Congestive heart failure [clinical manifestations --

(1) The main symptoms and signs used by clinical heart failure and started the main part of the performance of energy into the left Failure, right heart failure and from failure. Heart failure began in the left heart and lung congestion cycle mainly known as left ventricular failure; started in the right heart and bad blood circulation to the main body called right heart failure; both coexist said wholeheartedly failure. Right heart failure is often left heart failure caused. 1. Left ventricular failure : left ventricular failure is the failure and left. The former was particularly prevalent in hypertension, coronary artery disease, aortic disease, mitral regurgitation, myocarditis, acute glomerulonephritis; the latter is common in mitral stenosis, left atrial myxoma. Clinical performance was mainly due to lung congestion, caused by pulmonary edema. (1) difficulty in breathing : Left ventricular failure is the main symptom, lung congestion and reduced lung compliance where vital capacity reduction. Varying degrees of pulmonary congestion, breathing difficulties decision different manifestations : 1) exertional dyspnea : Initially only to the heavy physical or violent activities, there are shortness of breath, the rest may ease. With the degree of pulmonary congestion increased, to the progressive development of the less or manual, or even rest there dyspnea. 2) respiratory center : severe left ventricular failure, even if the rest are scattered flu breathing difficulties, were forced to take high pillow, Banwo or to alleviate's seat. This is because when sitting gravity, allowing some blood to transfer parts of the body to sag to relieve lung congestion; Moreover, the diaphragm decreased vital capacity will be increased. 3) paroxysmal nocturnal dyspnea : also known as cardiac asthma, heart failure is left early characteristic performance. Occurred during the night sleeping 1-2 hours later, the patient suddenly feeling chest tightness, short breath and forced to rise immediately, with Qinghai. Wheezing respiratory noise or cough spit bubble-like sputum. Available for several consecutive nights, nightly attack or intermittent seizures. Light were to rise after a few minutes can be alleviated, but also recumbent sleep, the day may not feel abnormal. Severe cases may progress to pulmonary edema. The mechanism may be related to venous return when recumbent, the diaphragm up, vital capacity and lower night vagal tone elevation. 4) acute pulmonary edema : as a typical hair suddenly serious short breath and breathe every minute up to 30-40 times, and center breathing, RUF cough sweating lips purple, his gray, 1,10 bubble-like sputum, have gone so far as to a large number of pink bubble-like sputum. Attack faster heart rate, blood pressure after the first or low, and both lungs could be heard extensive blisters Xeno wheezing can be heard flying horse law But often blisters noise exposure. X-ray typical large butterfly-shaped shadows from hila to expand. But in the early pulmonary interstitial edema stage only short breath RUF cough, rapid heart rate, the apex Benma legal and lungs wheezing. If timely treatment, can avoid the development of pulmonary alveolar edema. More pressure on the pulmonary circulation by the dramatic increase in the infiltration of plasma interstitial lung, alveolar then, the effect of the gas exchange caused. (2) fatigue, weakness : left ventricular failure early performance, which is probably a low cardiac output due. (3) coughing, breathlessness and hemoptysis : Department of alveolar and bronchial mucosa caused by congestion. They left ventricular failure of one of the main symptoms. Especially in the attack before the main performance for cough, and more physical activity or night recumbent aggravating. Sputum samples of the bubble, acute pulmonary edema of pink, or even bright red, ranging from the number of volume. (4) Other symptoms : left ventricular failure often associated with cyanosis, nocturia increase left pulmonary artery compression of the left recurrent laryngeal nerve expansion can be induced hoarseness. Serious brain ischemia, there may be lethargy, their right mind symptoms such as respiratory and weakened, dysrhythmia Chen-respiratory and other facilities, and then coma can occur. (5) cardiac signs : rapid heart rate, increased left ventricular apical region diastolic Benma law Second pulmonary valve heart sounds hyperthyroidism, and left ventricular enlargement due to the formation of relative mitral regurgitation have apical systolic murmur and other areas. Diastolic Benma which most legal diagnostic value in patients