Sharp expansion of heart
Sharp expansion of heart – the restretching of a cardiac muscle resulting from the sharp growth of OTsK at the wrong calculation of a dose and speed of an infusion/transfusion. HELL, signs of respiratory insufficiency, breast pains is shown by bystry increase systolic. Development of hypostasis of lungs is possible. At the anamnesis usually there is IBS, congenital kardialny defects, anemia. The diagnosis is established on the basis of a clinical picture, the fact of violation of the equipment of a transfusion taking place, data of laboratory and hardware inspection. Treatment includes diuretics, inhalations of O2 passed via the defoaming agent, cardiacs, a plasma exchange.
Sharp expansion of heart
ORS – the main symptom of a volemichesky overload which caused all further displays of this pathology. Arises at bystry introduction of large volume of infusion solutions or medicines of blood. The state often develops at the patients having diseases of a cardiological profile, chronic anemia, pulmonary diseases. In pediatrics the gipervolemichesky syndrome comes to light at the newborns needing completion of OTsK. From the listed groups leads to development of dilatation in patients even the small volume of intravenously entered liquid. It is considered that the risk of ORS at the predisposed patients repeatedly increases if the speed of infusion makes more than 1 ml/h on kilogram of body weight.
Reasons of sharp expansion of heart
The overload liquid at the patients who do not have chronic diseases practically does not arise as heart copes with the increased OTsK, and systems of an ekskretion quickly delete surplus of water from an organism. Sharp RS at the healthy person develops only at very big excess of admissible volume of infusion that in practice meets extremely seldom. The Gipervolemichesky syndrome, including coronary expansion, is usually diagnosed in the presence of the following contributing factors:
- Renal failure. Decrease in functionality of an urinary system leads to the slowed-down removal of surplus of water and products of a metabolism from an organism. The positive balance of liquid at which the volume of the arrived H2O considerably exceeds amount of urine is created. Weight of a state directly depends on expressiveness of a water imbalance.
- Heart failure. In the presence of HSN heart works at a limit of the residual resources. It is incapable to pump over fully even that volume of blood which is available in an organism constantly. Sharp filling of vessels additional liquid provokes excessive increase in preloading, there is a sharp expansion of kardialny cameras, a bigger reduction of their functionality is noted.
- Respiratory pathology. At a bronkhektaziya, vaskulita, bronchial asthma, HOBL pressure in a small circle of blood circulation increases. It increases load of the right departments and promotes their expansion, exponentiates mechanical violation of activity of the left ventricle. Sharp or chronic pulmonary heart is formed. Further process of formation of changes does not differ from that at HSN.
The mechanism of development of pathology is rather simple. Sharp increase in volume of the liquid circulating in vessels strengthens load of the venous and arterial device and heart. The last appears incapable to pump over necessary amount of blood. In it gemoralny surplus collects, walls stretch, the body loses an opportunity to be reduced fully. In both circles of blood circulation there is a stagnation. On the periphery and in lungs there is a strengthened proliferation of plasma in soft fabrics, massive hypostases are formed.
Ascites which becomes the reason of increase in intra abdominal pressure with the subsequent dysfunction of internals can be formed. There is a preload of a diaphragm that aggravates respiratory insufficiency even more. Propotevaniye the transsudata in interstitsialny space or alveoluses provokes pulmonalny hypostasis which is followed by sharp deterioration in ventilation with development of the corresponding clinical picture. The death of the patient comes from the expressed respiratory and cardiovascular insufficiency, an asistoliya.
Symptoms of sharp expansion of heart
At the initial stage pathology is shown by rapid growth of systolic arterial pressure. Indicators diastolic HELL rise not so considerably. The difference between the "top" and "lower" result of a tonometriya increases. Pulse of the patient differs in weak filling and tension, tachycardia is found. The patient feels a severe headache, the complicated breath comes to light. The bronchospasm with formation of an attack of cardiac asthma can take place.
In process of process development the symptomatology amplifies. There are signs of insufficiency of peripheral blood circulation (a blue shade of lips, a nasolabial triangle, lobes of ears, finger-tips) and a hypoxia (diffusion cyanosis, inclusion in process of breath of auxiliary muscles, inflating of wings of a nose, psychomotor excitement). Arterial pressure decreases due to reduction of force of warm reductions. Tachycardia remains and has compensatory character.
At a terminal stage of a disease all its manifestations reach a maximum. From a mouth white or pinkish foam is emitted, the expressed cyanosis of skin is noted, ChSS and HELL fall up to the critical sizes. Psychomotor excitement is succeeded by consciousness oppression. The warm rhythm is broken, there is a fibrillation of ventricles which is followed by respiratory standstill and blood circulations. There comes the stage of clinical death which in the absence of medical care passes in biological in 3-5 minutes.
