Symptoms and treatment of cardiovascular insufficiency. 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 malnutrition of all organs and tissues. Manifested: fainting, collapse.

Fainting

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

Cardiac:

with a complete transverse blockade - attacks of Morgagni-Edems-Stokes,

with aortic stenosis during exercise,

with stenosis of the mouth of the pulmonary artery,

with severe pulmonary hypertension;

Extracardiac causes:

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

when coughing (after prolonged bouts of coughing, venous inflow is disturbed in conditions of increased intrathoracic pressure);

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

with malnutrition,

with overwork, fright, in a stuffy room, with overheating.

Clinical manifestations:

Suddenly there is dizziness, weakness, loss of consciousness.

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

Breathing shallow, slow.

Arterial pressure falls sharply.

Pulse rare 40 - 50 beats per minute, small, weak filling and tension, muffled heart sounds.

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 (croupous pneumonia, typhoid fever, typhus, etc.);

acute blood loss;

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

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

acute diseases of the abdominal organs;

Clinical manifestations:

Suddenly, a feeling of general weakness, dizziness, chilliness, chills, 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, blood pressure lowered.

The heart is not dilated, the tones are muffled, sometimes arrhythmic.

Breathing is shallow, rapid.

Diuresis is reduced.

Shock(from French choc) - an acutely developing pathological process caused by the action of a superstrong stimulus and characterized by a violation 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).

PON (definition) is a severe non-specific 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 state with a temporary predominance of symptoms of one or another organ failure - cardiac, pulmonary, renal, etc. The main feature of PON is the unstoppable 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 reduced 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 (minute volume of the heart, i.e. the volume of blood ejected by the ventricles in 1 minute). It occurs with myocardial infarction, with rapidly developing defects in the heart valves, or with hemopericardium with tamponade of the heart shirt. The central venous and ventricular diastolic pressure decreases. 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 mm Hg. 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

Disturbance of consciousness

lactic acidosis

 Lack of improvement in the condition after the removal of the pain syndrome and the use of O2

Mortality in cardiogenic shock reaches 80%.

Treatment

Treatment for shock should be directed to an increase in BCC; plasma interfering fluids, isotonic solutions of sodium chloride and glucose are administered. In this case, it is necessary that systolic blood pressure increase to 100 mm Hg. and more, and CVP rose to 15 mm Hg. With a high IVD, one should refrain from the introduction of plasma-substituting solutions and direct efforts to increase the contractile function of the heart. Such patients are administered symlatomimetic amines. Thus, dopamine, which is the biological precursor of norepinephrine, increases cardiac output more strongly than norepinephrine, and, along with the inotropic effect, has an expanding effect on the vessels of the heart, brain, and kidneys.

Vascular insufficiency is a violation of local or general circulation, which is based on the 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 violations spread. Depending on the rate of the course of the disease, there may be acute vascular insufficiency and chronic.

Pure vascular insufficiency is rare, most often along with symptoms of vascular insufficiency, cardiac muscle insufficiency is manifested. Cardiovascular insufficiency develops due to the fact that the heart muscle and vascular musculature are often affected by the same factors. Sometimes cardiovascular failure is secondary and heart disease occurs due to poor muscle nutrition (lack of blood, low pressure in the arteries).

Reasons for the appearance

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

Basically, acute vascular insufficiency develops due to traumatic brain and general injuries, various heart diseases, blood loss, in pathological conditions, such as 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 insufficiency. Symptoms of vascular insufficiency during fainting: weakness, nausea, darkening in the eyes, rapid loss of consciousness. The pulse is weak and rare, the pressure is lowered, the skin is pale, the muscles are relaxed, there are no convulsions.

In collapse and shock, the patient is in most cases conscious, but his reactions are inhibited. There are complaints of weakness, low temperature, and pressure (80/40mm Hg and 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. Conditionally, this diagnosis can be made with the following symptoms: in older children, systolic pressure is below 85, up to 30l. - pressure below the level of 105/65, in older people - below 100/60.

Diagnosis of the disease

At the stage of examination, the doctor, assessing the symptoms of vascular insufficiency, recognizes which form of insufficiency manifested itself, fainting, shock or collapse. At the same time, the level of pressure is not decisive in making a diagnosis; one 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 insufficiency has developed: cardiac or vascular, because. emergency care for these diseases is provided in different ways.