with heart rate or left lying for deep breathing and easily heard. Will also include the original signs of a heart attack (which can display certain changes). Pulse is the turn of the left heart failure early one of the important signs, only mildly alternating pulse in blood pressure was found. (6) pulmonary signs : pulmonary interstitial edema, pulmonary no dry sexual rales, only weakened breath sounds, But X-ray examination can be found. Mild pulmonary edema to the bottom of both lungs fine moist rales; Moderate pulmonary edema pulmonary rales up wet hilar level; Severe pulmonary edema may exceed hilar levels, or even across the entire lung, wheezing. Fourth of the patients had pleural effusion can be confined to the lung, or with a unilateral or bilateral pleural effusion. 2. Right heart failure : left over from heart failure caused. The main clinical manifestations of systemic venous stasis caused. (1) Symptoms : mainly caused bad blood in the long-term sustainability of the changes in organ function. If digestive congestion caused loss of appetite, nausea, vomiting, abdominal distention and constipation; Renal hematoma caused renal function, there decreased urine output increased nocturia, proteinuria and azotemia; right upper quadrant liver hematoma caused satiety. liver pain or severe abdominal pain, chronic liver congestion can cause jaundice, cardiac cirrhosis. (2) signs : In addition to the original signs of a heart attack, there are : a) signs of heart : from left ventricular failure caused, was fully extended. To the right ventricle increases were mainly associated with the former district favors heart beat (sternum left edge of the heart beat stronger and lasting). Xiphoid process can often see obvious beat. Heart rate increase, some patients may hear the sternum left edge early diastolic Benma law. Right ventricle can be significantly expanded to form a relatively tricuspid regurgitation, have tricuspid District briefing kind systolic murmur, inspiratory noise increase. 2) vein filling : filling the external jugular vein is right heart failure early signs. Semi - supine or sitting at the top of the clavicle to see the external jugular vein was often more visible in the right side. Serious vein at the back of the hand and other superficial vein is filling and can obviously see jugular vein pulsatility. These have the right heart failure venous hypertension. 3) hepatomegaly with tenderness : multiple subcutaneous edema occurred in the former, and each of right heart failure patients with no exceptions. Hepatomegaly xiphoid process than Adominal Obviously, the texture is relatively soft, with full Chongshigan, sometimes palpable edge unclear. xiphoid process is spontaneous delivery voiced area. Liver jugular levy positive return of right heart failure is an important clinical sign, but it can also be found in constrictive pericarditis or exudative. The improvement of cardiac failure or deterioration in the short-term hepatomegaly with reduced or increased. When the right heart failure increased rapidly in a short period of time, acute liver began to bleed, the same was true cell necrosis, led to a sharp increase in liver, with xiphoid process and the right upper quadrant pain and obvious tenderness, jaundice, elevated transaminase. If improve heart failure, the signs and symptoms in 1-2 weeks to improve or return to normal. Right chronic heart failure patients can lead to cardiac cirrhosis, liver flaky texture, tenderness is not obvious. many accompanied by jaundice, ascites and chronic liver dysfunction. 4) drooping edema : Early more insidious, often in the jugular vein filling and hepatomegaly after more visible. First subcutaneous water accumulation, weight gain, to a certain degree there before pitting edema, and the first to be found in the body drop site. Get up activities, edema of the foot, ankle and tibia before more visible, most of the afternoon for drama; Supine may lead sacral and thigh edema significantly; lateral horizontal limbs were significantly edema. Severe right heart failure patients to be sustained systemic edema. 5) pleural effusion and ascites : pleural effusion appeared to wholeheartedly failure patients. and the main pulmonary venous pressure and systemic venous pressure and increased capillary permeability pleural increased. For more bilateral pleural effusion, and the right amount more often, unilateral pleural effusion is also the right of styles, the reasons not clear, Right with the average venous pressure than the left lung, right lung capacity and the surface area of filter out more big left lung, and so on. Pleural effusion higher protein content (about 2~3g/100ml), the normal cells. Ascites right can be found in chronic heart failure or failure of the late wholeheartedly, patients often interested in mice with liver cirrhosis. 