Pulmonary edema

Patient complains on severe breathlessness, cough with expectoration of sputum, heaviness in the heart.

Objective examination. The general patient's condition is extremely grave, deranged consciousness, disorder of the mental function, forced posture - sitting with trunk slightly bent forward, the skin pall, cyanosis with grey tint, cold sweet.

Respiration becomes rattling and heard even at the distance. Ample foaming sputum with traces of blood (pink or red) is expectorated.

In percussion over the lungs in the posterior inferior parts of the chest - dull sound.

In auscultation harsh respiration, moist rails of various calibers are heard over entire surface of the lungs. The heart sounds are weakened, protodiastolic gallop rhythm, tachycardia.

Pulse - small frequent pulse, alternative, with poor filling.

Blood pressure - decreased.

If patient is not treated urgently, this attack can lead to death.

Additional methods of examination

ECG: hypertrophy of the left ventricle, signs of overloading of the left ventricle.

X-ray examination: congestion changes in lungs.

Echo-CG: hypertrophy of the interventricular septum and the back wall of the left ventricle, decrease of contractility of the myocardium, increase end-systolic end-diastolic dimensions of the left ventricle.

Acute left atrial heart failure

The syndrome of acute left atrial failure develops in patients with mitral stenosis, myxoma of the left atrium (in mechanical obstruction of the intracardiac blood flow) in markedly weakened contractility of the left atrium and normal function of the right ventricle, which continues pumping blood into the lesser circulation. Clinically acme left atrial failure manifested by cardiac asthma and pulmonary edema may resemble acute left ventricular heart failure.

Acute right ventricular heart failure

Acute right ventricular heart failure resulted from the sharply suddenly limitation of the lung's surface from the breathing and consequently development of the congestion in greater circulation.

Etiology

• thromboembolism of the trunk of the pulmonary artery or its branches: spontaneous pneumothorax;

• bronchial asthma (status asthmaticus);

• lobar pneumonia;

• lung atelectasis;

• rupture of the aorta aneurism into the pulmonary artery.

Pathogenesis. In thromboembolism of the pulmonary artery or its branches occurs mechanical occlusion of vessel lumen and complete or incomplete blood supply to corresponding part of lung. In case of pulmonary disease develops reduction of blood flow. All these disorders lead to hemodynamic disturbances at first in pulmonary circulation, later intracardial and systemic circulation. As a response to decrease of arterial amount of blood occurs the resistance of pulmonary blood flow. The right ventricular heart failure with dilation of the chamber is developed. Increasing of end diastolic pressure at right ventricle, right atrium and central veins are observed. The features of congestion m greater circulation appear.

Clinical features

Clinical features of acute right ventricular heart failure include symptoms and signs due to common process and presence of complication in a form of acute pulmonary heart.

The main complaints according to leading process: severe acute pain in the chest, cough, and hemoptysis in patient with thromboembolism of pulmonary artery. The general condition is extremely grave, deranged consciousness, diffuse cyanosis, pallid skin, cold sweat and dyspnea. Acute pulmonary heart is characterized by complaints on the heaviness m the right hypochondrium and edema at the low extremities.

The objective examination of respiratory, cardiovascular systems reveals the clinical features of main pathology: infarction of the lung, pneumonia, pneumothorax, and atelectasis.

The neck veins become swollen later develops edema of legs. Epigastric pulsation and pulsation left to the sternum are determined as a result of dilation of right ventricle. Right border of the relative heart dullness displaced to the right from the sternum, the heart sound are diminished, splitting of the second sound over the pulmonary artery, tachycardia, gallop rhythm. The pulse is small and frequent. Blood pressure: hypotension.

In palpation of abdomen the enlarged liver is detected.