If cardiovascular insufficiency is manifested, the patient is forced to sit - in the supine position, his condition worsens significantly. If it is vascular insufficiency that has developed, the patient needs to lie down, because. in this position, his brain is better supplied with blood. The skin with heart failure is pinkish, with vascular insufficiency it is pale, sometimes with a grayish tint. Also, vascular insufficiency is 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 stagnation in the lungs characteristic of cardiac pathology.

After a preliminary diagnosis is made on the basis of the general clinical picture, the patient is given first aid, if necessary, hospitalized, and an examination of the circulatory organs is prescribed. To do this, he may be assigned to undergo auscultation of blood vessels, electrocardiography, sphygmography, phlebography.

Treatment of vascular insufficiency

Medical care for vascular insufficiency should be provided immediately.

With all forms of development of acute vascular insufficiency, the patient should be left in a supine position (otherwise there may be a fatal outcome).

If fainting occurs, it is necessary to loosen the clothes on the victim’s neck, pat him on the cheeks, spray his chest and face with water, give him a sniff of ammonia, and ventilate the room. This manipulation can be carried out independently, usually a positive effect occurs quickly, the patient regains consciousness. After that, you should definitely call a doctor who, after conducting simple diagnostic tests on the spot, will inject a subcutaneous or intravenous solution of caffeine with sodium benzoate 10% - 2 ml (with a fixed reduced 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 is still unconscious, pulse, pressure, heart sounds are not detected, there are no reflexes, they begin to administer these drugs already intracardiac, and do artificial respiration, heart massage.

If, after fainting, additional resuscitation measures were needed, or the cause of fainting remained unclear, or this happened for the first time, or the patient’s pressure after bringing him to consciousness remains low, 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 receives first emergency care to maintain pressure and heart activity. If necessary, stop bleeding (if necessary), carry out other procedures of symptomatic therapy, focusing on the circumstances that caused the attack.

With cardiogenic collapse (often develops with cardiovascular insufficiency), tachycardia is eliminated, atrial flutter is stopped: atropine or isadrin, adrenaline or heparin are used. To restore and maintain pressure, mezaton 1% is injected subcutaneously.

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

Disease prevention

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

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

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

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

In some cases, untimely assistance can lead to death.

Pathogenesis

The human body is permeated with vessels through which blood circulates, delivering oxygen and nutrients to organs and tissues. The redistribution of blood occurs due to the 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 body metabolites. Dysregulation can lead to an outflow of blood from vital organs and disruption of their functions.

The total amount of blood circulating in the circulatory system can also cause a lack of supply. The combination of these factors causes a violation 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 circulatory failure. The patient suddenly feels dizzy, nausea. Notes the veil before the eyes, noise in the ears. The skin of the face turns pale.

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

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

Reasons for development:

Collapse

This is a more serious manifestation of acute vascular insufficiency. Occurs unexpectedly. The patient's consciousness is preserved, but lethargy is observed.

The skin is pale, there is a slight cyanosis of the extremities. Breathing shallow, rapid. Face covered with cold sweat. The pressure is reduced, the pulse is weak.

Further development of the collapse can lead to loss of consciousness.

Types of collapse:

1. Cardiogenic. Occurs in diseases of the heart, causing a violation of cardiac output and a decrease in blood circulation of organs.
2. Hypovolemic. It is characterized by a decrease in the volume of blood circulating in the system.
3. Vasodilator. Pronounced changes in vascular tone are observed, microcirculation of organs and tissues is disturbed.

Causes of disturbances leading to collapse make it possible to single out some of its forms.

Shock

This is the most serious form of acute heart failure. Many researchers do not find a difference in the pathogenesis of collapse and shock.

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

It has three flow phases.

1. erectile. The patient is excited, screaming. The pressure may be increased, the pulse is frequent. This phase quickly flows into the next, sometimes it is so short that it ends faster than the patient comes under the supervision of a doctor.
2. Torpid. The central nervous system is inhibited. The pressure drops, the pulse becomes thready. The patient is lethargic, apathetic. The skin is pale, cyanosis of the extremities is pronounced. Breathing is frequent shallow, shortness of breath.
3. Terminal. It occurs with the final disruption of the adaptive capabilities of the body. The pressure is below critical, there is no pulse. Consciousness is absent. Death comes quickly.

