Acute heart failure and stroke. Drug for acute heart failure and stroke. Chronic heart failure and ischemic stroke

Basic concepts and terms on the topic: first aid, clinical death, angina pectoris. heart attack, acute heart failure, stroke, shock, fainting

Topic study plan(list of questions required to study):

The concept of first aid, clinical death, signs of clinical death

Causes of cardiac and brain disorders

Symptoms, first aid for angina, heart attack

Symptoms, first aid for stroke

Signs of shock, fainting, first aid

Brief summary of theoretical issues:

First aid is a set of simple, expedient measures to protect the health and life of a person who has suffered from an injury or suddenly fallen ill.

Heart disease kills millions of people around the world every year. However, the number of deaths can be reduced by knowing first aid techniques.

In acute heart failure, which manifests itself as a sudden attack of suffocation, it is extremely important to properly help the patient. Most affordable way help - give a person sitting position. « Ambulance"You need to call immediately. Before the team arrives, the patient needs to put a nitroglycerin tablet under his tongue and give him Corvalol or Valocordin. It makes sense to take a strong diuretic drug, which is most often Lasix (furosemide). All further activities should be carried out by professionals.

With sudden attacks of pressing (squeezing) pain in the chest, angina pectoris (formerly called angina pectoris) can most likely be suspected. Often attacks are triggered by stress or heavy physical exertion.

The pain is localized behind the sternum or in the region of the heart, often radiating to the left shoulder blade and left arm. Some patients appear discomfort in the upper abdomen. The duration of an acute attack of angina is from several minutes to half an hour.

At the time of the attack, severe weakness develops, the patient strives to quickly take a lying position, and often it is difficult for him to find and take the medicine himself.

Before the ambulance arrives, a nitroglycerin tablet is placed under the patient’s tongue (if these are drops, they are dripped onto a piece of sugar). You can use validol, valocordin, although their effect is weak. At the same time, it is a good idea to use distracting means, for example, mustard plasters on the heart area. On a hot day outside the city, a cold compress on the chest helps.

In order to prevent attacks, people suffering from angina pectoris need to limit physical and nervous stress and eat rationally (reduce the consumption of fats and alcohol).

The most dangerous form of manifestation of heart disease is myocardial infarction, which has been rapidly growing younger in recent years.

The direct cause of myocardial infarction is a persistent disruption of the blood supply to the heart muscle with the development of one or more foci of necrosis (death) in it. This happens due to blockage of the coronary arteries by a blood clot or their prolonged spasm. The causes of a heart attack include stress, as well as smoking, excess weight, and a sedentary lifestyle. In most cases, the development of the disease is preceded by an increase in the frequency of previously existing attacks of angina, but a heart attack can develop suddenly, without any warning signs.

The main sign of a heart attack is acute, unbearable pain localized behind the sternum, in the region of the heart, in the area of ​​the left shoulder blade or between the shoulder blades, spreading to adjacent areas - the shoulder, left arm, both arms, neck, lower jaw. Occasionally, pain occurs in the right half of the chest and in the right arm. Even more rarely, acute pain develops in the upper abdomen, which can cause an erroneous diagnosis of “acute abdomen.”

Simultaneously with the pain, severe weakness, pallor and cyanosis of the skin develop, and cold sweat appears.

The attack can last several days.

First medical aid for suspected myocardial infarction consists of creating the following conditions: strict rest; taking one nitroglycerin tablet; if the pain does not go away, after 5–10 minutes take nitroglycerin again and after another 5–10 minutes take a third tablet of the same drug.

A stroke or cerebral stroke is an acute disruption of blood circulation in the system of arteries that supply blood to the brain. Stroke can be hemorrhagic or ischemic. Hemorrhagic stroke is a consequence of hemorrhage (when blood vessels rupture) into the substance of the brain or under its membranes. The cause of ischemic stroke is a decrease in blood flow to areas of the brain due to narrowing or complete blockage of a vessel. Common signs of a stroke are as follows: severe headache, loss of consciousness, vomiting, involuntary loss of urine and feces. The face becomes purple with blueness of the nose and ears, sweat, and increased pulsation of blood vessels in the neck. Breathing disorders are typical - severe shortness of breath with noisy wheezing breathing. alternating with pauses of cessation of breathing or sharp single breaths. Paralysis of the limbs often appears immediately. There is asymmetry of the face, the eyeballs are pulled to the side, the corner of the mouth is drooping, the pupils can be of different widths, and there is a “blowing” of the cheeks when breathing.

First aid for stroke:

• conveniently place the patient on the bed, unbuttoning clothing that makes breathing difficult
• provide fresh air flow
• turn your head to the side so that your tongue doesn’t stick out
• clear your mouth of mucus and vomit
• cover the patient's head with ice packs or cloth, constantly wetting it with cold water
• apply heating pads to your feet
• If the patient can swallow, give a sedative
• monitor the patient’s condition, in case of cardiac or respiratory arrest, begin primary resuscitation measures

Sudden cardiac arrest is the most common immediate cause of death. It can occur in the midst of complete well-being in a seemingly healthy person, or it can be a consequence of diseases and damage to the heart.

What are the main causes of cardiac arrest? Most often it is caused by coronary circulatory disorders (angina pectoris, heart rhythm disorders, myocardial infarction) that occur after emotional or physical stress. Cardiac arrest often occurs in severe respiratory failure due to massive blood loss, shock, mechanical, electrical and burn injury, poisoning, and an allergic reaction.

The most important condition for resuscitation is timely identification of signs of circulatory disorders and clinical death. Here's what you need to remember:

Loss of consciousness during cardiac arrest occurs after 4–5 seconds and is determined by the lack of reaction of the victim to an audio or tactile stimulus (calling, patting the cheek).

The absence of a pulse in the carotid artery is determined by the index and middle fingers at a distance of 2 - 3 centimeters to the side of the thyroid cartilage protruding on the neck.

Stopping breathing is easy to notice by the absence of respiratory movements of the chest or diaphragm.

Pupil dilation and lack of response to light are detected by opening the upper eyelid and illuminating the eye. If the pupil is significantly dilated (into the entire iris) and does not constrict to the light, then this sign serves as a signal to begin cardiopulmonary resuscitation.

In case of clinical death, all resuscitation actions should begin with ensuring the airway is patent. To do this, it is necessary to move the patient’s head back, open his mouth, remove foreign bodies if there are any, dry his mouth with a napkin, then cover it with a napkin or handkerchief and quickly make 3 to 5 blows into the lungs. The patient is also given a short blow with the edge of the palm or with a fist from a distance of 20 - 30 centimeters on the sternum (the bone located in the middle of the chest in front). If after five seconds the pulse does not recover, then you should begin external cardiac massage, alternating it with artificial respiration (Fig. 11).

Stroke chronic hypertension heart failure

The most common and serious complications of hypertension are:

As stated earlier, hypertension is accompanied by constant tension in the vascular wall, which leads to its thickening, impaired elasticity, and deterioration in the nutrition of surrounding tissues. In a thickened wall, lipid particles are retained much more easily, which leads to a narrowing of the lumen of the vessel, a slowdown in blood flow, an increase in its viscosity, and thrombus formation. A sharp increase in pressure causes a malnutrition of the heart muscle, leading to necrosis of the damaged area, which is manifested by pain in the heart area. A prolonged pain attack is the main symptom of myocardial infarction.

A painful attack has a number of characteristic features (Table 23).

It is extremely important to provide first aid for myocardial infarction as soon as possible. The more timely assistance is provided, the more it will go faster healing process and fewer complications are expected.

First aid for myocardial infarction is to: if pain occurs:

Take nitroglycerin, which relieves pain well within a few seconds or minutes;

Call an ambulance;

Try not to make sudden movements until the attack stops, stay in bed until the doctor arrives;

Try to calm down, because the attack will stop within a few seconds after taking nitroglycerin and the danger will be left behind, so the disease is under your control, but if you cannot curb your emotions, the attack will last longer;

Do not endure the pain: if it does not stop with one tablet, you need to take another one;

After taking a nitroglycerin tablet, try to restore your breathing: take a deep breath (as far as possible), hold your breath and then exhale slowly, repeat this exercise several times;

Try to relax after taking nitroglycerin: ease muscle tension, rub the numb fingers of your left hand or your entire hand.

Relatives should put mustard plasters on the patient’s calves and heart area, help him take warm foot or hand baths with a water temperature of 30–40 °C for 10–15 minutes, not leave the patient, cheer him up and calm him down.

