Symptoms of acute left heart failure in the elderly

Acute left heart failure is caused by severe compression of the front and back of the ventricles due to damage to the heart valve, which leads to reduced blood output from the body and congestion in the lungs, causing difficulty breathing. If such symptoms occur at night, it is very dangerous. If the patient suddenly wakes up at night, he will feel a strong sense of suffocation and oppression, and have inexplicable panic about the surrounding things.

The elderly are very susceptible to acute left heart failure. When the disease occurs, the patient will have difficulty breathing, which affects the person's normal work and gradually reduces their labor force. These symptoms are often very difficult to control, especially for the elderly. It is best to detect and treat them early. So what are the symptoms of acute left ventricular failure in the elderly? The following will introduce you in detail!

1. Difficulty breathing

Dyspnea is the most common and prominent symptom of acute left heart failure. Patients feel difficulty breathing, and also have labored and short breathing. External manifestations include excessive activity of the chest respiratory muscles, increased frequency, and flaring of the nostrils.

(1) Paroxysmal nocturnal dyspnea: It is an early manifestation of acute left heart failure. Most patients suddenly wake up due to chest tightness and shortness of breath after sleeping for 1 to 2 hours at night. They need to sit up immediately and have frequent coughing and wheezing, coughing up foamy sputum. After sitting up, it usually gradually eases after a few minutes. Otherwise, it may develop into a persistent state of cardiac asthma and develop into acute pulmonary edema. Its mechanism of occurrence:

① After the patient lies flat, the amount of venous blood returning to the heart increases, exceeding the limit of the left heart load and aggravating pulmonary congestion.

② After lying down, the systemic venous pressure decreases, and the surrounding subcutaneous edema fluid is gradually absorbed, which increases the circulating blood volume and aggravates pulmonary congestion.

③The excitability of the vagus nerve increases at night. On the one hand, it causes the coronary artery to constrict, reducing the myocardial blood supply, affecting the myocardial contractility, and reducing the left ventricular output, thus aggravating pulmonary congestion; on the other hand, it causes the bronchial smooth muscle to contract, aggravating pulmonary ventilation disorders, increasing myocardial hypoxia, and seriously affecting cardiac function.

④ When lying flat, the diaphragm rises, lung capacity decreases, and hypoxia aggravates.

(2) Orthopnea: Patients experience breathing difficulties when lying flat, and are often forced to sit or semi-recumbent to alleviate or relieve the symptoms. This is called orthopnea. In severe cases, patients must sit on the edge of the bed or on a chair with their feet hanging down, their upper body leaning forward, and their hands tightly grasping the edge of the bed or chair to assist breathing and relieve symptoms. The mechanism of orthopnea is mainly the redistribution of circulating blood in the body.

① Influence of pulmonary blood volume: When lying down, the blood originally in the small veins of the lower limbs and abdominal cavity flows back to the heart and lung circulation due to the change in body position, which can increase the pulmonary blood volume by hundreds of milliliters. When sitting, the blood in the upper body is partially transferred to the abdominal cavity and lower limbs due to gravity, reducing the amount of blood returning to the heart and reducing pulmonary congestion.

② Changes in vital capacity: When lying down, vital capacity decreases significantly (an average decrease of 25%) due to the elevation of the diaphragm, while when sitting up, vital capacity increases by 10% to 30% compared to lying down.

(3) Dyspnea caused by acute pulmonary edema: Cardiogenic pulmonary edema in the elderly is caused by a sharp and sustained increase in pulmonary capillary filtration pressure and damage to the alveolar capillary membrane. The dyspnea is caused by:

① Pulmonary interstitial edema: A large amount of fluid in the capillaries extravasates and cannot be absorbed by the lymphatic tissue. The fluid first extravasates into the pulmonary interstitium, causing the alveoli to be squeezed. The gas in the alveoli is difficult to diffuse into the pulmonary capillaries, reducing the effective area of ​​gas exchange, leading to hypoxemia and severe dyspnea. The fluid in the pulmonary interstitium can also compress the bronchioles, aggravating dyspnea and emitting a wheezing sound like asthma, which is called cardiac asthma.

② Intra-alveolar edema: If emergency measures are not taken during the pulmonary interstitial edema stage, the condition may further develop, and fluid may extravasate into the alveoli, filling the alveoli with exudate containing plasma protein. Foam is formed due to respiratory agitation, and the bronchiolar mucosa is swollen, which may cause obstruction of the alveoli and bronchioles, seriously affecting gas exchange and aggravating hypoxemia. The fluid in the alveoli also reduces its surface tension, further reducing lung compliance, increasing the elastic resistance of lung tissue, and accelerating the respiratory rate through neural reflexes. In order to assist the lungs in exhaling and inhaling, the respiratory muscles must increase their workload and breathe harder, resulting in increased lung oxygen consumption, further aggravating hypoxia and causing patients to have extreme breathing difficulties.

Acute left heart failure in the elderly is a very dangerous disease. Many elderly people suffer from it while walking on the road. In mild cases, they will become unconscious, and in severe cases, they will faint. Therefore, it is best for the elderly to be accompanied by family members when going out. Usually, you should maintain an optimistic mood and listen to music. You should not be overly depressed. When an attack is about to occur, you must inhale oxygen.