Depending on the causes that cause shock, there are:

Treatment of the disease

Fainting. He often does not need medical treatment. It is enough to lay the patient down, it is better to raise the legs, unbutton the clothing that restricts the chest and neck.

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

Collapse . The 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 raised, warm. Before transportation, an injection of a vasoconstrictor is made.

In a hospital, medicinal substances are prescribed that act both on the mechanisms of the onset of acute vascular insufficiency and on the elimination of the cause that caused its development.

Important: Salt solutions do little to help if the 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 a violation of tissue microcirculation changes the absorption of substances.

Prevention

Since the syndrome of acute vascular insufficiency 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 body and treating concomitant diseases.

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

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

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

Exercising, eating healthy, giving up bad habits, regular check-ups - all this helps to 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 experienced a pre-fainting state or a fainting spell, which 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 rising from the stomach...
• blurred vision, ringing in the ears...
• sudden feeling of weakness and fatigue, legs give way ...
• panic fear...
• cold sweat, loss of consciousness...

Now answer the question: does it suit you? Can ALL THIS be tolerated? And how much time have you already "leaked" for ineffective treatment? After all, sooner or later the SITUATION WILL AGAIN.

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 disrupted; thus, their tone decreases, the venous bed expands, the pressure in it drops. Therefore, little blood enters the heart to the artery - 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 NS, with intense heat, emotional overstrain. The patient turns pale, loses consciousness, becomes covered with a cold sweat, nausea may appear, the pulse of weak filling is not quickened, there is a decrease in breathing.

Collapse - occurs as a result of a violation of the regulation 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 be with a severe course of the disease, with heavy bleeding, loss of fluid.

The clinic is a sharp weakness without loss of consciousness, thirst, pallor, cold sweat, shallow breathing, decrease in t, pulse is frequent, thready.

Shock is the most pronounced 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, 2 phases: 1 - erectile (short-term excitation); and 2 - torpid (oppression).

The patient is conscious, complains of lack of air. The skin is pale, cold sweat, pulse and respiration are quickened, blood pressure is lowered. 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 the head), air access, release from tight clothing. Sprinkle with water, ammonia, you can cordiamine.

Collapse: if possible, eliminate the cause (bleeding, detoxification). Physical and mental rest. In / m or / in 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. In the future, in / in the drip of about 5 ml. 1% mezaton or norepinephrine in 500 ml. physical solution or 5% glucose. To increase the effect of 1ml.0.1% atropine. It is effective to add prednisolone to the mixture. Sometimes it is necessary to pump blood inside arterially 250 ml., Then in / in the cap. 150-500 ml. blood or blood-substituting fluids (polyglucin).

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

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

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

Pharmacotherapy of acute vascular insufficiency syndrome

The main groups of drugs used in AHF syndrome

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

Plasma substituting 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 in case of urgent need to restore the BCC. Its introduction restores the osmotic pressure of the plasma, normalizes the water-electrolyte metabolism, increases the BCC. Rapidly excreted by the kidneys.
Solutions "Laktosol", "Atsesol", "Trisol", "Chlosol" are balanced saline solutions. They have a hemodynamic effect, reduce hypovolemia, correct disturbances in water and electrolyte metabolism. Used for blood loss and dehydration.
Glucose solution 5% is available in vials of 200 and 400 ml for intravenous administration. Used for infusion therapy for shock, collapse, comas, 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. Within a few days is in the vascular bed. It is 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.
Reopoliglyukin - 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 the rheological properties of blood, microcirculation, and a decrease in severe metabolic acidosis. It is 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. It is used for shocks of moderate severity.
Hemodez is a detoxifying solution with low viscosity and high adsorption capacity. It has high detoxification properties, including post-transfusion complications. In patients with unstable hemodynamics, it can reduce blood pressure.
With the introduction of fluid into the body, it is necessary to control diuresis and, if possible, central venous pressure.

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

Narcotic analgesics
Mechanism of action. They eliminate pain without significant impairment of consciousness. Under their influence, not only the patient's reactions to pain change, but also fear, psycho-emotional stress decreases, and an increase in muscle tone is removed. 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 the possible respiratory depression (especially when using opiates). The least respiratory depression is observed when using the usual doses of butorphanol preparations.
Contraindications. Senile and early childhood (up to 2 years) age, conditions accompanied by hypoventilation and bronchospasm.