Acute heart failure and cardiogenic shock

Acute heart failure and cardiogenic shock can be a serious complication of myocardial infarction. Relatives of the patient should know the rules of behavior in the event of such complications.

Acute heart failure develops sharply, suddenly against the background of an acute process in the myocardium, with increasing shortness of breath, bubbling breathing, rapid heartbeat, foamy sputum, cyanosis of the lips, the tip of the nose, coldness of the hands and feet.

The rules of conduct are:

Cover the patient with heating pads;

Place the patient in a half-sitting (half-lying) position;

To raise blood pressure, press on a point located on the left hand in the triangle between the first phalanges of the thumb and index finger, in the middle of the phalanx of the thumb;

Massage your fingers, apply sharp pressure with your nail in the area of ​​your fingertips;

Do not leave the patient, try to calm him down.

An even more serious complication that can occur after acute heart failure is cardiogenic shock.

Cardiogenic shock is manifested by symptoms such as:

Sudden severe weakness;

Paleness of the skin;

Cold clammy sweat;

Weak, rapid pulse;

Drop in blood pressure;

Cardiac arrest (the most dangerous manifestation of shock), disappearance of the pulse in large vessels (there are only single breaths, and soon breathing stops), pale or ash-gray skin, dilated pupils.

In case of cardiac arrest, the patient needs emergency care; everyone must be able to provide it (you must master the skills of chest compressions and artificial respiration techniques) in order to save the life of the patient, who may be your relative. There is very little time allotted for this - only 3-4 minutes.

Immediate artificial respiration and chest compressions are required; the key to success is correct technique carrying out:

Place the patient on a hard surface;

Place a cushion of clothing under your shoulder blades so that your head tilts back a little;

Hand position: Place the palm of one hand on the lower third of the chest, place the second on the first;

Apply several energetic push-like pressures, the sternum should move vertically by 3-4 cm;

Alternate massage with artificial respiration using the “mouth to mouth” or “mouth to nose” method, in which the person providing assistance exhales air from his lungs into the patient’s mouth or nose;

For 1 exhalation there should be 4–5 pressures on the sternum; if one person is providing assistance, then for 3 exhalations there should be 10–15 pressures on the sternum.

If the massage is successful, the skin will begin to take on its normal color, the pupils will narrow, the pulse will be palpable, and breathing will be restored.

Brain disorders include cerebral stroke and mental disorders.

Brain stroke. Due to damage to the blood vessels of the brain during long-term hypertension and a violation of their elasticity, the development of a cerebral stroke is possible - an acute circulatory disorder (Table 24).

Your tactic is to call a doctor, an ambulance; it is not recommended to take any other actions. If the patient is on the floor, carefully move him to the bed and turn his head to the side, as vomiting is possible and the patient may choke on the vomit.

In acute cerebrovascular accidents, mental disorders:

Visual and auditory hallucinations;

Try to limit the patient’s movement;

Do not argue or enter into conflicts with the patient;

Try to take the patient's hands and massage the hands and fingers.

The main mistake is that relatives call the psychiatric ambulance team, wasting time to provide targeted assistance (lowering blood pressure), although the introduction of appropriate medications by the doctors of the psychiatric ambulance team can reduce blood pressure, which is the main cause of the development of mental disorders.

Let's hope that the above information will help you and your family in preventing unwanted complications from the cerebral vessels.

Chronic heart failure

Heart failure is a condition in which the heart's pumping function does not provide enough blood to the body's organs and tissues. With chronic heart disease, it increases in size, it contracts poorly and pumps blood worse. Chronic heart failure occurs gradually against the background of a chronic disease and develops over years. Chronic heart failure is characterized by a number of symptoms, the presence of each of which indicates a varying degree of severity of heart failure. For the patient and his relatives, it is necessary to know the main signs (Table 25) in order to consult a doctor in time, make changes to treatment and lifestyle (diet, drinking regimen, etc.)

To better understand the symptoms, let's briefly look at each of them.

Weakness, fatigue and limitation of physical activity. The reason for weakness and fatigue is that the body as a whole does not receive enough blood and oxygen; even after a full night's sleep, patients may feel tired. Loads that were previously well tolerated now cause a feeling of fatigue, a person wants to sit or lie down, and needs additional rest.

1. If weakness and fatigue increase, consult a doctor immediately.

3. Spend more time outdoors, sleep in a well-ventilated area.

4. Create an optimal work and rest regime for yourself.

Dyspnea– increased and increased breathing, which does not correspond to the state and conditions in which the person is at the moment.

At first, shortness of breath may only occur with heavy exertion. Then it appears under light loads. As heart failure progresses, shortness of breath occurs when dressing, showering, and even at rest. If shortness of breath increases, you should immediately consult a doctor!

Heartbeat– increased and rapid contractions of the heart, a feeling that the heart is “jumping out of the chest”, the pulse becomes frequent, weak filling, it is sometimes difficult to count, it may become irregular.

First aid rules for palpitations:

Try to calm down and relax;

Start by restoring your breathing: take a deep breath, hold your breath, then exhale slowly - repeat this exercise several times;

If the heartbeat does not go away, close your eyes, lightly press on the eyeballs or exhale as deeply as possible and tighten your abs a little.

The main thing is to remember that the situation is manageable; excessive fuss and tension will prolong the symptoms rather than help overcome them.

The main symptom of pulmonary congestion is dry cough, most often at night.

If you experience this symptom, you should immediately consult a doctor for advice and consultation. Only a doctor can assess the severity of shortness of breath and make the necessary decision.

Edema– accumulation of fluid in typical places, primarily in the ankle area, on back side stop. Swelling appears in the evening and disappears overnight. With a more pronounced process, they become permanent. The severity of edema is assessed by the increase in body weight. An increase in body weight of 1 kg per day in patients with heart failure corresponds to a retention of 1 liter of fluid, so it is important to weigh yourself every day and adhere to the rules below:

Weigh yourself on the same scales every morning before meals after the morning toilet;

Keep a self-control diary (Table 26).

If you gain 1.0–1.5 kg in 1 day or 1.5–2.0 kg in 5 days, you should consult a doctor immediately.

Lethargy, lethargy. The patient constantly wants to sleep, he is lethargic, has ceased to be interested in others, his movements are slow, etc. These signs are very serious, since fluid retention occurs in the brain cells, which entails irreparable consequences, so it is necessary to immediately consult a doctor.

Stroke and heart failure

Heart failure is the most severe pathological condition of the human body. It lies in the fact that the heart, for one reason or another, is not able to perform its function of pumping blood completely.

Because of this, the entire body, every cell, every organ experiences very severe oxygen starvation. But the most serious complication of heart failure is a stroke, which is caused by a severe circulatory disorder in the brain.

Acute heart failure develops very, very quickly, almost instantly. It is a terminal condition and can easily lead to the death of the patient. And therefore, stroke and heart failure are diseases whose symptoms everyone should know.

What can lead to the fact that the heart begins to work incorrectly and not to its full potential? In first place among such causes is, of course, myocardial infarction - a very common disease that most often occurs in men. This is followed by disruption of coronary blood flow and compression of the heart by other organs. Compression of the heart or tamponade very often occurs with pulmonary edema or tumors that are located in the chest. In this case, the heart simply does not have enough space to function normally, and it begins to malfunction. Heart failure often occurs due to infectious lesions of the pericardium or myocardium, when bacteria and microbes literally destroy the walls of this organ.

An attack of heart failure develops within a few minutes. This condition is always sudden and unexpected both for the patient himself and for his relatives. At the same time, the patient feels that he simply can’t breathe and everything in his chest is compressed. A person’s skin begins to turn sharply and quickly blue due to a lack of oxygen reaching it. The man loses consciousness. But the worst thing is that very often all these symptoms are accompanied by complications such as pulmonary edema, myocardial infarction and hypertensive crisis. And, of course, stroke. Stroke and heart failure are two diseases that in most cases occur in parallel.

A stroke is a sudden cessation of blood flow to the veins and arteries of the brain. There are 3 types of this serious disease.

The first type is the ischemic type or cerebral infarction. This condition most often develops after 60 years of age. For the development of this condition there must be some prerequisites - heart defects, diabetes mellitus or the same heart failure. Most often, cerebral infarction develops at night.

The second type is a hemorrhagic stroke or cerebral hemorrhage. This pathology very often manifests itself in people aged 45 to 60 years. The cause of this condition is usually high blood pressure or hypertensive crisis. This condition develops very suddenly and most often in daytime after strong emotional or physical stress.