6) pericardial effusion : the serious long-term right ventricular failure or failure often appears dedicated a small amount of pericardial effusion, generally does not cause symptoms of cardiac tamponade, and often makes the echocardiographic examination. 7) Other findings : some patients with heart failure may appear he vein. Long-term right heart failure patients who have cyanosis, the performance of facial telangiectasia, bruising and pigmentation. Advanced performance can be significant malnutrition, weight loss or cachexia. 3. Dedicated failure : both the left and right heart failure in clinical performance. Secondary to left ventricular failure of the whole heart failure, as of right ventricular volume emission reduction, left heart failure lung congestion mitigation, dyspnea performance but less visible. (2) failure of the contractile function and diastolic dysfunction recent study confirmed that Congestive heart failure patients 70% of myocardial contractile dysfunction of the main features 30% was mainly attributable to primary diastolic dysfunction caused. Both in clinical signs and symptoms of inability to distinguish identify the two rely mainly on echocardiography, cardiac catheterization, radionuclides and other tests. Diastolic dysfunction heart failure without lowering the ejection fraction, the heart and not the (small heart failure) may be detected through these checks. Diastolic dysfunction in heart failure, if diastolic filling more complete stroke volume will be greater. Cause of left ventricular diastolic dysfunction heart failure is mainly due to hypertrophic obstructive cardiomyopathy, Aortic stenosis after valve replacement, coronary heart disease and cardiac hypertrophy associated with hypertension heart disease. At this time of end-diastolic relaxation may not be adequate, particularly tachycardia. Its incidence was mainly due to the mechanism of myocardial ischemia, myocardial fibrosis, myocardial hypertrophy and ventricular hypertrophic cardiomyopathy caused the stiffness, ventricular diastolic incomplete and / or ventricular diastolic different regions of the lack of co-ordination, resulting in diastolic dysfunction. Right ventricular diastolic dysfunction of the study was relatively small, right ventricular coronary artery involvement or support inferior myocardial infarction patients can be seen. Understanding heart failure is systolic or diastolic dysfunction dysfunction, the difference between the two is the therapeutic significance. (3) a cardiac function classification. A cardiac function (the equivalent of decompensated heart function) : ?٠only signs of a heart attack, unrestricted activities; ?ڠgeneral physical activity without causing fatigue, palpitation, dyspnea or angina symptoms. 2. Cardiac Function 2 (equivalent to mild heart failure or grade I) : ?٠physical activity slightly restricted break asymptomatic; ?ڠgeneral physical activities (on the third floor, often uphill or walking speed 3-4 km) can lead to fatigue, palpitation, dyspnea or angina symptoms; ?۠medical examination in addition to signs of a heart attack, but also a rapid heart rate, mild liver enlargement. 3. Cardiac Function 3 (equivalent to moderate heart failure or second degree) : ?٠obvious limitation of physical activity; Symptoms little break; ?ڠminor physical activity (as the second floor, Xiao and Sheung walking speed of 0.5-1 km) that is, palpitation, breathing difficulties and other symptoms of congestive heart failure or angina attack; ?۠moderate swelling of the liver, and mild to moderate edema. 4. Cardiac Function 4 (equivalent to severe heart failure or third degree) : ?٠not competent in any physical activities; ?ڠrest are still signs and symptoms of heart failure, or angina syndrome; ?۠visceral congestion and edema significantly, chronic heart failure can be derived cirrhosis, and other interested change. (4) due to complications of heart failure patients are bedridden and slow blood flow may lead to deep vein thrombosis, shedding can occur pulmonary embolism and pulmonary infarction, and the performance of hemoptysis, chest pain, jaundice, heart failure or even shock. Left and right ventricular wall enclosing thrombosis can be caused systemic arterial and pulmonary embolism, which can lead to brain, kidney, spleen, mesenteric infarction and upper and lower extremities necrosis. Bedridden patients with heart failure is particularly vulnerable to pulmonary edema with respiratory infections often occur bronchopneumonia.