Clinical manifestations and treatment of heart failure

Heart failure, also known as heart failure, refers to an impairment of the heart's contractile and diastolic functions, which makes it impossible to fully discharge the venous blood out of the heart, causing blood congestion in the venous system. This can cause the patient to experience a variety of symptoms, including physical fatigue and a significant decrease in exercise endurance. Sometimes there are moist rales in the lungs. If it is an acute disease, it may lead to a more rapid onset of the disease.

Clinical manifestations

(1) Early symptoms: Early signs of reduced left ventricular function include fatigue, significantly reduced exercise tolerance, and a heart rate increase of 15 to 20 beats per minute in people with normal heart function, followed by exertional dyspnea, paroxysmal nocturnal dyspnea, and high-back sleep. Examination may reveal left ventricular enlargement, early or mid-diastolic gallop rhythm, and moist rales, dry rales, and wheezing at the bases of both lungs.

(2) Acute pulmonary edema has an acute onset and can rapidly develop into a critical condition. Sudden severe dyspnea, orthopnea, wheezing, irritability and fear, with a respiratory rate of 30 to 50 times per minute; frequent coughing and spitting up large amounts of pink foamy sputum; rapid heart rate, with a gallop rhythm often audible at the apex of the heart; both lungs are filled with moist rales and wheezing.

(3) Cardiogenic shock 1) Hypotension persists for more than 30 minutes, with systolic blood pressure dropping below 90 mmHg, or in patients with pre-existing hypertension, systolic blood pressure drops by ≥60 mmHg. 2) Tissue hypoperfusion state: ① The skin is cold, pale and cyanotic with purple streaks; ② Tachycardia>110 beats/min; ③ The urine volume is significantly reduced (<20ml/h), or even anuria; ④ Consciousness disorder, often with irritability, agitation, anxiety, fear and a sense of impending death; Systolic blood pressure is lower than 70mmHg, and depression symptoms may occur, gradually developing into confusion or even coma. 3) Hemodynamic disorder: PCWP ≥ 18 mmHg, cardiac output index (CI) ≤ 36.7 ml/s·m (≤ 2.2 L/min·m).

Once diagnosed, treatment should be provided according to standard procedures.

(1) Initial treatment is oxygen inhalation via mask or nasal cannula; morphine, loop diuretics, cardiotonic drugs, etc. are given intravenously. Have the patient sit or semi-recumbent with his legs hanging down to reduce venous return in the lower limbs.

(2) If the condition still does not improve, vasoactive drugs such as positive inotropes, vasodilators and vasoconstrictors should be selected according to systolic blood pressure and pulmonary congestion.

(3) For patients with severe conditions, persistently low blood pressure (<90 mmHg) or even cardiogenic shock, hemodynamics should be monitored and various non-drug treatments such as intra-aortic balloon pump, mechanical ventilation support, blood purification, ventricular mechanical assist devices and surgery should be used.

(4) Dynamic measurement of BNP/NT-proBNP helps guide the treatment of acute heart failure. If the level remains high after treatment, it indicates a poor prognosis and treatment should be strengthened. If the level decreases after treatment and the decrease is >30%, it indicates that the treatment is effective and the prognosis is good.

(5) Control and eliminate various risk factors and promptly correct underlying cardiovascular diseases.