And finally, the third type of stroke is subarachnoid hemorrhage. It occurs between the ages of 30 and 60 years. Here, the leading factor is most often smoking, simultaneous consumption of large amounts of alcohol, high blood pressure, excess body weight or chronic alcoholism.

A sudden onset stroke may well result in the death of a person, which is why it is imperative to immediately call an ambulance. Only professional medical workers will be able to correctly determine the type of stroke and provide the necessary first aid. All further treatment will take place in the hospital.

But during its treatment, a stroke is often accompanied by pneumonia and bedsores. These complications themselves can cause a lot of problems for the patient, and pneumonia, again, can lead to death.

Everyone should know that acute heart failure and stroke are very dangerous conditions. Every person should know what needs to be done to prevent their development. And for this you don’t need to do much: lead a healthy lifestyle, don’t drink alcohol, don’t smoke, watch your weight, don’t overexert yourself and avoid stress, measure your blood pressure daily and just enjoy life. It is also worth knowing that stroke is not only a disease of older people. Under some circumstances, it also affects fairly young people.

Acute heart failure: first aid

Heart failure is the leading cause of death in cardiovascular diseases. Due to coronary heart disease, hypertension or valve defects, the heart cavities lose the ability to contract synchronously. The pumping function of the heart decreases. As a result, the heart stops supplying tissues and organs with oxygen and nutrients. A person will face disability or death.

Acute heart failure (AHF) is an acute clinical syndrome that is caused by a violation of the systolic and diastolic function of the ventricles of the heart, leading to a drop in cardiac output, an imbalance between the body's need for oxygen and its delivery and, as a result, dysfunction of organs.

Clinically, acute heart failure manifests itself in several ways:

1. Right ventricular heart failure.
2. Left ventricular heart failure.
3. Small output syndrome (cardiogenic shock).

Left ventricular acute heart failure

Symptoms

Left ventricular acute heart failure occurs as a result of stagnation in the pulmonary circulation, which leads to impaired gas exchange in the lungs. This manifests itself as cardiac asthma. the characteristic features of which are:

• sudden shortness of breath
• suffocation
• heartbeat
• cough
• severe weakness
• acrocyanosis
• pale skin
• arrhythmia
• decrease in blood pressure.

To alleviate the condition, the patient takes a forced position and sits with his legs down. In the future, symptoms of congestion in the pulmonary circulation may increase and develop into pulmonary edema. The patient develops a cough with foam (sometimes mixed with blood) and bubbling breathing. The face becomes cyanotic, the skin becomes cold and sticky, the pulse is irregular and weakly palpable.

First aid for acute left ventricular heart failure

Pulmonary edema is an emergency. The first thing you should do is call an ambulance.

1. The patient is placed in a sitting position with legs down.
2. Nitroglycerin or ISO-MIK is given under the tongue.
3. Provide access to fresh air.
4. Apply tourniquets to the thighs.

After hospitalization, the patient undergoes further treatment:

• Reduces increased excitability of the respiratory center. I prescribe narcotic analgesics to the patient.
• Reducing congestion in the pulmonary circulation and increasing the contractile function of the left ventricle. For high blood pressure, drugs that dilate peripheral blood vessels are administered. At the same time, diuretics are administered.

For normal blood pressure, nitrates (nitroglycerin preparations) and diuretics are prescribed. For low blood pressure, Dopamine and Dobutamine are administered.

Right ventricular acute heart failure

Right ventricular acute heart failure is manifested by venous congestion in the systemic circulation. Most often it occurs as a result of pulmonary embolism (PE).

It develops suddenly and is manifested by the following symptoms:

• shortness of breath, suffocation, chest pain, bronchospasm
• cyanosis, cold sweat
• swelling of neck veins
• liver enlargement, pain
• rapid thready pulse
• decrease in blood pressure
• swelling in the legs, ascites.

First aid for acute right ventricular heart failure

Before the ambulance arrives:

1. Elevated position of the patient in bed.
2. Access to fresh air.
3. Nitroglycerin under the tongue.

In the intensive care unit:

1. Oxygen therapy.
2. Anesthesia. If agitated, a narcotic analgesic is prescribed.
3. Administration of anticoagulants and fibrinolytic drugs.
4. Administration of diuretics (usually not prescribed for pulmonary embolism).
5. Administration of Prednisolone.
6. Prescription of nitrates, which reduce the load on the heart and improve right ventricular function.
7. Cardiac glycosides are prescribed in small doses along with polarizing mixtures.

Low cardiac output syndrome

Cardiogenic shock occurs as a result of myocardial infarction. cardiomyopathy, pericarditis, tension pneumothorax, hypovolemia.

It manifests itself as pain, a drop in blood pressure down to 0, a frequent thread-like pulse, pale skin, anuria, and collapsed peripheral vessels. The course may further develop into pulmonary edema and renal failure.

Eczema causes stroke and heart failure

(Average rating: 4)

Due to skin problems, people often lead an unhealthy lifestyle.

Eczema can cause heart failure and stroke. Doctors came to these conclusions after analyzing the health status of 61 thousand adults aged 18 to 85 years.

The study showed that people with eczema are 54% more likely to be obese and 48% more likely to have hypertension.

In adults with the skin disease, doctors also noted an increased risk of heart failure and stroke.

The risk may be the result of an incorrect lifestyle and bad habits. As doctors explained, eczema often appears in childhood and leaves its mark on a person’s life: it reduces self-esteem and self-esteem. Due to psychological problems, people resort to bad habits.

“Eczema is not just a skin disease. It affects every aspect of a patient's life,” explained lead researcher Dr. Jonathan Silverberg, assistant professor of dermatology at Northwestern University Feinberg School of Medicine in Chicago.

Thus, scientists have found that people with eczema drink and smoke more than others. In addition, a person with problem skin is less likely to exercise: sweating and increased body temperature provoke scabies.

Although, as scientists explained, even if you remove harmful factors, eczema itself causes problems with the heart and blood vessels due to chronic inflammation.

Normal blood pressure after a stroke

A stroke of the hemorrhagic or ischemic type is a severe cardiovascular catastrophe that leaves an imprint on the functioning of the entire system. Blood pressure, as one of the main indicators, also undergoes significant changes, but it cannot be said that in some situations it will be guaranteed to have such values, and in others - completely different.

In fact, everything is a little more complicated, since several factors operate at once, each of which, in one way or another, affects the indicator.

Association between hypertension and stroke

Arterial hypertension (hereinafter this condition will be called hypertension) can significantly increase the risk of developing hemorrhagic stroke - American researchers claim by 4-6 times. The thing is that chronic hypertension causes thickening of the walls of blood vessels and the deposition of atherosclerotic plaques. For this reason, the elasticity of arterial vessels, capillary beds and veins is lost, after which a balloon increase in their diameter immediately occurs. As a result, microaneurysms appear in the brain parenchyma. A sudden hypertensive crisis causes them to rupture, leading to a hemorrhagic stroke.

From all of the above, we can draw an elementary conclusion that the risk of stroke is directly related to increased level HELL. In addition, there is an opinion that hypertension contributes to the manifestation of acute stroke by indirectly affecting various pathophysiological mechanisms, among which are oxidative stress, endothelial dysfunction, increased peripheral vascular resistance, “HMC and small vessels” disease, and many others.

Some researchers argue that high blood pressure after a stroke is normal, and this indicates that the cardiovascular system is still working (in other words, a relatively favorable outcome is implied, since there are no signs of developed heart failure). In fact, everything is somewhat different - the blood pressure level after a stroke remains the same as before it, and if nothing is done to lower arterial hypertension, then there is a high probability of a recurrence of a hemorrhagic stroke, after which there is practically no chance of recovery no longer - mortality tends to 100%.

Normal pressure readings

Contrary to the widespread stereotype that everyone’s blood pressure numbers should be in approximately the same range, we can safely say that this indicator is purely individual, and in fact depends on the action of a variety of factors. In other words, for each person the blood pressure norm is purely individual, but in most cases this value ranges from 100-140 upper and 50-90 lower. The absolute norm is from 110-130 SBP and 60-90 DBP. Again, the given values ​​are relevant only for adults - in children they will be slightly different (under the age of 15 years, the blood pressure level will be slightly lower).

Many people have a completely logical question as to why the pressure should not drop quickly if hypertension is considered the main etiological factor in the occurrence of hemorrhagic stroke. In fact, if the pressure begins to “jump” - that is, after a short-term increase, it is immediately followed by a sharp decrease (for example, from 160 and above to 100), even greater dissonance and disruption of the functioning of the cardiovascular system will occur.

