Отеки при cordial недостаточности: как снятьheart swelling

Update: October 2018 A situation where legs swell is not at all
should be considered normal. Even if it happens in the evening, and
you spent the whole day on your feet. It may be that such a symptom
you do not manifest at all a vein disease, but a pathology of the heart, oh
which you did not guess.

Что такое «heart swelling» и когда они возникают

There are many heart diseases. it и ишемическая болезнь
сердца, при которой участок cordial мышцы недостаточно
blood supply, and heart defects, when one of the holes is between
atrium and ventricle, or between the ventricle and those coming from it
vessels – becomes either too narrow, or, conversely,
expands. Heart disease also includes cardiomyopathy;
which for unknown reasons disrupts the normal structure
myocardium, myocardiodystrophy, hypertension and others.

All of them are united by the fact that in the absence of adequate treatment
они приводят к перегрузке cordial мышцы, миокарда. Called it
cordial недостаточностью. When it develops gradually, and
affects the right ventricle, swelling is formed. They are so
называются – отеки при правожелудочковой cordial
failure.

�”Just”, with uncomplicated heart disease, fluid in the skin
will not accumulate. it произойдет только в том случае, когда
right ventricle, working with a large circle of blood circulation, not
will be able to pump the standard volume of blood and will “leave” it
in the vessels.

Causes of heart swelling

Edema, as well as cardiac (cardiac) insufficiency, occur
not in one day. Initially, as a result of the disease,
right ventricular overload. Increased pressure in him gradually
reported to the right atrium, into which 2 vena cava flows,
collected venous blood from the whole body. In the veins is not developed
muscle layer and they cannot push the right amount of blood into
right atrium, so there is stagnation in them. it повышенное
pressure is transferred to smaller veins, and fluid from them
begins to gradually go out through the wall in the fabric – arise
swelling. Since the veins of the lower
limbs – they are acted upon by gravity – first arise
heart swelling ног.

When the fluid stagnates in the veins, it means that
less blood is returned to the heart. It throws in
an aorta is an insufficient amount of this important fluid, and tissues,
nutrition through arteries extending from the aorta is not enough
oxygen and nutrients. In response, the body activates
protective mechanism:

  • increases the activity of the sympathetic nervous system, due to
    Adrenaline is released into the bloodstream, which narrows the vessels and increases
    heartbeat;
  • activates hypothalamic vasopressin secretion, which also
    reduces the diameter of the arteries and reduces the amount of secreted
    urine;
  • with narrowed vessels and a smaller amount coming to the kidneys
    more fluid is retained in the body;
  • due to insufficient oxygen supply to the tissues, to
    vessels receive a command to increase the gap between the cells;
  • as a result, more fluid is released into the tissue;
  • if at the previous stage the situation is not corrected, then
    hypoxia suffers and liver. It produces less protein
    which, among other things, kept the liquid in the vessels. And to
    hydrostatic edemas that were before, join more
    безбелковые swelling.

The described mechanism begins with the right ventricle only
with:

  • chronic respiratory diseases leading to
    respiratory failure: emphysema, chronic bronchitis,
    pneumosclerosis;
  • insufficiency (i.e., poor closure) tricuspid
    valve between the right atrium and the ventricle;
  • pulmonary valve insufficiency where pushes
    blood right ventricle;
  • перикардите с появлением жидкости между сердцем и cordial
    bag (suffers more right ventricle, since the left ventricle
    is stronger and harder to squeeze).

Other causes of cardiac edema are those that cause first.
left ventricular failure, and then, as a result of increasing
pressure in the pulmonary circulation, and right ventricular
failure. it:

  • cardiosclerosis – the appearance in the heart instead of reducing
    muscle cells scar tissue. it обычно происходит после
    myocardial infarction;
  • hypertension: to overcome high blood pressure
    arteries, the heart can, only pushing blood into them more strongly,
    as a result, the left ventricle initially increases its muscle mass,
    and then, on the contrary, becomes flabby;
  • cardiomyopathy – a change in the structure of the myocardium that occurs according to
    unknown reasons;
  • myocardial dystrophy – a group of diseases in which muscle
    heart metabolic processes are disturbed, and its function deteriorates;
  • mitral stenosis and insufficiency, mitral prolapse
    valve – heart defects in which the valve suffers between the left
    atrial and left ventricle;
  • many congenital heart defects;
  • long existing arrhythmias;
  • inflammatory heart diseases: endocarditis, myocarditis;
  • amyloidosis of the heart.

Most of these diseases lead to cardiac
deficiencies in older people, so heart swelling
(edema) are more common in the elderly. The more pronounced
несостоятельность cordial мышцы, тем более распространена
edema.