According to researches, the probability of death of the patient increases by 20% with each liter of positive total water balance. The general survival of patients with surplus of liquid within 1-4 l does not exceed 25%. Alveolar hypostasis, brain hypostasis, sharp decrease in sokratitelny ability of heart becomes a cause of death. At successful timely knocking over of an overhydratation there can be a reactivation of chronic coronary diseases, development of HSN owing to restretching of kardialny cameras. After an episode of a heavy hypoxia against the background of hypostasis damage of a brain up to a decortication (cerebral death) is possible or post-hypoxemic encephalopathy.
Taking into account that massive infusion or a transfusion is carried out only in the conditions of ORIT or the operating room, diagnostics of dilatation is performed by the doctor the intensivist. Without fail it is necessary to differentiate sharp expansion of heart with hypostasis of lungs and strengthening of heart failure of other etiology. For this purpose consultations of the cardiologist, the heart surgeon, the expert of functional diagnostics can be required. The following laboratory and hardware techniques are applied to specification of the nature of the available violations:
- Fizikalny inspection. Includes survey of the patient, a palpation, percussion and an auskultation of lungs, hearts. Shift of coronary borders, change of kardialny tones and a rhythm comes to light. Rigid breath is listened, there can be krupnopuzyrchaty rattles, a krepitation. At percussion obtusion of a perkutorny sound is defined.
- Laboratory inspection. There is a gipoksemiya (PaO2 ≤ 95 mm of mercury), respiratory (pH ≥ 7.35, PaCO2 ≤ 40 mm. / Art.). In the presence of the accompanying changes from cardiovascular system (OIM owing to restretching of a coronary wall and reduction of capacity of arteries) increase in level of a troponin, myoglobin, KFK, KFK-MV can be noted.
- Hardware inspection. During ultrasonography of heart expansion of its cameras and borders is found. At the ECG there are symptoms of arrhythmia of this or that type, shift of an electric axis up to horizontal position. On roentgenograms strengthening of the vascular drawing, expansion of a coronary shadow, emergence of lines of Kerli is visualized. The central venous pressure increases to 14 mm of a water column and more.
Treatment of sharp expansion of heart
Therapy of a volemichesky overload is directed to normalization of vital indicators. Treatment as a result of which ChSS decreases to 90-100, TsVD – to 8-12 mm, lactate level – 1-2 mmol/litre is considered effective. The warm rhythm has to be restored, the phenomena of pulmonalny hypostasis are stopped. At an auskultation the cured patient has no rattles, other signs of a congestion of a transsudat. As recovery measures all-regime actions, a medicamentous and resuscitation grant are used:
- General actions. At the first signs of expansion on sharp type it is necessary to stop supply of infusion solution to the venous course. The patient should give a sitting or semi-sitting position, it allows to deposit a part of blood in legs and to lower preloading. Short-term imposing of venous plaits on three extremities from four is allowed.
- Medicines. Loopback diuretics are shown. It gives the chance to quickly remove surplus of water in the natural way, without resorting to a plasma exchange. Inhalations of the oxygen passed through 70% ethyl alcohol are applied. At considerable weakening of warm activity injection of inotropny medicines is necessary: dopamine, dobutamin, levosimendan, glycosides. Hypostasis of lungs demands introduction of morphine or a promedol.
- Resuscitation help. At the expressed ODN of the patient intubirut, transfer to artificial respiratory support. Make the round-the-clock monitoring of a state by means of the anesteziologichesky monitor. Provide the central venous access, irreplaceable for measurement of TsVD and bystry introduction of medicines to the vascular course. If necessary excessive volumes of liquid can be removed by means of the procedure of a plasma exchange.
Forecast and prevention
The forecast is adverse. Mortality in the absence of the timely help reaches 75%. If coronary expansion was revealed at an initial stage, chances of a happy end increase, the lethality does not exceed 18-20% of total of cases. Prevention consists in competent calculation of the necessary volume of infusion or a transfusion by the doctor who is carrying out treatment. It is necessary to consider that patients with the available contributing factors have to have the minimum injection speed. Accurater tactics of the expert is demanded by purpose of solutions to babies.
1. Overload liquid: reasons, diagnostics, complications, Treatment / Dats A. V., Gorbachov V. I.//the Messenger of anesthesiology and resuscitation – 2015 – No. 3.
2. Transfusion of components, medicines of blood and gemokorrektorov/Volodchenko N. P. – 2013.
3. Blood transfusion and its components / Beloborodov V. A., Kelchevskaya E. A. – 2013.