Complications of heart failure

Complications may occur at different stages of heart failure. As the degree of heart failure increases, complications occur more frequently and are more severe. Some complications may become the immediate cause of death.

Electrolyte disturbances

Hyponatremia

True hyponatremia develops with prolonged use of diuretics against the background of a salt-free diet. In this case, the sodium content in the blood serum is less than 130 mmol/l. There is a painful thirst, loss of appetite, dry mouth, vomiting, etc.

On the ECG, there may be a shortening of the AV conduction and a change in the terminal part of the ventricular complex.

Hypernatremia

Occurs when the sodium content in the blood serum increases to more than 150-160 mmol/l. Clinically characteristic are drowsiness, increased muscle tone, hypersensitivity, and increased body temperature. Hypernatremia develops when the amount of sodium administered increases and sodium excretion by the kidneys is impaired.

Hypokalemia

Clinical signs appear when the potassium content in the blood serum decreases to less than 3.5 mmol/l. Drowsiness, arterial hypotension, tachycardia, prolongation of the ventricular complex, depression of the terminal part of the ventricular complex, and extrasystole are observed. Treatment of the condition is aimed at prescribing potassium preparations - potassium and magnesium aspartate (panangin, asparkam), etc.

Hyperkalemia

This condition is not typical for heart failure. It occurs with unreasonably long-term use of aldosterone antagonists (spironolactone) against the background of additional administration of potassium preparations.

Acid-base imbalances

In heart failure, metabolic alkalosis often develops, which may be associated with potassium deficiency. In young children, respiratory or mixed acidosis often develops as a result of impaired gas exchange in the lungs and hypoxia. Sodium bicarbonate-containing drugs are used to eliminate acidosis.

Heart rhythm and conduction disorders

The causes of such disorders may be both the heart disease itself (myocarditis, cardiomyopathy), and the therapy and its consequences (electrolyte disorders). The cause of the development of AV blocks may be inadequate use of cardiac glycosides.

Thrombosis and embolism

Thrombosis and embolism are the most formidable complications. The causes may be both the links in the formation of heart failure syndrome (slowing of blood flow velocity against the background of an increase in the volume of circulating blood), and hemostasis disorders against the background of changes in liver function due to secondary changes in the organ.

When blood clots form in the right sections of the heart, pulmonary embolisms occur, which can lead to death from acute respiratory failure. Sometimes, pulmonary embolisms of small vessels are asymptomatic and are not diagnosed during life.

Coronary embolism occurs with angina syndrome and has a certain reflection on the ECG.

Embolism of the abdominal vessels is accompanied by abdominal pain, and the development of a clinical picture of “acute abdomen” is possible.

Embolism of the vessels of the extremities is accompanied by acute pain, numbness, cold skin, and decreased local sensitivity.

Cardiogenic shock

The cause of cardiogenic shock is a sharp decrease in the pumping function of the heart, which is due to the rapidly developing weakness of the left ventricle. In children, cardiogenic shock develops relatively rarely. It is formed with severe heart defects, myocarditis, cardiomyopathy, complex heart rhythm disturbances. Serious complications of cardiogenic shock are pulmonary edema and renal and hepatic failure. Clinical symptoms develop quite quickly: the pallor of the skin increases, cyanosis intensifies, cold sweat appears, the jugular veins swell, breathing becomes more frequent or shallow, a comatose state and seizures may develop. Blood pressure is sharply reduced, it quickly increases and the liver becomes painful. Emergency treatment measures involve the following actions: o restoration of the contractility of the myocardium, for which cardiac glycosides are administered intravenously;

• increasing blood pressure by prescribing sympathomimetic amines (norepinephrine, dopamine);
• the administration of glucocorticoids, using their positive inotropic effect, influence on increasing blood pressure and decentralization of blood circulation.

Peripheral vasodilators are less effective.

Heart failure is one of the leading problems in modern cardiology, as it determines the prognosis of most cardiovascular diseases.

Success in the treatment of heart failure syndrome depends not only on the impact on individual links in pathogenesis, but also on the targeted influence on the etiological factor.

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