How to determine heart swelling

Determining whether there is swelling or not is not difficult. Need only pin down
soft tissue to the underlying bone and observe the formed
fossa: during edema it does not disappear within 30 seconds or
longer.

The symptoms of cardiac edema are first determined on the legs. For this
you need a man to lie, and his lower limbs are not
raised above the body. Next, finger press on
the lower third of the tibia on its inner side, where the bone is not
covered with a thick layer of fiber. Estimate the time of expansion
It is this fossa, lightly holding over this area, starting from not
depressed skin. If the place of pressing is felt (even if not
seen) “failure”, which lasts longer than 1 minute, this means that
there is a clear swelling (there are still hidden swelling, but it is detected
in a different way, in the conditions of a medical institution).

Explicit edema may be of lymphatic origin (lymphedema),
occur when varicose veins, renal failure and in
the result of insufficient production / entry into the body
proteins.

Edema of cardiac origin is different:

  • preferred location on the legs and (slightly less)
    feet With decompensated cardiac failure, they
    �”Rise” from the bottom up, reaching the abdomen, hitting the hands, but before
    persons they reach in extreme cases;
  • symmetry;
  • gradual development;
  • density;
  • painless;
  • immobility;
  • bluish tinge of cold skin in the area of ​​edema;
  • increase in the evening and the decrease of the degree in the morning.

In addition, the heart origin of edema say such
symptoms:

  • increased respiration first with physical exertion, and then with
    cordial недостаточности 2A или выше – в покое;
  • arrhythmia – constant or periodic;
  • feeling of pressure, compression, burning in the chest;
  • increased fatigue;
  • blue lips, nasolabial triangle, fingers and
    feet;
  • heaviness in the right hypochondrium;
  • headaches, dizziness with unchanged vessels of the head and
    neck and exception neurologist diseases of the nervous system.

Venous and lymphatic edema have one characteristic difference:
they are not symmetrically located on both limbs. therefore
The most common question is the difference between cardiac and renal
swelling. We describe them in the table:

Sign of Heart Kidney
First appearance On the legs On the face
When most noticeable In the evening In the morning, swollen face
Color of the skin With a bluish tint Pale
Skin temperature edema Colder than uncut skin The same temperature as the skin without edema.
Density Tight to the touch Soft
Development rate Grow gradually Appeared in a matter of days

Diagnostics

So the doctor can tell you how to remove heart swelling, he needs to
define:

  1. that excess fluid in tissues accurately accumulates due to
    cardiac failure;
  2. what kind of heart disease caused by failure.

Diagnosis begins with examining, listening to heart sounds and
congestive, characteristic only for cardiac pathology, wheezing in
lower parts of the lungs. Next, the doctor will need to see the ECG and data
Ultrasound of the patient’s heart. You may also need scintigraphy, MRI
hearts, coronary angiography (contrast study of vessels feeding
heart) as well as Holter (round-the-clock) monitoring
pressure and / or ECG.

Also for the treatment of cardiac edema, the doctor needs to find out how
they are pronounced: it is only swelling of the limbs, or takes place
sweating fluid in the pleural, abdominal cavity, pericardium. For
diagnosis is performed ultrasound of the abdominal cavity, chest radiography
cells

Treatment

What to do with heart swelling? The first is to sign up to
cardiologist or therapist. The second is before visiting this.
specialist start to follow a diet. Self medication
can not be taken. So you can significantly worsen your condition.
Drug treatment prescribed only by a doctor. About folk
recipes also need to consult a specialist.

Diet

It consists in the following:

  • daily caloric content – high: 2200-2500 kcal;
  • proteins: 90 g / day;
  • carbohydrates 350-400 g / day;
  • fats 70-80 g / day;
  • liquids – up to 1200 ml / day (these are teas, and drinks, and
    soups);
  • salt – 5 g / day maximum. It is an increase in its quantity in
    the body will cause swelling;
  • alcohol – exclude;
  • Fatty and fried foods, pickles and smoked foods – exclude;
  • dishes – only cooked, baked in the oven or
    steamed products;
  • fiber-rich food – limit;
  • canned food, fatty varieties of poultry, fish and meat – exclude;
  • eat pumpkin dishes, berries of cranberries and viburnum, apples –
    for diuretic effect;
  • when taking diuretics include baked potatoes in the diet,
    raisins, nuts and dried apricots: they contain potassium.

