Symptoms and treatment of cardiovascular failure. Acute vascular insufficiency Acute vascular insufficiency syndrome manifests itself

Acute vascular insufficiency develops as a result of an acute drop in vascular tone and expansion of the peripheral vascular bed (venules and arterioles), which leads to a sharp decrease in blood flow to the heart and disruption of nutrition of all organs and tissues. Manifests: fainting, collapse.

Fainting

Mild form of vascular insufficiency. This is an acute, short-term cerebral ischemia due to a violation of the neurohumoral regulation of vascular tone.

Cardiac:

with complete transverse blockade - Morgagni-Edams-Stokes attacks,

with aortic stenosis during exercise,

with stenosis of the pulmonary artery mouth,

with severe pulmonary hypertension;

Extracardiac reasons:

with irritation of the carotid sinus, with compression of the carotid arteries;

when coughing (after prolonged coughing attacks, venous flow is disrupted in conditions of increased intrathoracic pressure);

when moving to a vertical position - orthostatic hypotension (drop in blood pressure);

for eating disorders,

when overworked, frightened, in a stuffy room, when overheated.

Clinical manifestations:

Suddenly dizziness, weakness, and loss of consciousness occur.

The skin is pale, the limbs are cold to the touch.

Breathing is shallow and slow.

Blood pressure drops sharply.

The pulse is rare 40 - 50 beats per minute, small, weak filling and tension, heart sounds are muffled.

Collapse

It is characterized by a sharp drop in vascular tone or a rapid decrease in the mass of circulating blood, which leads to a decrease in venous flow to the heart, a drop in arterial and venous pressure, brain hypoxia and inhibition of vital body functions.

Main reasons:

acute severe infections (lobar pneumonia, typhoid, typhus, etc.);

acute blood loss;

diseases of the endocrine and nervous system (tumors, etc.);

exogenous intoxication (poisoning with carbon monoxide, organophosphorus compounds);

acute diseases of the abdominal organs;

Clinical manifestations:

A sudden feeling of general weakness, dizziness, chilliness, chills, and thirst develops.

The patient is conscious, lethargic, lethargic.

The facial features are pointed, the limbs are cold, the skin and mucous membranes are pale with a cyanotic tint.

Small and weak rapid pulse, collapsed veins, low blood pressure.

The heart is not enlarged, the sounds are muffled, sometimes arrhythmic.

Breathing is shallow and rapid.

Diuresis is reduced.

Shock(from the French choc) is an acutely developing pathological process caused by the action of a super-strong irritant and characterized by disruption of the central nervous system, metabolism and, most importantly, autoregulation of the microcirculatory system, which leads to destructive changes in organs and tissues, resulting in the development of multiple organ failure (MOF).

MODS (definition) is a severe nonspecific stress reaction of the body, failure of two or more functional systems, universal damage to all organs and tissues of the body by aggressive mediators of a critical condition with a temporary predominance of symptoms of one or another organ failure - cardiac, pulmonary, renal, etc. The main feature of MOF is the uncontrollable development of damage to a life-support organ or system to such a depth, after reaching which it is necessary to state the inability of the organ to function in the interests of maintaining vital functions in general and preserving its structure in particular. The direct factors that determine the severity of multiple organ dysfunction are the different ability of organs to withstand hypoxia and decreased blood flow, the nature of the shock factor and the initial functional state of the organ itself.

Cardiogenic shock develops in response to an acute decrease in cardiac output (cardiac minute volume, i.e. the volume of blood ejected by the ventricles in 1 minute). It occurs with myocardial infarction, with rapidly developing heart valve defects, or with hemopericardium with tamponade of the cardiac membrane. Central venous and ventricular diastolic pressure decreases. The changes are similar to those that occur with hypovolemia and are associated with a drop in blood pressure and a decrease in blood supply to tissues.

Cardiogenic shock is manifested by the following symptoms:

 Systolic blood pressure decreases most often below 80 mmHg. Art., pulse pressure is reduced to 25 - 20 mm Hg. Art.

- Hypoperfusion syndrome:

Cold pale marbled skin

Cold sweat

Oligouria less than 20 mm/hour, anuria

Impaired consciousness

Lactic acidosis

 Lack of improvement after pain relief and O2 use

The mortality rate for cardiogenic shock reaches 80%.