In other words, a jump in blood pressure is an even more dangerous factor in the manifestation of hemorrhagic stroke than banal hypertension.

High blood pressure readings

An elevated blood pressure level, which can definitely be considered pathological, is a value exceeding 140 to 90. The pressure value given above is the most important symptom of hypertension. If it is recorded over a certain amount of time, then a diagnosis of hypertension can be made.

The level of AL fluctuates from the amount of blood that is sent by the heart into the vascular bed, and vascular resistance - vascular resistance to blood flow in the arteries. From this we can conclude that the greater the volume of incoming blood pumped by the heart and the narrower the diameter of the arteries, the higher the blood pressure will be.

An uncontrolled increase in this indicator increases the risk of developing health problems, which include stroke and heart attack. Although, essential hypertension may not manifest itself for several years and be almost asymptomatic, making itself felt only by episodic (and then short-term) headaches, dizziness when changing body position and (only occasionally) nosebleeds.

In the event that in one month it was noted that the pressure can rise to values ​​of 150 and higher (the top number, and the bottom ones reach 100-110), several times, then this is definitely not normal, and this figure should be lowered , taking antihypertensive drugs, and in as soon as possible, since in otherwise There may be adverse consequences for the brain and heart.

Low blood pressure during stroke

The most negative sign of the clinical course of this disease is low blood pressure in the first two to three days after a stroke occurs. Hypertension is not as dangerous as heart failure or collapse. In addition, the prognosis regarding the prospects for recovery and the time required for rehabilitation will be much less favorable.

The reasons that cause low blood pressure can be a variety of factors - heart failure is not always the direct cause of persistent hypotension. Very often, the condition in question is the result of a significant overdose of antihypertensive drugs - this phenomenon is encountered, as a rule, if the patient self-medicates and takes his own medications for hypertension, which were not previously prescribed to him by the attending physician.

Statistical data indicate that too low pressure, just like too high pressure, observed in the first two days from the moment of manifestation of the disease, leads to death in the vast majority of cases.

In the event that after an acute stroke occurs, a consistently low level of pressure is observed, the prognosis can be considered unfavorable, especially provided that the pulse is also not elevated. Rehabilitation of such a patient will be extremely difficult. The thing is that these symptoms clearly indicate that heart failure is developing. And you shouldn’t expect a surge in pressure either, because the heart simply does not fulfill its assigned functions of pumping blood.

If you don’t start giving special pills and making droppers that allow you to speed up the heart and squeeze the maximum out of the myocardium (medicines mezaton, dopamine), then blood pressure may drop to zero, which will lead to the inevitable death of the patient.

Blood pressure indicators during stroke

It is important to know which blood pressure indicators in hemorrhagic or ischemic stroke are critical and are highly likely to lead to death. So, the most dangerous values ​​are considered to be those that are less than 40 units between the systolic and diastolic levels (in other words, between the upper and lower values). Yes, it may be that the patient tolerates the increase in blood pressure well without experiencing any deterioration in well-being; in principle, the same can be said about low blood pressure, but reducing the difference between these two figures is almost always critical.

Hemorrhagic stroke is essentially an intracranial hematoma. That is, unlike ischemic stroke, in in this case There is an excessive “supply” of blood to the brain tissue, so much so that necrotic damage occurs because of it. Please note that the more blood is retained in the meninges, the more significant the damage will be. It is for this reason that it is necessary to ensure that the fluid is removed from the skull by any means as soon as possible.

It is possible to normalize the blood circulation of brain tissue only if blood pressure levels are stabilized. If it is elevated, 25% magnesium sulfate, 5 ml should be administered at the prehospital stage; otherwise, another drug of choice will be administered in the hospital - adrenaline or mezaton.

Recovery period

The modern classification identifies three periods that are observed during post-stroke rehabilitation:

1. Early recovery - its duration is from 3 to 6 months from the moment the disease manifests itself. This period is considered to be the most productive for rehabilitation (restorative) treatment and should not be postponed under any circumstances. This approach is easily explained by the fact that it is during this period that the body has the highest recovery potential.
2. Late recovery - lasts from 6 to 12 months from the moment the pathology manifests. Recognized as a fertile period for carrying out rehabilitation measures, the recovery potential still remains high, but it is inferior to the early recovery period.
3. The period of delayed consequences is more than a year from the moment of manifestation of the necrotic process. The recovery here is already much slower than in earlier recovery periods.

Another important point that makes sense to pay attention to is that with a relatively successful course of the nosology, all rehabilitation measures It makes sense to carry it out right at the patient’s bedside in a hospital (meaning the early recovery stage).

After sudden changes in the state of the cardiovascular system can be stabilized, a slight drop in blood pressure is no longer so dangerous. With a high degree of probability, it can be argued that after the decrease there will be no significant jump in blood pressure numbers, which in most cases becomes the direct cause of death. If the numbers reach stable values ​​and remain at a certain level for several days, then even if they increase, reducing blood pressure to the normal level will not be difficult.

Preventing pressure fluctuations

The most dangerous thing during the post-stroke recovery period is blood pressure fluctuations. Even if it remains at a consistently high level, it does not pose such a great threat to the life and health of the patient. To avoid such fluctuations, you must follow a number of simple rules:

• Taking medications strictly in the dosage and frequency prescribed by the treating doctor.
• Any actions (walking, sitting, mental stress) should be gradual. Even if the patient feels full of strength, one should not put a sharply large load on the body.
• It is important to watch your diet. Meals should be fractional. Too much lunch can also cause a sharp rise in blood pressure.
• Avoid nervous stress.

Acute heart failure, stroke

Heart failure is one of the severe pathological conditions of the body. In this condition, the heart does not perform the entire volume of necessary work, as a result of which the body tissues experience oxygen starvation. The most serious complication of heart failure is cerebrovascular accident, which can lead to stroke.

Acute heart failure is a condition that occurs instantly. This is a terminal condition that can easily lead to death. It is important to know the symptoms of this condition and be able to prevent it and provide the necessary assistance in time.

The cause of acute heart failure can be myocardial infarction, impaired coronary blood flow, cardiac tamponade, pericarditis, infections and much more.

The attack occurs abruptly and develops within a few minutes. At this time, the patient feels a sharp lack of oxygen, and there is a feeling of squeezing in the chest. The skin acquires a bluish tint. These symptoms are often accompanied by loss of consciousness, pulmonary edema, myocardial infarction, or hypertensive crisis.

If you notice such symptoms in a person, you should provide him with the necessary help. The first thing to do is call an ambulance. It is necessary to ensure a flow of fresh air to the patient and free him from constricting clothing.

Good oxygenation will be ensured by the patient adopting a certain position: it is necessary to sit him down, lower his legs down, and put his hands on the armrests. In this position, a large amount of oxygen enters the lungs, which sometimes helps to stop an attack.

If the skin has not yet acquired a bluish tint and there is no cold sweat, you can try to stop the attack with a nitroglycerin tablet. These are activities that can be carried out before the ambulance arrives. Only qualified specialists can stop an attack and prevent complications.

One of the complications of acute heart failure can be a stroke. A stroke is the destruction of brain tissue due to a previous hemorrhage or acute cessation of blood flow. Hemorrhage can occur under the membranes of the brain, in its ventricles and other places, the same applies to ischemia. The further condition of the human body depends on the location of the hemorrhage or ischemia.

Various factors can trigger a stroke. If a stroke is caused by hemorrhage, then such a stroke is called hemorrhagic. The cause of this type of stroke can be a sharp increase in blood pressure, cerebral atherosclerosis, blood diseases, traumatic brain injuries, etc.

Ischemic stroke can be triggered by thrombosis, sepsis, infections, rheumatism, disseminated intravascular coagulation syndrome, a sharp decrease in blood pressure due to acute heart failure, and much more. But one way or another, all these reasons are associated with disruption of the cardiovascular system.

If a patient’s blood pressure rises sharply, blood flow to the head increases, and sweat appears on the forehead, then we can talk about the occurrence of a hemorrhagic stroke. This is all accompanied by loss of consciousness, sometimes vomiting and paralysis on one side of the body.

If the patient experiences dizziness, headache, or general weakness, then these may be symptoms of an ischemic stroke. With this type of stroke, there may be no loss of consciousness, and paralysis develops slowly. An ischemic stroke is accompanied by a drop in blood pressure, fainting, and pallor of the patient’s skin.

