Clinical manifestations of heart failure

Written by Wang Li Bing

Intensive Care Medicine Department

Updated on September 27, 2024

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Heart failure is divided into left heart failure, right heart failure, and total heart failure. Left heart failure mainly manifests as exertional dyspnea or nocturnal paroxysmal dyspnea. It is often accompanied by palpitations, orthopnea, coughing, coughing up pink frothy sputum, accompanied by palpitations, fatigue, etc. Right heart failure primarily presents with symptoms of the digestive system, such as abdominal distension, nausea, vomiting, edema, oliguria, etc. Once heart failure occurs, active treatment must be administered. In clinical practice, treatments mainly include cardiotonics, diuretics, vasodilators, and other symptomatic treatments.

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Triggers of acute heart failure

The triggers of acute heart failure include the following aspects: Respiratory infections are the most common and important trigger, and infective endocarditis is also not uncommon. However, due to its concealed onset, it is easily underdiagnosed. The second is arrhythmia, among which atrial fibrillation is one of the most common arrhythmias in organic heart disease and is also an important factor leading to heart failure. Additionally, rapid arrhythmias can also cause acute heart failure. The third is an increase in blood volume, such as excessive salt intake or excessive or rapid intravenous fluid administration. The fourth is excessive physical exertion or emotional excitement, such as during late pregnancy or childbirth. The fifth aspect is improper treatment, inappropriate use of diuretics or antihypertensive drugs, which can also trigger an episode of acute heart failure. Furthermore, whether it is an exacerbation of existing heart disease or complications with other diseases, such as coronary heart disease with myocardial infarction, rheumatic disease becoming active, or complications with hyperthyroidism or anemia, can all cause acute heart failure.

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Causes of acute heart failure include

Most patients with acute heart failure have a history of heart disease, and the common causes mainly include: 1. Acute myocardial necrosis or damage, such as acute coronary syndrome, peripartum cardiomyopathy, and myocardial damage caused by drugs or toxins, including sepsis-induced myocardial damage. 2. Acute exacerbation of chronic heart failure due to infection or other stressful factors. 3. Acute hemodynamic changes, mainly including conditions like cardiac tamponade, hypertensive crisis, aortic dissection, and acute valvular regurgitation, all of which can lead to acute heart failure.

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Written by Fan Yan Fu

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Why do we need to supplement potassium for heart failure?

Potassium ions are very important in the cardiac muscle cells, playing a critical role in maintaining the stability of the electrical activity of these cells. Thus, in conditions like heart failure or other cardiovascular diseases, it is essential to keep potassium levels within a certain range in order to reduce serious cardiac events. When potassium levels fall, cardiac electrical activity can become disordered, potentially leading to a sudden cardiac arrest. This is particularly the case in heart failure where the cardiac muscle cells are in a diseased state, making them more sensitive to low potassium levels. Thus, they are more prone to sudden cardiac arrest or sudden cardiac death. Therefore, for cardiovascular diseases, particularly heart failure, there is a high priority on supplementing potassium, generally increasing it to above 4.0 and even around 4.5 to be safe. Additionally, patients with heart failure often have poor diets, leading to lower potassium intake and consumption of potassium-rich foods, necessitating pharmacological potassium supplementation. Heart failure patients frequently use diuretics, which can lead to higher potassium loss, thus requiring additional potassium supplementation. For these reasons, potassium supplementation is particularly emphasized in patients with heart failure.

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Written by Wang Li Bing

Intensive Care Medicine Department

34sec

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The basic mechanisms of heart failure

Heart failure is not an independent disease; it can be caused by various factors, such as myocardial infarction, cardiomyopathy, and various myocarditis, which lead to changes in the heart structure and subsequent cardiac dysfunction. Heart failure is mainly due to a disturbance in the heart's contractile function or diastolic function, which prevents the heart from adequately ejecting the returning blood volume. This results in pulmonary congestion, systemic circulation congestion, and a series of syndromes caused by insufficient arterial perfusion.

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Written by Wang Li Bing

Intensive Care Medicine Department

1min 21sec

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How is acute heart failure treated?

Acute heart failure presents with significant respiratory distress and symptoms of hypoxia. Immediate intervention is necessary to alleviate breathing difficulties. Clinically, the following measures are generally adopted: First, position the patient to sit up with legs dangling to decrease venous return to the heart. Second, administer high-flow oxygen through a nasal cannula, and if necessary, proceed with endotracheal intubation and ventilator support. Third, administer morphine subcutaneously or intravenously to reduce agitation and myocardial oxygen demand. Fourth, use rapid diuretics, such as furosemide. Fifth, utilize vasodilators such as nitroglycerin or nitroprusside. Sixth, use positive inotropic agents such as dopamine or dobutamine as appropriate. Seventh, employ digitalis drugs, but avoid use in acute myocardial infarction within the first 24 hours. Eighth, consider using an intra-aortic balloon pump or other cardiopulmonary support systems, etc., and after stabilization of acute heart failure, further treat the underlying cause, etc. (Use medications under the guidance of a doctor.)