Drug therapy

Treatment сердечных отеков feet is prescribed by a doctor based on
heart conditions. Commonly used:

  • Angiotensin-converting enzyme inhibitors (ACE inhibitors):
    �”Captopril”, “Enalapril”, “Lisinopril”. They are needed for heart
    deficiencies, as they reduce blood pressure and
    prevent the progression of changes in the heart muscle.
  • An alternative to the first group of drugs are
    angiotensin receptor antagonist agents. If the inhibitors are not
    give angiotensin to turn into its active form, then this group
    blocks angiotensin receptors, resulting in an active
    the hormone can not have its effect – to narrow the vessels, reduce
    renal blood flow and increase pressure. Angiotensin Antagonists
    receptors are used for people celebrating the appearance of dry
    paroxysmal cough while taking ACE inhibitors and those who do not
    managed to reduce blood pressure to a sufficient extent.
  • Beta blockers: Corvitol, Metoprolol, Nebilet. Their task
    – reduce myocardial oxygen demand. They reduce
    blood pressure and reduce heart rate.
  • Cardiac glycosides: Digoxin, Strofantin. At the heart of them
    actions – improving nutrition of the ventricles of the heart, improving
    conduction of the pulse through the conductive system of the heart, reducing the frequency
    heartbeat, an increase in the volume of blood thrown into the blood vessels.
  • Drugs that improve heart nutrition: cocarboxylase,
    �Cardonat, Vazonat. They are prescribed for the initial stages of the heart.
    diseases.
  • Antiarrhythmic drugs. They are used for arrhythmias. it
    different groups of drugs; their choice is made based on the type
    arrhythmias.

In most cases, when cardiac edema is assigned
diuretic drugs. There are several groups of them: antagonists
hormone aldosterone (“Veroshpiron”), potassium-sparing diuretics
(“Triamteren”), osmodiuretiki (it is not used to treat
heart failure). The most powerful drugs – this is the fourth
group, loop diuretics: thiazide derivatives
(“Hydrochlorothiazide”) and sulfamoyl anthralinic acid derivatives
(“Furosemide”, “Torasemide”). Last drugs required
taken with potassium preparations (Asparkam, Panangin).

Diuretics can be prescribed as separate drugs,
and in combination with ACE inhibitors or calcium blockers
channels. With high degrees of heart failure may
administered a combination of several diuretics:
�”Veroshpiron” and “Trifas”, “Furosemide” and “Triamteren”. Important
just choose the right dosage of these drugs so as not to
have a toxic effect on the kidneys, do not cause additional and
renal failure.

Diuretic treatment is carried out under the control of drunk and
excreted fluid, as well as daily weight changes (it does not
should increase).

Surgical treatment

No, the swelling is not opened surgically. Operations can
be used to improve the condition of the heart, which will entail and
decrease in heart failure and, accordingly, decrease
swelling.

For surgical treatment include:

  • aorto-coronary bypass;
  • valve endoprosthetics;
  • palliative surgery (they will not cure, but will support the state).
    it: пункция плевральной или брюшной полости – для выведения оттуда
    excess fluid, the introduction of pacemaker – in violation
    rhythm.

Folk treatment

Folk remedies can only be used as an addition to
basic treatment. Recipes recommended for cooking decoctions
and infusions for internal use, have a diuretic effect.
Means the local destination should “pull” of tissue
excess fluid.

So, for oral intake, healers recommend:

  1. Mix 100 ml of freshly squeezed cucumber, carrot and lemon juice,
    dilute with warm water to an acceptable taste. Whole volume need
    divided into 3 doses and drink per day.
  2. Tear off the leaves of mint 30 g, rinse, pour 1000 ml of boiling water.
    Insist hour and drink 50 ml * 3-4 p / day.
  3. Take 700 g of parsley, wash, cut, cover with liter
    milk Boil the mixture over low heat until there is no milk left.
    500 ml. Next cool the broth, strain and drink 10-12 p / d by
    tablespoon.
  4. Collect 1 kg of rowan berries, squeeze the juice out of them. Take up to
    food 50 ml * 3p / day.

As a local treatment, these recipes are recommended:

  • Grate raw potatoes, put gruel on his legs. Above
    cover with cellophane, fix with a warm scarf. Overlay
    compress all night
  • Take 50 g of pine needles, pour 500 ml of boiling water, keep on
    water bath for 15 minutes, then remove the broth and cool. Add
    decoction in a plastic basin (or a bucket – if swelling on the legs) with
    warm water, where you need to keep your feet for 20 minutes.
  • Take 50 grams of grape leaves, pour 3 liters of boiling water, wait,
    until cool to 40 °, strain and use for
    trays.
  • Sea salt baths can be prepared: 10 g salt per 10 l
    warm water 35 °. After such a bath is useful to moisten gauze or
    Towels in the same solution and wrap their feet, hold another 1
    hour.

Why swelling occurs

The main cause of this condition is decompensation. cordial
deficiencies, but also causes can be:

  • self-medication;
  • salt abuse;
  • alcohol intake;
  • violation of the diet;
  • inadequately matched treatment;
  • joining a kidney or endocrine disease.

Автор: Кривега Мария Салаватовна врач-реаниматолог

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