If you notice such symptoms, call an ambulance immediately. Lay the patient on a horizontal surface, ensure free breathing. The patient's head must be turned to the side to prevent tongue retraction and suffocation with vomit.

It is advisable to place a heating pad at your feet. If, before the ambulance arrives, you notice a lack of breathing and cardiac arrest in the patient, it is urgent to perform chest compressions and artificial respiration.

Acute heart failure and stroke are life-threatening conditions. It is impossible to monitor their appearance and they respond very poorly to treatment. Therefore, the most important task facing us is the prevention of these conditions.

Lead a healthy lifestyle, do not abuse medications, avoid stress and take care of your health.

Arterial hypertension is one of the most common pathologies: according to statistics, high blood pressure is found in every third person.

• Hypertensive crisis and its symptoms
• Causes of pathology
• Types and consequences of hypertensive crisis
• What is crisis relief?
• First aid
• Cupping algorithm
• Help with a type 1 crisis
• Help with a type 2 crisis
• First aid for a complicated crisis
• Medicines used for relief
• Beta blockers
• Diuretics
• Calcium channel blockers
• Sleeping pills and sedatives
• Rehabilitation after relief of the crisis

With this disease, it is important to regularly measure blood pressure and use the necessary medications. Refusal of therapeutic measures can cause a hypertensive crisis. This phenomenon poses a health hazard, and any delay can cost life, so it is important to know how to relieve a hypertensive crisis.

Hypertensive crisis and its symptoms

Hypertensive crisis is a sharp increase in blood pressure above 180/120 millimeters, as a result of which there is an increased load on the blood vessels and heart.

During a crisis, the endocrine glands produce certain substances that affect the blood vessels and promote their rupture.

This condition occurs most often in older people. However, the pathology often appears in people under 40 years of age.

Characteristic of pathology fast development: The problem may occur within a few hours. A sharp increase in blood pressure is considered a crisis in the presence of the following symptoms of brain damage:

• intense headache, localized mainly in the occipital area;
• impaired coordination of movements;
• dizziness;
• feeling of nausea, vomiting that does not cause relief;
• the appearance of floating spots before the eyes, temporary loss of vision;
• numbness of the hands and facial muscles;
• loss or decrease in sensitivity of the tongue, lips;
• “goosebumps” appearing on the hands;
• weakness of arms and legs;
• short-term loss of ability to speak;
• convulsions.

Signs of a cardiac crisis:

• pressing pain in the chest;
• the occurrence of shortness of breath in a calm state;
• heart dysfunction;
• accelerated pulse.

Symptoms of pathology associated with the functioning of the autonomic nervous system:

• trembling hands;
• chills;
• the appearance of unreasonable anxiety, fear, irritability;
• increased sweat production;
• dry mouth;
• feeling of heat in the body;
• excessive urination after low blood pressure readings.

Based on the characteristics of the course, the severity of the disease, the manifestations of the disease may change.

Causes of pathology

The development of a crisis can be caused by the following reasons:

• regular stress, emotional tension - these situations contribute to the release of adrenaline into the blood, causing an increase in heart rate, which, in turn, provokes an increase in blood pressure;
• pathologies of the endocrine system - the thyroid gland normalizes the body’s hormonal levels, due to a malfunction, a strong increase in pressure occurs;
• using antihypertensive drugs without a doctor’s prescription or ignoring his recommendations - reducing or increasing the dose, stopping the use of the medication on your own;
• adding to food large quantity salt, consumption of alcohol, coffee, tea, other caffeine-containing foods or drinks;
• sudden changes in weather - heat, magnetic storms often cause deterioration in the condition of weather-sensitive people;
• diseases of the cardiovascular system, kidneys;
• the occurrence of a cold;
• injuries.

Types and consequences of hypertensive crisis

Doctors divide hypertensive crisis into two types:

• uncomplicated - characterized by transience and absence of consequences in most cases;
• complicated.

The latter is divided into several subspecies:

1. Cerebral. Occurs due to disruption of blood flow to the cerebral cortex. Can cause stroke, complete loss of vision and hearing, and encephalopathy.
2. Coronary. The consequences of this type of pathology can be cardiac asthma, pulmonary edema, and other life-threatening complications.
3. Asthmatic. Can cause pulmonary edema, cardiac asthma, heart failure.

Any type of pathology can provoke the occurrence of angina pectoris, wall dissection of the aorta, renal failure, cerebral edema, ischemic disease of the heart muscle, the appearance of blood clots, retinopathy, cardiogenic shock.

What is crisis relief?

Relief of a hypertensive crisis is a complex of therapeutic measures carried out urgently. With the help of these measures, manifestations of pathology are eliminated, the risk of dangerous complications is reduced, and the functioning of the patient’s cardiovascular system is normalized.

The effectiveness of relieving a hypertensive crisis depends on compliance with a certain procedure algorithm. It is worth knowing that within 2 hours from the time of the attack, the upper blood pressure should be reduced by no more than a quarter of the total value. In the next 6 hours, the indicators, if this has not already happened, can be reduced to 160/100 millimeters.

It is forbidden to sharply reduce blood pressure during relief - this can cause deterioration in the blood flow of the heart, cerebral cortex and other organs. Such actions can cause severe hypertension, which can lead to heart attack, hemorrhage, and swelling of the lungs.

First aid

When identifying the first signs of a hypertensive crisis, you need to:

1. Call an ambulance and open the front door in advance.
2. Measure your blood pressure and, if necessary and possible, take medication to lower it.
3. Lie down, try to calm down and even out your breathing.
4. Massage the shells of the ears.
5. If chills occur, cover yourself with a blanket and place a heating pad.

Cupping algorithm

In case of hypertensive crisis, it is necessary to first normalize psychological condition sick. With a sharp increase in blood pressure and deterioration in health, almost every person develops a feeling of anxiety and fear, which negatively affects the effectiveness of relieving a hypertensive crisis.

The next stage of crisis relief is collecting an anamnesis. The doctor needs answers to the following questions:

1. How long has the patient suffered from hypertension?
2. Which blood pressure readings are normal for the victim, and which are low and high?
3. How long ago did the hypertensive crisis begin?
4. What medications does a person use to normalize the functioning of the cardiovascular system?
5. Did the person take any medications before the doctor arrived?
6. Are there any concomitant diseases (arthrosis, arthritis, diabetes)?

The completeness and veracity of the data obtained directly affects the effectiveness of relieving a hypertensive crisis.

After this, the specialist selects groups of medications to eliminate the symptoms of the disease.

Help with a type 1 crisis

The first type of hypertensive crisis begins abruptly. It is accompanied by the following symptoms:

• severe headache;
• dizziness;
• flashing before the eyes;
• nausea;
• vomit;
• feeling of heat;
• shiver;
• red spots;
• increased heart rate;
• increased pulse pressure;
• increased systolic pressure, up to 200 and above.

If medical worker realized that a type 1 hypertension crisis had developed, he would most likely administer dibazole intravenously. There are practically no contraindications to the use of this drug, but in many patients the pressure rises again after a few days. This gives reason to simultaneously administer a diuretic drug.

In order to stop an attack, propranolol is often used. Beta blockers should not be used in cases of bronchial asthma, complete transverse heart block, bradycardia and severe heart failure.

Help with a type 2 crisis

Symptoms of the second type of crisis develop more slowly, but intensely. The headache increases over several hours. The following symptoms appear:

• nausea:
• vomit;
• deterioration of hearing and vision;
• lethargy;
• tense, but not rapid pulse;
• increase in diastolic pressure to 160.

For these symptoms, catapresan or clonidine are often used. Hyperstat has a rapid hypotensive effect. However, it should be used with caution in cases of coronary and cerebral circulation disorders. Also, after its administration, a collaptoid state may occur. In this case, a mesatone solution is administered intravenously.

First aid for a complicated crisis

Against the background of high blood pressure, acute coronary insufficiency may develop in the form of pulmonary edema or cardiac asthma. Other serious complications are also possible, so first aid for a hypertensive crisis should be provided quickly and effectively.

If signs of coronary or cerebral circulatory disorders are minimal, antipsychotic drugs are used for relief. Feeling improves with intravenous administration of droperidol and glucose solution. To enhance the effect of droperidol, antihypertensive drugs are used.

If the crisis is complicated by acute coronary insufficiency, then nitrates and painkillers are used simultaneously. To relieve pain, medications are used depending on its intensity.

Medicines used for relief

To relieve a hypertensive crisis, many groups of drugs are used. The doctor’s task is to select, based on individual characteristics patient, the most effective ones, determine their dosage and duration of treatment.