Treatment

Treatment for shock should be aimed at increasing blood volume; interfering liquids, isotonic solutions of sodium chloride and glucose are introduced into the plasma. In this case, it is necessary that systolic blood pressure increases to 100 mm Hg. or more, and the central venous pressure rose to 15 mm Hg. If IPV is high, one should refrain from administering plasma replacement solutions and direct efforts to increase the contractile function of the heart. Such patients are administered symlatomimetic amines. Thus, dopamine, which is a biological precursor of norepinephrine, increases cardiac output more than norepinephrine, and, along with an inotropic effect, has a dilating effect on the vessels of the heart, brain, and kidneys.

Vascular insufficiency is a violation of local or general blood circulation, which is based on insufficiency of the function of blood vessels, caused in turn by a violation of their patency, a decrease in tone, and the volume of blood passing through them.

Deficiency can be systemic or regional (local) - depending on how the disorders spread. Depending on the rate of progression of the disease, there may be acute or chronic vascular insufficiency.

Pure vascular insufficiency is rare; most often, heart muscle insufficiency occurs simultaneously with the symptoms of vascular insufficiency. Cardiovascular failure develops due to the fact that the same factors often affect the heart muscle and vascular muscles. Sometimes cardiovascular failure is secondary and heart pathology occurs due to poor muscle nutrition (lack of blood, low pressure in the arteries).

Reasons for appearance

The cause of the disease is usually circulatory disorders in the veins and arteries that arise for various reasons.

Basically, acute vascular insufficiency develops due to traumatic brain and general injuries, various heart diseases, blood loss, in pathological conditions, for example, acute poisoning, severe infections, extensive burns, organic lesions of the nervous system, adrenal insufficiency.

Symptoms of vascular insufficiency

Acute vascular insufficiency manifests itself in the form of fainting, shock or collapse.

Fainting is the mildest form of failure. Symptoms of vascular insufficiency during fainting: weakness, nausea, darkening of the eyes, rapid loss of consciousness. The pulse is weak and rare, the pressure is low, the skin is pale, the muscles are relaxed, there are no cramps.

During collapse and shock, the patient is in most cases conscious, but his reactions are inhibited. There are complaints of weakness, low temperature and blood pressure (80/40 mm Hg or less), tachycardia.

The main symptom of vascular insufficiency is a sharp and rapid decrease in blood pressure, which provokes the development of all other symptoms.

Chronic insufficiency of vascular function most often manifests itself in the form of arterial hypotension. Conventionally, this diagnosis can be made with the following symptoms: in older children - systolic pressure below 85, up to 30l. – pressure below 105/65, in older people – below 100/60.

Diagnosis of the disease

At the examination stage, the doctor, assessing the symptoms of vascular insufficiency, recognizes what form of insufficiency has manifested itself: fainting, shock or collapse. In this case, the level of pressure is not decisive in making a diagnosis; you should study the medical history and find out the causes of the attack. It is very important at the examination stage to establish what type of failure has developed: cardiac or vascular, because Emergency care for these diseases is provided in different ways.

If cardiovascular failure manifests itself, the patient is forced to sit - in a supine position his condition worsens significantly. If vascular insufficiency has developed, the patient needs to lie down, because in this position, his brain is better supplied with blood. The skin with cardiac failure is pinkish, with vascular failure it is pale, sometimes with a grayish tint. Vascular insufficiency is also distinguished by the fact that venous pressure is not increased, the veins in the neck are collapsed, the boundaries of the heart do not shift, and there is no congestion in the lungs characteristic of cardiac pathology.

After a preliminary diagnosis has been made based on the general clinical picture, the patient is given first aid, hospitalized if necessary, and an examination of the circulatory organs is prescribed. To do this, he may be prescribed to undergo vascular auscultation, electrocardiography, sphygmography, venography.

Treatment of vascular insufficiency

Medical care for vascular insufficiency should be provided immediately.

In all forms of acute vascular insufficiency, the patient should be left in a supine position (otherwise there may be death).

If fainting occurs, it is necessary to loosen the clothes around the victim’s neck, pat him on the cheeks, spray his chest and face with water, let him smell ammonia, and ventilate the room. This manipulation can be carried out independently; usually the positive effect occurs quickly, the patient regains consciousness. Afterwards, you should definitely call a doctor, who, after conducting simple diagnostic tests on the spot, will administer a solution of caffeine with sodium benzoate 10% - 2 ml subcutaneously or intravenously (with a recorded low blood pressure). If severe bradycardia is noticed, atropine 0.1% 0.5-1 ml is additionally administered. If bradycardia and low blood pressure persist, orciprenaline sulfate 0.05% - 0.5-1 ml or adrenaline solution 0.1% is administered intravenously. If after 2-3 minutes the patient still remains unconscious, pulse, pressure, heart sounds are not detected, there are no reflexes, these drugs are started to be administered intracardiacly, and artificial respiration and cardiac massage are performed.

