Additional methods of examination

Clinical blood analysis is required in order to reveal inflammatory process, anemia.

Clinical urine analysis is required for estimation kidney pathology.

Biochemical blood analysis – creatinin, urine acid, total protein levels, potassium, calcium concentration.

ECG is required for detection of main cardiac process.

X-ray examination in order to estimate lung and heart pathology.

Echo-CG is required for estimation of ejection fraction; structural and functional state of heart.

Echo-stress test with dobutamin.

Measurement of pressure in ventricle:

end-diastolic pressure in right ventricle using the catheterization of vena cava superior;

end-diastolic pressure in left ventricle using the Swan-Gаnz catheter in pulmonary artery.

Acute heart failure Acute left ventricular failure

Acute left ventricular failure - is state resulted from suddenly sharp decreased contractility of left ventricle and normal one of right ventricle.

Causes acute left ventricular failure:

• essential hypertension, especially hypertensive crisis;

• heart valve diseases (aortic regurgitations, aortic stenosis);

• ischemic (coronary) heart disease;

• myocardial infarction;

• myocarditis;

• arrhythmias.

Pathogenesis. Acute heart failure may be provoked by infections, intoxications, physical and nervous strain. The lesser circulation becomes overfilled with blood because during a sharply decreased contractility of the left ventricle the right ventricle continues working normal to pump the blood from the greater circulation to the lesser one; arterial blood pressure increases in pulmonary veins and capillaries, its permeability increases, gas exchange is impaired. If congestion in the lesser circulation progresses, hydrostatic pressure in capillaries is equal or higher than oncotic pressure (25-30 mm Hg). The blood plasma pass from the overfilled pulmonary capillaries to the alveoli and accumulates in the respiratory ducts, pulmonary edema develops. Interstitial edema means the thickening of the alveoli walls due to accumulation of the blood plasma; alveolar edema means the presence of the blood plasma in the alveoli space.

There are two clinical forms of acute left ventricular failure: cardiac asthma and pulmonary edema.

Cardiac asthma

Clinical features. The patient complains on severe dyspnea as attack, with more difficulty inspiration, which often arises during night sleep, so called cardiac asthma. May be dry cough or with expectoration of small amount the tenacious sputum. The patient complains on marked weakness, feeling of fear, excitement.

Objective examination. General patient's condition is from moderate grave to extremely grave. Consciousness is clear but if this state lasts a long time, may be cloudiness.

Posture: patient assumes a forced position - sitting with legs hanging down from the bed or he stands up.

The skin becomes pallid and cyanotic, acrocyanosis, cold sweat appears.

Examination of the respiratory system. The accessory muscles take part in the breathing, tachypnea - 30-40 per minute. Over the low regions of the both sides of lungs the vocal fremitus is increased. Over the lungs is revealed dull-tympanic sound. Harsh respiration and crepitation in the posterior part of the lungs are heard.

Examination of the cardiovascular system. The apex beat displaced to the left and cardiac dullness and configuration of the heart depends on many pathology. The heart sounds are decreased at the apex, accentuated second heart sound over the pulmonary artery, tachycardia, gallop rhythm. Pulse is frequent, arrhythmia, blood pressure may be normal, or decreased.

In case of appropriate treatment may disappear the clinical picture of cardiac asthma. In some case this state transforms in pulmonary edema.