Beta blockers

They normalize blood pressure and the number of heart contractions during a hypertensive crisis. The effect is achieved by blocking beta-adrenergic receptors. This group of tablets used for relief has the following effect:

• reduces the intensity and frequency of contraction of the heart muscle;
• minimizes cardiac output;
• reduces renin levels in the blood;
• reduces increased tension in the nervous system;
• reduces the tone of vascular walls.

There are two groups of beta blockers:

• cardioselective - Lokren, Bisoprolol;
  non-selective - Sotalol, Timolol.

Depending on the method of elimination, there are:

1. Lipophilic beta blockers. Dissolves in fat cells and is processed by the liver.
2. Hydrophilic agents. They are not processed by the liver and are excreted from the body in urine.

There are new generation beta blockers. These products are safe and highly effective. These drugs include Nebilet, Concor.

Diuretics

Diuretics (diuretics) help remove excess salt and fluid from the body. Sodium ions are excreted along with the urine, which reduces the pressure in the blood vessels. Diuretics reduce swelling and stress on the heart.

There are several types of diuretic drugs:

1. Thiazide. They have a less pronounced effect. However, when using them, the pressure decreases gradually, which minimizes possible risks. This type of product maintains the required amount of calcium in the body. Thiazide drugs include Dichlorothiazide, Furosemide.
2. Diuretic potassium-sparing drugs. Used in combination with other types of diuretics. They have a more pronounced effect and remove excess salts from the body. This is Veroshpiron, Spironolactone.
3. Loop diuretics. They have the strongest and fastest effect. This type includes Torasemide, Bumetadine.

Calcium channel blockers

Quite often, calcium ion antagonists are used in the fight against hypertensive crisis. Such means include:

• Nifedipine;
• Sakur;
• Amlodipine;
• Verapamil and others.

The action of medications is to block and prevent the penetration of calcium into cells, which helps stabilize pulse and blood pressure and reduce heart rate.

Sleeping pills and sedatives

Drugs for the relief of hypertensive crisis are varied, using sedatives, sedatives and hypnotics. Thanks to these medications, the increased excitation of receptors in the nervous system is inhibited.

This action helps lower blood pressure, normalize the psycho-emotional state, improve the quality of sleep and overall well-being.

Neurotropic medications include Clonidine, Dopegit, Rilmenidine.

Rehabilitation after relief of the crisis

After stopping the crisis, you should be careful about your health. Quite often, after taking medications, blood pressure decreases, but headache, anxiety, and weakness remain. In order not to aggravate the condition or cause a relapse, it is worth taking some preventive measures.

To improve the psycho-emotional state after stopping the crisis, it is recommended to drink herbal teas - mint, chamomile, calendula, thyme.

After stopping the crisis, you should change your diet. You should avoid the following products:

• salt in large quantities;
• spicy, fatty, smoked dishes;
• fatty meats and fish;
• alcoholic drinks, strong coffee, tea, soda;
• rich, sweet pastries;
• fatty dairy and fermented milk products;
• mushrooms, sausages.

You should eat foods with a minimum content of carbohydrates and fats:

• vegetable purees and soups;
• lean varieties of fish and meat;
• whole wheat bread;
• fruits vegetables;
• cereals;
• low-fat dairy products.

It is worth changing your lifestyle - devote enough time to sleep, avoid excessive physical activity. You can take a walk in the fresh air, ride a bike, swim or do yoga.

The main thing is to avoid worries and stressful situations, regularly monitor your blood pressure and take responsibility for your own health.

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• Arrhythmia
• Atherosclerosis
• Varicose veins
• Varicocele
• Haemorrhoids
• Hypertension
• Hypotension
• Diagnostics
• Dystonia
• Stroke
• Heart attack
• Ischemia
• Blood
• Operations
• Heart
• Vessels
• Angina pectoris
• Tachycardia
• Thrombosis and thrombophlebitis

• Heart tea
• Hypertension
• Pressure bracelet
• Normalife
• Allapinin
• Asparkam
• Detralex

Difficulty breathing and rapid heartbeat

• 1 Provoking reasons
• 2 Why are heavy breathing and heart palpitations dangerous?
• 3 Other symptoms
• 4 Diagnostics
• 5 How to treat?
  • 5.1 Symptomatic
  • 5.2 With complex VSD
  • 5.3 For heart pathologies

Many people experienced disturbances in the form of a strong heartbeat and a feeling that it was difficult to breathe. This can happen in absolutely healthy people during severe physical exertion or emotional stress. This condition is the response of the cardiovascular system to various loads. If this condition recurs too often and without significant physical or emotional stress, then it is necessary to undergo a full range of medical examinations so as not to miss the symptoms of a terrible disease.

Provoking reasons

The reasons that cause palpitations and shortness of breath are as follows:

• excessive physical activity;
• severe overexcitation;
• intense emotional situations;
• lack of nutrition;
• endocrine pathologies;
• menopause;
• dehydration;
• CVD diseases;
• uncontrolled use of medications;
• excessive consumption of energy tonics.

Rapid heartbeat and difficulty breathing may be due to intense activity. physical work. The heart rate after intense physical labor quickly returns to normal after a short rest. It becomes difficult to breathe after emotional shock, when the pulse quickens. It is enough to normalize the work and rest schedule, avoid psycho-emotional disorders, and the condition will stabilize.

Rapid heartbeat and difficulty breathing at rest can be caused by:

• heart failure;
• heart attack;
• tachyarrhythmia;
• stroke;
• an attack of bronchial asthma;
• panic attack;
• pregnancy;
• poisoning;
• high blood loss.

In the above situations, you will need the help of a highly qualified doctor or an ambulance call.

Return to contents

What are the dangers of heavy breathing and rapid heartbeat?

Impaired breathing and rapid heartbeat can lead to loss of consciousness.

Rapid heartbeat and heavy breathing may be symptoms of the following conditions:

• heart attack or stroke;
• acute heart failure;
• loss of consciousness;
• thromboembolism;
• pulmonary edema;
• seizures

Return to contents

Other symptoms

A pathological condition can be suspected when tachycardia occurs systematically and without cause. Palpitations syndrome is a side effect of various pathological conditions. Tachycardia is often combined with the following symptoms:

• headache;
• general weakness;
• nausea;
• dyspnea;
• dizziness;
• fainting;
• blood loss.

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Diagnostics

A local therapist will help you find out the reason for your high heart rate and why it’s difficult to breathe. Consultations with narrow specialists and the following types of studies may be prescribed:

• blood and urine tests;
• hormonal tests;
• blood biochemistry;
• immunological indicators;
• radiography;
• Ultrasound diagnostics;
• ECHO monitoring;
• electrophysiological examinations.

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How to treat?

A cool compress will help relieve tension and pain.

Before starting treatment, it is necessary to determine the cause of the discomfort-causing symptoms. At home, you can use the following methods to reduce your heart rate:

• stop physical activities;
• ensure a flow of fresh air into the room;
• apply a cool compress to your forehead;
• calm the patient and give him the opportunity to relax;
• breathe deeply, inhaling quickly and exhaling slowly;
• hold your breath and tense your abdominal muscles;
• take soothing drops (Corvalol containing valerian);
• if the above methods do not lead to improvement, call an ambulance.

Return to contents

Symptomatically

To reduce heart rate, doctors prescribe medications of 2 groups. The medications are taken in a strictly prescribed dosage, determined by the doctor. Short description these medications are given in the table.

Contrary to fairly widespread belief, stroke (from the Latin word insultus - attack), or acute cerebrovascular accident, occurs not only in the elderly, but also in young people and even children. In Russia, stroke affects more than 400 thousand people every year. Almost half of them die within a year, and only about 20% of those sick return to work. This is associated with the development of gross disturbances of speech, movements, sensitivity, coordination, gait and a number of other functions.

There are two types of stroke: ischemic (cerebral infarction) and hemorrhagic (cerebral hemorrhage, as well as subarachnoid hemorrhage). Ischemic stroke usually develops when acute failure blood supply to a region of the brain. Ischemic stroke occurs 4 times more often than hemorrhagic stroke. One of the leading causes of this suffering is heart disease, which impairs its functioning, resulting in impaired blood flow in the arteries and reduced blood supply to the brain.

Blood supply to the brain is carried out through these arteries. Ischemia (blockage) or rupture of a vessel causes functional changes in the area of ​​the brain responsible for a specific function. (Paresis, paralysis, dizziness, speech disorders, etc.)

