Complications of heart failure

Complications can be associated at different stages of heart failure. As the degree of heart failure increases, complications occur more often and occur more severely. Some complications can become the direct cause of death.

Electrolyte disturbances

Hyponatremia

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

On the ECG, AB-conduction may be shortened, the end part of the ventricular complex may be changed.

Hypernatremia

It occurs when the content of sodium in the serum increases more than 150-160 mmol / l. Clinically characterized by drowsiness, increased muscle tone, hypersensitivity, fever. Hypernatremia develops with an increase in the amount of sodium administered and a violation of excretion of sodium by the kidneys.

Hypokalemia

Clinical signs appear with a decrease in serum potassium levels of less than 3.5 mmol / l. They note drowsiness, arterial hypotension, tachycardia, lengthening of the ventricular complex, depression of the terminal part of the ventricular complex, extrasystole is possible. The treatment of the condition is aimed at the administration of potassium-potassium and magnesium asparaginate preparations (panangin, asparcam), and others.

Hyperkalemia

For heart failure, this condition is not characteristic. It occurs when the use of aldosterone antagonists (spironolactone) is unfounded for a long time against the background of additional administration of potassium preparations.

Violations of the acid-base state

With heart failure, metabolic alkalosis develops more often, which may be due to potassium deficiency. In young children, respiratory or mixed acidosis develops more often as a consequence of gas exchange in the lungs and hypoxia. To eliminate acidosis use drugs containing sodium bicarbonate.

Heart rhythm and conduction disorders

The causes of such disorders can be either cardiac disease itself (myocarditis, cardiomyopathy), and the therapy and its consequences (electrolyte disturbances). The reason for the development of AV blockade may be inadequate use of cardiac glycosides.

Thrombosis and embolism

Thrombosis and embolism are the most formidable complications. Causes may be the proper links of the formation of the heart failure syndrome (slowing of the blood flow speed against the background of an increase in the volume of circulating blood), as well as violations of hemostasis against a background of changes in liver function due to secondary changes in the organ.

With the formation of blood clots in the right heart, embolism of the lungs arises, when death from acute respiratory failure may occur. Sometimes thromboembolism of small vessels of the pulmonary artery proceeds in a low-symptom, and during their life they are not diagnosed.

Embolisms of coronary vessels flow with an anginal syndrome and have a certain reflection on the ECG.

The embolism of the vessels of the abdominal cavity is accompanied by pains in the abdomen, the development of a clinical picture of the "acute abdomen" is possible.

The embolism of the vessels of the limbs is accompanied by acute pain, a feeling of numbness, cold skin, a decrease in local sensitivity.

Cardiogenic shock

The cause of the development 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, cardiomyopathies, complex heart rhythm disturbances. Serious complications of cardiogenic shock include pulmonary edema and renal and hepatic insufficiency. Clinical symptoms develop rapidly: the pallor of the skin grows, cyanosis increases, cold sweat develops, cervical veins swell, breathing becomes more frequent or becomes superficial, it is possible to develop a coma, seizures. Arterial blood pressure is sharply reduced, rapidly increases and the liver becomes painful. Emergency medical activities include the following: restoration of the contractility of the myocardium, for which intravenous cardiac glycosides are administered;

• increase of arterial pressure by appointment of sympathomimetic amines (norepinephrine, dopamine);
• the appointment of glucocorticoids, using their positive inotropic effect, influence on increasing arterial pressure and decentralizing blood circulation.

Peripheral vasodilators are less effective.

Heart failure occupies one of the first places among the problems of modern cardiology, as it determines the prognosis of most diseases of the cardiovascular system.

Advances in the treatment of heart failure syndrome depend not only on the impact on individual links of pathogenesis, but also on the directional effect on the etiologic factor.

[1], [2], [3]