If after fainting additional resuscitation measures are needed, or the cause of fainting remains unclear, or this happened for the first time, or the patient’s blood pressure remains low after regaining consciousness, he must be hospitalized for further examination and treatment. In all other cases, hospitalization is not indicated.

Patients with collapse who are in a state of shock, regardless of the cause that caused this condition, are urgently taken to the hospital, where the patient is given first emergency care to maintain blood pressure and heart function. If necessary, stop the bleeding (if necessary), carry out other symptomatic therapy procedures, focusing on the circumstances that caused the attack.

In case of cardiogenic collapse (often develops with cardiovascular failure), tachycardia is eliminated, atrial flutter is stopped: atropine or isadrine, adrenaline or heparin are used. To restore and maintain pressure, mesaton 1% is administered subcutaneously.

If collapse is caused by infection or poisoning, caffeine, cocarboxylase, glucose, sodium chloride, and ascorbic acid are injected subcutaneously. Strychnine 0.1% is very effective for this type of collapse. If such therapy does not bring results, mezaton is injected under the skin, prednisolongemisuccinate is injected into a vein, and sodium chloride 10% is injected again.

Disease prevention

The best prevention of vascular insufficiency is the prevention of diseases that can cause it. It is recommended to monitor the condition of blood vessels, consume less cholesterol, and undergo regular examinations of the circulatory system and heart. In some cases, hypotensive patients are prescribed a prophylactic course of blood pressure-maintaining medications.

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A condition characterized by a sharp decrease in circulating blood volume and impaired vascular function - acute vascular insufficiency.

Its most dangerous manifestations are fainting, collapse, shock, and they require immediate help.

This syndrome is usually accompanied by heart failure and rarely occurs in its pure form.

In some cases, failure to provide timely assistance can lead to death.

Pathogenesis

The human body is penetrated by vessels through which blood circulates, delivering oxygen and nutrients to organs and tissues. Redistribution of blood occurs due to contraction of the muscles of the walls of blood vessels and changes in their tone.

Vascular tone is mainly regulated by the autonomic nervous system, hormones and metabolites of the body. Dysregulation can cause blood to flow away from vital organs and impair their function.

The total amount of blood circulating in the circulatory system can also cause a lack of supply. The combination of these factors causes disruption of blood supply and is called vascular insufficiency. It can be acute or chronic.

Extreme manifestations of the disease

Acute vascular insufficiency is characterized by a decrease in blood pressure - hypotension. Its extreme manifestations are fainting, collapse, shock.

Fainting

This is a mild form of blood supply deficiency. The patient suddenly feels dizzy and nauseated. Notices blurred vision and ringing in the ears. The skin of the face turns pale.

Then the person loses consciousness. Breathing becomes rare, deep, the pupils are dilated. Within a few minutes the patient comes to his senses.

If fainting lasts more than five minutes, convulsions may occur.

Reasons for development:

Collapse

This is a more serious manifestation of acute vascular insufficiency. It comes up unexpectedly. The patient's consciousness is preserved, but inhibition is observed.

The skin is pale, there is slight cyanosis of the extremities. Breathing is shallow and rapid. The face is covered with cold sweat. The blood pressure is low and the pulse is weak.

Further development of collapse can lead to loss of consciousness.

Types of collapse:

1. Cardiogenic. Occurs in heart diseases that cause impaired cardiac output and decreased blood circulation to organs.
2. Hypovolemic. Characterized by a decrease in the volume of blood circulating in the system.
3. Vasodilator. There are pronounced changes in vascular tone, microcirculation of organs and tissues is disrupted.

The causes of disturbances leading to collapse make it possible to distinguish some of its forms.

Shock

This is the most serious form of acute heart failure. Many researchers find no difference in the pathogenesis of collapse and shock.

The mechanisms of their development are similar, but shock is characterized by a sharp effect on the body of damaging factors. Leads to severe circulatory disorders.

It has three flow phases.

1. Erectile. The patient is excited and screams. Blood pressure may be elevated and the pulse may be rapid. This phase quickly flows into the next, sometimes it is so short-lived that it ends faster than the patient comes under the supervision of a doctor.
2. Torpidnaya. The central nervous system is inhibited. The pressure drops and the pulse becomes thready. The patient is inhibited and apathetic. The skin is pale, cyanosis of the extremities is pronounced. Frequent shallow breathing, shortness of breath.
3. Terminal. Occurs when the adaptive capabilities of the body are completely disrupted. The pressure is below critical, there is no pulse. There is no consciousness. Death comes quickly.