Another cause of stroke in heart disease is thromboembolism, when clots called thrombi form in the cavities of the heart (most often in heart failure). Pieces come off from them, which are carried through the bloodstream and can clog the blood vessels of the brain. Heart failure is the cause of about a fifth of ischemic strokes, and coronary heart disease doubles the risk of ischemic stroke. Diseases that can lead to the formation of intracardiac blood clots and thromboembolism include myocardial infarction, rheumatism, coronary heart disease, arterial hypertension, etc. Blood clots can form due to cicatricial changes and calcification of the heart valves, and with heart rhythm disturbances (arrhythmias). As a result of these reasons, the heart chambers (atria and ventricles) are not completely freed from blood pushed into large vessels and become overfilled with it, which creates conditions for the formation of blood clots. Atrial fibrillation in chronic coronary heart disease causes about 50% of cases of cardioembolic stroke. In addition, in 10-15% of these patients, so-called “silent” cerebral infarctions are detected, which do not manifest themselves clinically. The risk of stroke also increases with hypertrophy of the left ventricle of the heart - thickening of its wall, which is usually observed with arterial hypertension.

According to the Guidelines for the treatment of arterial hypertension, prepared in 2007 jointly by the European Society of Arterial Hypertension (ESH) and the European Society of Cardiology (ESC), stage I arterial hypertension includes an increase in blood pressure to 140/159/90-99 mm Hg. Art., II degree - up to 160-179/100-109 mm Hg. Art., III degree - from 180/110 mm Hg. Art. and higher.

The prevalence of arterial hypertension is very high. According to a survey of a national representative sample of the Russian population aged 15 years and older, it occurs in 39.2% of men and 41.1% of women. With an increase in systolic (upper) pressure, the mass of the left ventricle of the heart increases (this process is called hypertrophy), which increases the risk of heart failure by 5-8 times, and coronary heart disease and stroke by 5 times. In addition, patients with signs of left ventricular hypertrophy according to ECG data are at 5 times greater risk of death from cardiac arrest. However, if it is possible to reverse the development of left ventricular hypertrophy, then these severe complications of arterial hypertension can be avoided.

The widespread introduction into practice of modern cardiological diagnostic methods (monitoring blood pressure and ECG, echocardiography, coronary angiography, biochemical tests and determination of the rheological properties of blood) has made it possible to verify that a number of serious diseases of the heart and blood vessels long time can be asymptomatic and sometimes, unfortunately, detected only in a hospital, where the patient is admitted with acute cerebrovascular accident or myocardial infarction. For example, coronary heart disease is asymptomatic in 26% of cases, and many patients with arterial hypertension do not even know that they have high blood pressure.

There is no doubt that early and comprehensive treatment of cardiovascular diseases reduces the risk of stroke. To do this, first of all, it is necessary to maintain physical activity, follow a diet in accordance with the recommendations of the attending physician, avoid stressful situations, and give up smoking and alcohol abuse.

For arrhythmias, antiarrhythmics are prescribed, and for bleeding disorders, anticoagulants are prescribed: antiplatelet agents (acetylsalicylic acid, clopidogrel, ticlopidine, dipyridamole) and anticoagulants (warfarin, etc.).

Patients with arterial hypertension must constantly take medications that lower blood pressure, with systematic monitoring of its level, for which it is advisable to have their own device for measuring pressure. Currently, medicine has a large arsenal of antihypertensive drugs, divided according to their mechanism of action into the following groups:
a) diuretics (diuretics): indapamide, clopamide, furosemide, hydrochlorothiazide, triamterene
b) angiotensin-converting enzyme inhibitors: captopril, enalapril, perindopril, fosinopril, lisinopril (Diroton)
c) calcium antagonists: nifedipine, nimodipine, amlodipine (Normodipine)
d) beta blockers: propranolol, atenolol, metoprolol, pindolol, betaxolol
e) alpha blockers: prazosin, doxazosin
e) angiotensin II receptor antagonists: valsartan, losartan, irbesartan
g) combination drugs
h) centrally acting drugs

These medications, especially angiotensin-converting enzyme inhibitors, can also reduce left ventricular hypertrophy. If blood pressure is high, you should not strive to necessarily reduce it to the “norm”: it is enough to achieve a decrease of 10-15% from the initial level. A sharp decrease in blood pressure (by 25-30% of the initial values) with atherosclerotic damage to the vessels of the head, which is detected in 1/3 of patients with arterial hypertension, can worsen the blood supply to the brain. Experts from WHO and the International Society of Hypertension recently proposed recommendations for the treatment of patients with arterial hypertension, which, in their opinion, regardless of the choice of the initial drug, should be based on the following principles.

1. To reduce the possibility of side effects, minimal doses are prescribed. At positive result and the drug is well tolerated, but there is insufficient reduction in blood pressure, increase its dose.

2. To achieve maximum effect To exclude or minimize side effects, use combinations of drugs (a low dose of another is added to a small dose of one), for example:
. diuretic and beta blocker;
. diuretic and angiotensin-converting enzyme inhibitor (or angiotensin II antagonist);
. calcium antagonist and beta blocker;
. alpha-blocker and beta-blocker;
. amlodipine and ACEI.

Cardiac medications are recommended for patients suffering from heart failure.
The progression of atherosclerosis and the risk of stroke and myocardial infarction are reduced when the level of lipids (fat-like substances) in the blood is normalized. In case of atherosclerosis and total cholesterol levels above 240 mg/dl (6.2 mlmol/l), simvastatin, lovastatin, pravastatin, probucol and other lipid-lowering drugs are prescribed to improve lipid metabolism. According to WHO recommendations, they are used if, despite following a strict diet, cholesterol levels remain high for 6 months.

We are by no means powerless in the fight against serious cardiovascular diseases. This is evidenced not only by the experience of foreign scientists, but also by the results of large-scale research conducted in our country. Thus, a preventive program carried out in the 1980s in 23 cities of the USSR under the leadership of the Cardiocenter of the USSR Academy of Medical Sciences turned out to be the most effective in preventing strokes, reducing the incidence by 2 times. A five-year program conducted by the Institute of Neurology of the Russian Academy of Medical Sciences in one of the districts of Moscow made it possible to reduce the incidence of stroke by 57%, and a preventive program at the largest enterprise in the country - the Novolipetsk Metallurgical Plant - reduced the incidence of stroke by 45%.

A Russian proverb says: “Take care of your dress and your health from a young age.” Be more attentive to your well-being, especially if you are over 40. The appearance of pain in the heart area, a feeling of interruptions in its work, headaches, dizziness, noise in the head, decreased memory, performance, pain in the calves when walking - these are serious reasons for contacting to the doctor. The hope for the still prevailing opinion that “maybe everything will go away on its own” will most likely not come true, and then what? Let's go back to the beginning of the article.

Institute of Neurology of the Russian Academy of Medical Sciences.

Heart and brain health are closely linked. Some heart diseases increase the risk of stroke. In turn, stroke is a risk factor for coronary heart disease.

In this article we will talk about how diseases of the cardiovascular system are related to circulatory disorders in the brain, how you can reduce the risks, and what to do if your heart hurts after a stroke or other symptoms occur.

Coronary heart disease and stroke

Coronary heart disease and stroke are to some extent interrelated diseases.

Heart muscle - myocardium– provide oxygen and nutrients coronary, or coronoid, arteries. If blood flow is disrupted for one reason or another, the myocardium experiences oxygen starvation. In the most severe cases, a section of the heart muscle dies - this condition is called myocardial infarction.

The main causes of coronary heart disease (abbreviated as IHD):

• . This is the most common cause of IHD. Atherosclerotic plaques grow inside the coronary arteries, which gradually block their lumen.
• Blood clots. When an atherosclerotic plaque ruptures in a coronary artery, a thrombus can form, which leads to sudden closure of the vessel lumen and often results in a heart attack.
• Spasm of the coronary arteries. This is a rare cause of CAD. There is a layer of muscle in the wall of the arteries. When they contract, the lumen of the vessel narrows and blood flow to the organ decreases.

Most often, coronary heart disease manifests itself in the form of attacks angina pectoris- stabbing, burning pain behind the sternum. They usually last no longer than 5 minutes and are quickly relieved with nitroglycerin.

If the pain is very severe, does not go away for a long time, is accompanied by a strong drop in blood pressure, cold sticky sweat, fear - most likely it is a heart attack.

Sometimes pain occurs in the neck, jaw, or arm. Attacks of IHD can manifest themselves in the form of shortness of breath, rapid heartbeat, sweating, nausea and vomiting, and a feeling of fatigue.

