Cardiogenic hypostasis of lungs
Cardiogenic hypostasis of lungs – a pathological state which is characterized by perfusion of liquid from pulmonary vessels in interstitsialny space and alveoluses. Is a consequence of an acute heart failure. At the initial stage of a disease at the patient tachycardia, short wind comes to light . In process of development of pathology from airways foam of white or pinkish color begins to be highlighted. Symptoms of a hypoxia are defined. The diagnosis is exposed on the basis of a clinical picture and anamnestichesky data. Treatment includes the oxygen passed through 70% ethyl alcohol, IVL, narcotic analgetics, loopback diuretic, nitrates. According to indications cardiotonics, bronchial spasmolytics are applied.
Cardiogenic hypostasis of lungs
The Cardiogenic Hypostasis of Lungs (CHL) – accumulation of liquid in pulmonary bubbles or interstitsialny space. It is usually observed at the patients having the cardiological anamnesis. Arises in the form of a passing complication which manages to be stopped sometimes at a pre-hospital stage. Regardless of results of first-aid treatment the patient is subject to hospitalization in ORIT. Occurrence frequency at men is slightly higher, than at women, a ratio – about 7:10. It is caused by a little later development of atherosclerosis and coronary pathology in female representatives. Cardiogenic OL can be noted at heart failure of any origin, however is more often diagnosed when weakening function of the left ventricle.
Reasons of cardiogenic hypostasis of lungs
Violations in work of heart arise at organic changes of body, significant increase in OTsK, under the influence of not cardiogenic factors. Definition of the prime cause – an important diagnostic stage as the scheme of treatment depends on an etiology of a state. Treat number of diseases at which hypostasis of a warm origin develops:
- Left Ventricular Insufficiency (LVI). Is true deterioration in sokratitelny ability of heart, most often becomes the reason of a gidrotization of lungs. It is observed at myocardites, the sharp myocardial infarction localized in the corresponding zone, an aortal stenosis, a coronary sclerosis, a hypertension, insufficiency of the aortal valve, arrhythmias of various origin, IBS.
- Increase in OTsK. It is noted at a sharp renal failure, against the background of violation of water balance. The liquid entered to the patient intravenously or used by him through a mouth is not removed from an organism, the STAKE is formed. The similar situation is created at incorrectly picked up volume of infusional therapy, a thyrotoxicosis, anemia, cirrhosis.
- Pulmonary venous obstruction. The reason – organic malformations of venous system. Is defined at a mitralny stenosis, an abnormal confluence of pulmonary veins, their hypoplasia, formation of vascular membranes, fibrosis. Besides, this state arises in the presence of postoperative hems, a vessel sdavleniya a sredosteniye tumor.
- Nekardialny reasons. Warm violations and, respectively, pulmonalny hypostasis can become result of sharp poisoning with cardiotoxic poisons, violations of brain blood circulation with defeat of the zones which are responsible for work of heart and a vascular tone, skull injuries. Pathology quite often is a symptom of shock of any etiology.
Cardiogenic pulmonalny hypostasis has two mechanisms of development. At true left ventricular insufficiency there is an easing of sokratitelny ability of the left ventricle. Heart is not able to pump over all blood arriving from pulmonary veins. In the last there is a stagnation, hydrostatic pressure increases. The second pathogenetic mechanism meets at an overhydratation. The left ventricle at the same time works normally, however its volume is insufficient to contain in itself all arriving blood. Further development of process does not differ from true version LN.
Allocate three stages of formation the STAKE. On the first stretching of large pulmonary vessels is observed, active involvement in process faded also capillaries. Further liquid begins to accumulate in interstitsialny space. J-receptors an interstition are irritated, persistent cough develops. At some point connecting tissue of lungs is overflowed with liquid which begins to propotevat in alveoluses. There is a foaming. About one and a half liters of foam which at cough separates outside through airways are formed of 100 ml of plasma.
Symptoms of cardiogenic hypostasis of lungs
The attack begins at night more often. The patient wakes up with feeling of suffocation, accepts the compelled semi-sitting or sitting position with an emphasis hands in a bed. Such position promotes connection of auxiliary muscles and facilitates breath a little. There is cough, feeling of shortage of air, short wind more than 25 breaths a minute. In lungs the dry whistling rattles, breath, distinguishable at distance, rigid are listened. Tachycardia reaches 100-150 beats/min. At survey comes to light .
Transition of interstitsialny cardiogenic pulmonary hypostasis to alveolar is characterized by sharp deterioration in a condition of the patient. Rattles become damp, krupnopuzyrchaty, the breath bubbling. At cough pinkish or white foam is emitted. Skin cyanotic or a marble shade, is covered with a large amount of cold sticky sweat. The concern, psychomotor excitement, fear of death, confusion of consciousness, dizziness is noted. The pulse gap between systolic and diastolic HELL is reduced.
Level of pressure depends on pathogenetic option of a disease. At true insufficiency of the left ventricle systolic HELL decreases to indicators less than 90 mm of mercury. Compensatory tachycardia higher than 120 beats per minute develops. The Gipervolemichesky option proceeds with rise in arterial pressure, increase in ChSS at the same time remains. There are squeezing pains behind a breast which can testify to a secondary attack of IBS, a myocardial infarction.