Depending on the reasons that cause shock, there are:

Treatment of the disease

Fainting. It often does not require drug treatment. It is enough to lay the patient down, it is better to raise the legs, unbutton the clothes that are constricting the chest and neck.

You can sprinkle your face with water, pat your cheeks, or bring a cotton swab moistened with ammonia. If this does not help, you can give injections of vasoconstrictor drugs.

Collapse. Treatment of collapse is aimed at eliminating the causes of its occurrence. It is carried out in a hospital setting. The patient must be laid down, legs elevated, and warmed. Before transportation, an injection of a vasoconstrictor drug is given.

In a hospital setting, medications are prescribed that act both on the mechanisms of acute vascular insufficiency and on eliminating the cause that caused its development.

Important: Salt solutions help little if collapse develops as a result of blood deposition in organs and intercellular substance. In such cases, it is better to administer colloidal solutions and plasma.

Shock. Treatment of vascular insufficiency in shock is aimed at improving the systemic functions of the body and eliminating the causes that cause them.

Important: in case of shock and collapse, all medications and solutions used are administered intravenously, since disruption of tissue microcirculation alters the absorption of substances.

Prevention

Since acute vascular insufficiency syndrome develops suddenly, and its manifestations: fainting, collapse, shock can cause serious consequences for the body, the doctor’s main recommendations are aimed at improving the health of the body and treating concomitant diseases.

It is necessary to detect and treat heart diseases and infectious diseases in a timely manner. Observe safety precautions at work.

Be careful and avoid injuries on the street and at home. Wear a hat if you are in the sun for a long time.

Health care workers need to strictly adhere to the rules of blood transfusion, check compatibility with donor blood, and be careful when administering medications to patients with allergies.

Exercising, healthy eating, giving up bad habits, regular examinations - all this helps prevent diseases that lead to the development of this syndrome.

Do you still think that it is impossible to GET RID of frequent fainting!?

Have you ever encountered a pre-fainting state or syncope that simply “knocks you out of the rut” and the usual rhythm of life!? Judging by the fact that you are now reading this article, then you know firsthand what it is:.

• an impending attack of nausea rising and growing from the stomach...
• darkening of the eyes, ringing in the ears...
• sudden feeling of weakness and fatigue, legs give way...
• panic fear...
• cold sweat, loss of consciousness...

Now answer the question: are you satisfied with this? Can ALL THIS be tolerated? How much time have you already wasted on ineffective treatment? After all, sooner or later the SITUATION WILL GET WORSE.

Fainting, collapse, shock.

Causes: physical, mental trauma, poisoning, blood loss, fluid loss (vomiting, diarrhea).

With vascular insufficiency, the function of blood vessels, mainly veins, is sharply impaired; Thus, their tone decreases, the venous bed expands, and the pressure in it drops. Therefore, little blood flows to the artery in the heart - bleeding of the heart and brain.

Fainting is a short-term loss of consciousness as a result of acute bleeding (ischemia) of the brain. Fainting occurs in people with weak nervous system, with extreme heat, and emotional overstrain. The patient turns pale, loses consciousness, becomes covered in cold sweat, nausea may appear, the pulse is weak, not rapid, and there is a decrease in breathing.

Collapse - occurs as a result of dysregulation of vascular tone (a discrepancy between the capacity of the vascular bed and the volume of circulating blood), which leads to acute arterial hypotension. Collapse can occur in severe cases of the disease, with heavy bleeding or loss of fluid.

Clinic - severe weakness without loss of consciousness, thirst, pallor, cold sweat, shallow breathing, decreased t, rapid, thread-like pulse.

Shock is the most severe form of acute vascular insufficiency. This is a neuro-reflex reaction of the body. Types of shock: 1. painful; 2. cardiogenic;

burn; 4. posthemorrhagic; 5. anaphylactic; 6. post-transfusion; 7. arrhythmogenic;

With traumatic shock there are 2 phases: 1 - erectile (short-term arousal); and 2 - torpid (oppression).

The patient is conscious and complains of lack of air. The skin is pale, cold sweat, pulse and breathing are increased, blood pressure is low. The clinical manifestations of shock are largely related to the symptoms of the underlying disease against which it occurs.

Treatment -

In case of fainting: lay the patient down (legs above head), access to air, free from tight clothing. Sprinkle with water, ammonia, or cordiamine.

