrhythmias, avoiding overwork and emotional tension, etc.

2. General treatment

(1) Rest: control physical activity, avoid mental stress, reduce heart load, and help restore heart function. At the same time, be wary of prolonged bed rest leading to venous thrombosis, muscle atrophy, etc.

(2) Control of sodium salt intake: The blood volume of patients with heart failure increases, and there is water and sodium storage in the body, so the sodium salt intake should be reduced to help reduce edema. In addition, pay attention to digestible, high-vitamin diet, rest, oxygen, avoid emotional excitement, and maintain smooth stool.

3. Drug treatment

(1) Diuretics: Hydrochlorothiazide, furosemide, bupropionamine, sodium diureate, ampicillin, spironolactone, etc. can be used alternately. Pay attention to toxic reactions and side effects (such as hyponatremia, hypochloremia, hypokalemia, etc.). The use of diuretics should pay attention to changes in urine output.

(2) Vasodilators: Isosorbide nitrate, nitroglycerin, hydralazine (hydrazine) and hydralazine are commonly used orally. Phentolamine or sodium nitroprusside are commonly used intravenously. Pay attention to changes in blood pressure during medication.

(3) Digitalis preparations: During the medication, the patient's condition should be closely observed, pay attention to the heart rhythm, heart rate (preferably at 70 to 80 times / min), iliac vein, urine output, and whether there are toxic reactions (such as vomiting, yellow vision, frequent Premature beats, dual rhythms and bradycardia, etc.).

(4) Angiotensin-converting enzyme inhibitors: Captopril or ilapril are commonly used.
(5) For patients with heart failure accompanied by increased heart rate or tachyarrhythmias, the use of antiarrhythmic drugs to control the ventricular rate can help improve heart function.

4. Surgery

heart transplant.
(Two) acute left heart failure

General treatment

(1) Those who have obvious dyspnea at rest should be in a semi-recumbent position or an end-to-end position with their legs drooping to reduce the amount of returning blood and reduce the preload of the heart.
(2) Inhale oxygen.

2. Drug treatment (1) Sedation: The main application of morphine is to observe closely the curative effect and adverse reactions of respiratory depression. Patients with obvious and persistent hypotension, shock, disturbance of consciousness, COPD, etc. are contraindicated. Use with caution or reduction in elderly patients.

(2) Bronchial spasmolytic agents: Aminophylline is generally used. Such drugs should not be used in patients with acute heart failure caused by coronary heart disease such as acute myocardial infarction or unstable angina pectoris. It should not be used in patients with tachycardia or arrhythmia. patient.

(3) Diuretics: suitable for patients with acute heart failure with significant congestion of the pulmonary circulation and / or systemic circulation, as well as overcapacity. Furosemide, tosemide, bumetanib intravenous application can quickly reduce the volume load in a short time, and should be listed as the first choice.
(4) Vasodilators: These drugs can be used in the early stages of acute heart failure. Systolic blood pressure level is an important indicator to assess the suitability of such drugs.
(5) Positive inotropic drugs: These drugs are suitable for low cardiac output syndrome, such as patients with symptomatic hypotension or reduced cardiac output and circulating congestion, which can alleviate tissue hypoperfusion Symptoms to ensure blood supply to vital organs.

3. Non-pharmacological treatments <br /> Patients with severe illness, continuous lowering of blood pressure (<90mmHg), and even cardiogenic shock should monitor hemodynamics and use IABP, mechanical ventilation support, blood purification, ventricular mechanical assist devices and surgery Various non-drug treatment methods such as surgery.