Complications are mainly connected with a hypoxia and a giperkapniya. At a long course of disease there is an ischemic defeat of cells of a brain (stroke) that leads further to intellectual and cognitive frustration, somatic violations. Insufficient content of oxygen in blood becomes the reason of oxygen starvation of internals that quite often comes to an end with partial or complete cessation of their activity. Myocardium ischemia which can come to the end with development of a heart attack, fibrillation of ventricles, asistoliya is most dangerous. Against the background of cardiogenic hypostasis accession of a secondary infection and developing of pneumonia is sometimes observed.
The preliminary diagnosis is established by an ambulance crew. Differentiation is carried out with hypostasis of lungs of not warm origin. It is difficult to define an etiology at the first contact with the patient as clinical signs the STAKE and pathologies of other genesis practically do not differ. Criterion of diagnosis is existence in the anamnesis of a chronic heart disease, arrhythmia. In favor of not warm reason existence of a thyrotoxicosis, an eklampsiya, sepsis, massive burns, injuries testifies. In a hospital the list of diagnostic actions extends, the following inspections are shown to the patient:
- Fizikalnoye. At an auskultation dry or damp rattles are defined, at percussion emergence of a "box" sound is noted. At the kept consciousness of the patient holds the compelled position, at psychomotor excitement rushes about, does not realize the events.
- Laboratory. In blood signs of a gipoksemiya and a giperkapniya are found. SpO2 less than 90%, Pao2 less than 80 mm of mercury., pH less than 7.35, lactate more than 2 mmol/litre. At an overhydratation the TsVD level exceeds 12 mm of a water column. If the heart attack is the reason of pathology, in blood concentration of a cardiospecific troponin, KFK and KFK of MV increase.
- Tool. On the ECG signs of paroksizmalny violations, a sharp coronary syndrome, myocardium ischemia (coronary t wave, raising of a segment of ST) come to light. The X-ray analysis demonstrates decrease in a pnevmatization of fields of lungs as a blizzard, at an alveolar version blackout in the form of a butterfly is looked through. Hearts are defined on ultrasonography signs of a gipokineziya of the left ventricle.
Treatment of cardiogenic hypostasis of lungs
Therapy at a stage of medical evacuation and in a hospital in general does not differ. Out of MPI some methods of treatment can be ignored due to the lack of technical capability of their realization. The purpose of first aid is elimination of clinical displays of a disease, stabilization of a state, transportation in cardiological resuscitation. The medical institution makes complete elimination of a pneumonic overhydratation and the reason which caused it. Are among medical techniques:
- Oxygenotherapy. When transporting introduction of the oxygen passed through 70% alcohol by means of nasal cannulas is carried out. In the conditions of a hospital transfer of the patient to artificial ventilation of lungs from 100% of O2 is possible. As the defoaming agent alcohol or is used. The IVL invasive method with a trachea intubation is preferable. Ventilation through a mask is not applied in connection with high risk of aspiration. For increase in overall performance of the device airways clear of foam by means of an electrosuction.
- Dehydration. For unloading of a small circle of blood circulation and reduction of OTsK of the patient receives loopback diuretics in high doses. Furosemide and its analogs is appointed. Use of a mannitol is contraindicated as in the beginning it increases intake of liquid to the vascular course that leads to aggravation of a situation. According to indications ultrafiltration of blood with selection of necessary volume of liquid fraction can be carried out.
- Analgeziya. Choice medicine – morphine. It is entered intravenously under breath control. Promotes elimination of pain and uneasiness, expansion of vessels of a big circle, reduction of load of pulmonary veins. At the expressed psychomotor excitement or a pain syndrome the neyroleptanalgeziya – a combination of a narcotic analgetic to antipsychotic means is applied. At the GARDEN it is lower than 90 units drugs and neyrotropny medicines are contraindicated.
- Stimulation of heart. Cardiotonic means are used only at true LZh. Medicine of the choice is dopamine which moves titrovanno via the syringe pump or infusional system with the batcher. For achievement of inotropny effect doses less than 5 mg/kg/h are required. For increase HELL dosages have to exceed the specified value. Instead of pressor amines warm glycosides can be appointed (, ).
- Decrease in OPSS. Nitrates (nitroglycerine) are shown. Medicines of this group promote expansion of peripheral and coronary arteries, facilitate work of heart, promote reduction of inflow of blood to lungs. At a stage of transportation the tableted sublingual forms are applied, in a hospital intravenous administration is carried out.
Treatment of cardiogenic hypostasis is performed by the resuscitator. If necessary to the patient appoint consultations of the cardiologist or the heart surgeon, the therapist, the pulmonologist. During stay of the patient in ORIT carry round the clock out monitoring of AD, ChSS, ChDD, SpO2, body temperature. Daily make analyses of biochemical composition of blood, define KShchS and electrolytes, markers of sharp coronary pathology, if necessary measure TsVD.
Forecast and prevention
At a timely initiation of treatment the forecast favorable, cardiogenic OL manages to be stopped in 95% of cases. The remote prospects depend on the disease which became the hypostasis reason. In the absence of medical care of the patient with high degree of probability perishes from sharp violation of blood circulation, shock, ischemia of a brain and heart. Specific preventive actions are absent. It is necessary to perform in due time diagnosis of vascular and heart diseases, to use all existing possibilities of their treatment, to observe the medical and guarding mode recommended by the doctor.