Collapse: eliminate the cause if possible (bleeding, detoxification). Physical and mental peace. IM or IV 0.5 ml. cordiamine and 0.3-0.5 1% mezaton or 0.3-0.5 ml. 1% norepinephrine in 20 ml. 40% glucose s.c. 20% caffeine 1 ml. Subsequently, approximately 5 ml of 1% mezatone or norepinephrine in 500 ml is administered intravenously. physical solution or 5% glucose. To increase the effect, 1 ml.0.1% atropine. It is effective to add prednisolone to the mixture. Sometimes you have to pump blood internally arterially 250 ml, then intravenously 150-500 ml. blood or blood substitute fluids (polyglucin).

In case of shock: warm it up, give a glass of strong, hot, sweet tea, 50-100 ml. alcohol and introduce ethyl alcohol IV 20-25 ml.40% with 50-70 ml.40% glucose. Ensure improvement of central nervous system activity. Along with this, measures are taken to increase the amount of fluid in the body and increase vascular tone. For severe pain, drugs, novocaine blockade. Bromine preparations, sleeping pills.

Chronic vascular insufficiency is less common. The main reason is hr. adrenal insufficiency (Addison's disease).

AHF syndrome, observed in various pathological conditions, is characterized by a sudden drop in blood pressure, severe weakness, impaired consciousness and so-called peripheral symptoms (pallor of the skin and mucous membranes, cold sticky sweat, cold extremities, collapsed veins, rapid pulse of small filling and tension or absence pulse).

Pharmacotherapy of acute vascular insufficiency syndrome

Main groups of drugs used in AHF syndrome

1. Plasma replacement solutions.
2. Vasopressors.
3. Glucocorticoids.
4. Painkillers.

Plasma replacement solutions

Crystalloid solutions provide mainly correction of the biochemical composition of the blood.
NaCL solution 0.9% (isotonic) is one of the most commonly used solutions for intravenous infusions when urgent restoration of bcc is necessary. Its administration restores the osmotic pressure of the plasma, normalizes water-electrolyte metabolism, and increases the blood volume. It is quickly excreted by the kidneys.
Solutions “Lactosol”, “Acesol”, “Trisol”, “Chlosol” are balanced salt solutions. They have a hemodynamic effect, reduce hypovolemia, and correct disturbances in water and electrolyte metabolism. Used for blood loss and dehydration.
Glucose solution 5% is available in bottles of 200 and 400 ml for intravenous administration. Used for infusion therapy for shock, collapse, coma, hypoglycemia, etc.

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Colloidal solutions
Polyglucin is a dextran with a molecular weight of 60 thousand. It has a pronounced hemodynamic effect. It stays in the vascular bed for several days. Used for shock associated with severe blood loss and trauma. The main purpose of use is plasma filling and increasing the oncotic properties of blood.
Reopolyglucin is a dextran with a molecular weight of up to 40 thousand. It has a good hemodynamic effect. The main effects are disaggregation, detoxification, replenishment of plasma volumes, improvement of rheological properties of blood, microcirculation, reduction of pronounced metabolic acidosis. Used for cardiogenic, anaphylactic shock, severe intoxication.
Gelatinol is a colloidal solution of gelatin in a 0.9% NaCL solution with a molecular weight of 20 thousand. It has a shorter hemodynamic effect compared to polyglucin. Can be mixed with donor blood in any ratio. Used for shocks of moderate severity.
Hemodez is a detoxification solution with low viscosity and high adsorption capacity. It has high detoxification properties, including post-transfusion complications. In patients with unstable hemodynamics, it may reduce blood pressure.
When introducing fluid into the body, it is necessary to monitor diuresis and, if possible, central venous pressure.

Painkillers
Relief of pain syndrome is very important in the treatment of patients with collapse and shock, when the factors of pain and hyperreactivity of the central nervous system play a significant role - in injuries, burns, acute myocardial infarction, pancreatic and exotoxic shock. Pain relief should begin at the scene of the incident. The choice of pain relief methods includes inhalational anesthetics, narcotic analgesics, drugs of the ketalar group, and non-narcotic analgesics.

Narcotic analgesics
Mechanism of action. They eliminate pain without significant impairment of consciousness. Under their influence, not only do the patient’s reactions to pain change, but also fear and psycho-emotional stress decrease, and the increase in muscle tone is relieved. These effects are more pronounced in opiates (morphine, omnopon) and less characteristic of opioids (fentanyl, promedol, buprenorphine, butorphanol). It is necessary to be aware of possible respiratory depression (especially when using opiates). The least respiratory depression is observed when using conventional doses of butorphanol drugs.
Contraindications. Senile and early childhood (up to 2 years) age, conditions accompanied by hypoventilation and bronchospasm.