If a person has atherosclerosis in the coronary arteries of the heart, most likely it is also in other vessels. According to the American Heart Association (American Heart Association), the likelihood of stroke with cardiac ischemia (CHD, angina) increases approximately twice.

Coronary heart disease is treated with nitroglycerin (in tablets or spray), antihypertensive drugs, aspirin (to thin the blood and prevent the growth of blood clots), statins (drugs that reduce the level of “bad” cholesterol in the blood).

The doctor may prescribe balloon angioplasty and stenting - endovascular interventions during which the lumen of the vessel is widened using a special balloon inserted inside, and then a stent - a frame with a mesh - is installed into it. It helps prevent artery narrowing.

In case of severe atherosclerosis of the coronary arteries, when there are many affected areas, heart surgery is performed - coronary artery bypass grafting.

Atrial fibrillation and stroke

Atrial fibrillation, or atrial fibrillation, is a condition in which the atria contract very quickly (350–700 beats per minute) and chaotically. It can occur at different intervals in the form of short or long attacks, or persist constantly. Atrial fibrillation increases the risk of stroke and heart failure.

The main causes of atrial fibrillation:

• High blood pressure.
• IHD and myocardial infarction.
• Congenital and acquired heart valve defects.
• Thyroid gland dysfunction.
• Excessive smoking, consumption of caffeine, alcohol.
• Previous heart surgery.
• Severe lung diseases.
• Sleep apnea.

During an attack of atrial fibrillation, there is a feeling that the heart is beating very quickly, “crazy”, “pounding”, “jumping out of the chest”. A person feels weak, tired, dizzy, and has a “fog” in his head. Shortness of breath and chest pain may occur.

Why does the risk of stroke increase with atrial fibrillation? During atrial fibrillation, blood does not move properly in the chambers of the heart. Because of this, a blood clot forms in the heart. A piece of it can come off and migrate with the bloodstream. If it gets into the blood vessels of the brain and blocks the lumen of one of them, a stroke will develop. In addition, atrial fibrillation can lead to heart failure, which is also a risk factor for stroke.

According to experts from the American Mayo Clinic, the relative risk of ischemic stroke in atrial fibrillation varies, it increases with age, and if a person has other risk factors.

Stroke Risk Score for Atrial Fibrillation

There is a special CHADS2 scale for assessing the risk of stroke in atrial fibrillation. In it, each risk factor has a certain score. The total score determines the likelihood of a brain stroke in the near future:

Prevention of stroke in atrial fibrillation

The main measure to prevent recurrent stroke in atrial fibrillation is taking anticoagulants, medicines that prevent the formation of blood clots:

• Warfarin, aka Jantoven, aka Coumadin. This is a fairly strong anticoagulant. It can cause severe bleeding, so it must be taken strictly in accordance with the doctor's recommendations and have regular blood tests to monitor it.
• Dabigatran etexilate, aka Pradaxa. Its effectiveness is comparable to warfarin, but it is safer.
• Rivaroxaban, aka Xarelto. Like Pradaxa, it belongs to the new generation of drugs. It is also not inferior in effectiveness to Warfarin. Take it once a day, strictly in accordance with the doctor's prescription.
• Apixaban, aka Eliquis. Also applies to new generation drugs. Taken 2 times a day.

Atrial fibrillation after stroke

Atrial fibrillation and stroke share common risk factors: high blood pressure, coronary artery disease, bad habits etc. Therefore, after a stroke, atrial fibrillation may well develop, and it will increase the risk of a second brain stroke. Therefore, in such cases, proper treatment, prevention and rehabilitation are especially important. This helps improve the prognosis for stroke and atrial fibrillation.

Stroke after heart surgery

Stroke is a fairly common complication after cardiology surgery. According to various sources, the risks range from 1.7 to 5%, and, first of all, they are increased in older people who already have cerebrovascular pathologies. In approximately 60% of cases, stroke symptoms occur immediately after surgery. The most dangerous in this regard are surgical interventions on heart valves (the risk is up to 16%, while with coronary artery bypass surgery - up to 5%).

Three factors are believed to play a role in the occurrence of ischemic stroke after heart surgery:

• Microemboli- pieces of blood clots that break off and migrate into the brain vessels during surgery.
• Hypoperfusion– insufficient blood flow to brain tissue during surgery.
• Atrial fibrillation, which sometimes occurs in the postoperative period.

The surgeon must identify patients who are at high risk, show increased attention to them, and carry out preventive measures.

Heart failure and stroke

Heart failure is a condition in which the heart muscle cannot properly cope with its function of pumping blood. According to statistics, 10-24% of patients who have had a stroke previously suffered from heart failure. In people with heart failure, the risk of stroke and heart attack is approximately 5 times increased, in 9% of cases the heart disorder is considered as probable cause stroke.

Often we are talking about. Due to the fact that the heart cannot cope with its work, blood stagnates in its chambers, which contributes to the formation of a blood clot. A piece of blood clot (embolus) can break off and migrate into the vessels of the brain.

There are two types of heart failure:

• Acute. It develops very quickly, the patient’s condition deteriorates greatly, and his life is threatened. Acute heart failure and stroke are equally dangerous conditions that can lead to death.
• Chronic. Disturbances and symptoms increase gradually.

Heart failure after stroke

Patients who have had a stroke often develop congestive heart failure and other heart problems. The reasons for these violations:

• Stroke and cardiovascular disease have some common risk factors: high blood pressure, diabetes, atherosclerosis, arrhythmias.
• After a stroke, brain tissue can release substances into the bloodstream that negatively affect the functioning of the heart.
• During a stroke, direct damage to the nerve centers that affect heart contractions can occur. When the right hemisphere of the brain is damaged, heart rhythm disturbances are often observed.

The main symptoms of heart failure after a stroke: shortness of breath (including at rest), weakness, dizziness, swelling in the legs, in severe cases - abdominal enlargement (due to the accumulation of fluid - ascites).

Consequences of heart failure after stroke

Congestive heart failure is a progressive pathology. Periodically, the patient’s condition stabilizes, then a new exacerbation occurs. The course of the disease is very variable among different people and may depend on various factors. In order to assess the degree of cardiac dysfunction, there are four classes of heart failure:

• Class I: heart function is impaired, but is not accompanied by symptoms or decreased quality of life.
• Class II: symptoms occur only during intense exercise.
• Class III: Symptoms occur during daily activities.
• Class IV: severe symptoms occur at rest.

Heart failure after stroke significantly increases the risk of arrhythmia. While 50% of patients eventually die due to progression of heart failure itself, the remaining 50% die due to abnormal heart rhythms. The use of implantable cardioverter defibrillators helps improve survival.

First aid for acute heart failure and stroke

It is important for every person to be able to correctly provide primary care for acute heart failure and stroke - sometimes this helps save lives. Acute heart failure most often develops at night. A person wakes up from the feeling of lack of air, suffocation. Shortness of breath and cough occur, during which thick, viscous sputum is released, sometimes mixed with blood. Breathing becomes noisy and bubbling. All these symptoms increase very quickly. At the first sign of a heart attack or stroke, you need to act immediately:

• Call an ambulance.
• Lay the patient down, give him a semi-sitting position.
• Provide an influx of fresh air into the room: open the window, door. If the patient is wearing a shirt, unbutton it.
• Spray the patient's face with cold water.
• If the patient has lost consciousness, place him on his side and check his breathing and pulse.
• If the patient is not breathing, his heart is not beating, chest compressions and artificial respiration must be started.

Stroke due to heart disease

There are different types of congenital heart defects. Some of them are life-threatening immediately after birth, while the symptoms of others appear for the first time only in adulthood. A 2015 study found that people who were born with a heart defect have an increased risk of stroke. Scientists came to this conclusion after analyzing data from 29,638 patients aged 18–64 years who had some type of heart abnormality.

• The incidence of ischemic strokes in people with congenital defects was increased by 9–12 times at the age of up to 55 years and by 2–4 times at the age of 55–64 years.
• Frequency hemorrhagic strokes in people with congenital defects it was increased by 5–6 times at the age of up to 55 years and by 2–3 times at the age of 55–64 years.
• 8.9% of men and 6.8% of women with congenital heart disease had at least one stroke before age 65.

The strongest effects in people with congenital heart abnormalities were: heart failure, diabetes mellitus, and recent heart attacks.

People who were born with heart abnormalities are at increased risk. They should visit cardiologists more often and undergo examinations.