The cause of disease
Due to cardiac dysfunction, the function declines, and the venous return blood volume cannot be completely discharged from the heart.
Most patients have a history of heart disease. Coronary heart disease, hypertension and senile degenerative valvular heart disease are the main causes of heart failure in the elderly, while rheumatic valvular heart disease, dilated cardiomyopathy and acute severe myocarditis are the main causes of heart failure in young people. The common disease of systolic heart failure is coronary heart disease, and active reconstruction of blood supply can prevent the development and deterioration of heart failure. Diastolic (or normal ejection fraction) heart failure is a common disease. Because of high blood pressure, controlling blood pressure is extremely important. Otherwise, the rapid progress of heart failure can also induce acute heart failure.
classify
First of all, according to cardiac circulatory disorder syndrome,
According to the different periods and degrees of cardiac circulatory disorder syndrome, heart failure can be divided into the following two types:
1, obvious heart failure, due to cardiac dysfunction, decreased function, venous return blood can not be completely discharged from the heart, leading to obvious signs of congestion in the venous system. We call these symptoms overt heart failure. If there is no sign of congestion in the venous system, the diagnosis of heart failure is difficult to determine. This obvious heart failure is also called congestive heart failure.
2. Recessive heart failure is actually the prophase of overt heart failure. Before the signs of venous congestion appeared, the pressure in the heart cavity was already rising. If the right ventricular end-diastolic pressure is greater than10mmhg, it is right heart failure. If the left ventricular end-diastolic pressure is greater than 20 mm Hg, it is left heart failure. The increase of heart pressure is several hours to more than ten hours earlier than the signs of venous congestion. There is no sign of venous congestion at this stage, but the heart pressure increases, which is called recessive heart failure.
Second, according to the acute and slow onset of the disease
Heart failure is divided into the following two types according to the acute and slow onset:
1, chronic heart failure Chronic heart failure (CHF) refers to the continuous state of heart failure, which can be stable, worsening or decompensated.
2. Acute heart failure Acute heart failure (AHF) refers to the clinical syndrome of acute pulmonary congestion, pulmonary edema with insufficient perfusion of tissues and organs and cardiogenic shock caused by acute attack or aggravation of left ventricular insufficiency, which leads to a sharp decline in acute cardiac output, an increase in pulmonary circulation pressure and an increase in peripheral circulation resistance. Left heart failure is the most common.
clinical picture
I. Chronic heart failure
1. Symptoms caused by decreased exercise endurance Most patients with heart failure seek medical treatment for dyspnea or fatigue caused by decreased exercise endurance. These symptoms may appear during rest or exercise. The same patient may have multiple diseases, and it is difficult to explain the exact reason for the decline in exercise tolerance.
2. Symptoms caused by fluid retention Patients may have abdominal or leg edema, which is the main or only symptom for medical treatment. Exercise tolerance injury occurs gradually, and it may not attract the attention of patients unless they are carefully asked about the changes in their daily living ability.
3. Patients with asymptomatic or other symptoms caused by heart disease or non-heart disease may find heart enlargement or cardiac insufficiency when examining other diseases (such as acute myocardial infarction, arrhythmia or pulmonary or somatic thromboembolic diseases).
Second, acute heart failure.
1, history and manifestations Most patients have a history of heart disease, and coronary heart disease, hypertension and senile degenerative valvular disease are the main causes of the elderly; Rheumatic valvular heart disease, dilated cardiomyopathy and acute severe myocarditis are often the main causes of young people.
2. Common inducing factors include poor compliance with chronic heart failure treatment, cardiac overload, serious infection, severe brain injury or severe mental tension and fluctuation, after major surgery, renal insufficiency, acute arrhythmia, bronchial asthma attack, pulmonary embolism, high cardiac output syndrome, application of negative inotropic drugs, application of non-steroidal anti-inflammatory drugs, myocardial ischemia, acute diastolic dysfunction in the elderly, drug abuse, alcoholism, pheochromocytoma, etc.
3. The early signs of left ventricular dysfunction are fatigue, and the exercise endurance is obviously decreased. The heart rate of patients with normal cardiac function increases to 65,438 0.5 ~ 20 beats/min, followed by fatigue dyspnea, paroxysmal dyspnea at night and high pillow sleep. Left ventricular enlargement, early or middle diastolic rhythm, wet rales, dry rales and wheezing can be seen at the bottom of both lungs, suggesting that left ventricular dysfunction has occurred.
4, acute pulmonary edema onset is urgent, the condition can rapidly develop to a critical state. Sudden severe dyspnea, sitting breathing, wheezing, irritability and fear, the breathing frequency can reach 30 ~ 50 times/minute; Cough frequently and have a lot of pink foam-like sputum; The heart rate is fast, and the rhythm of running horses can often be heard at the apex; Both lungs are full of wet rales and wheezing.
5. Cardiogenic shock
When the hypotension lasts for more than 30 minutes, the systolic blood pressure drops below 90mmHg, or the systolic blood pressure drops ≥60mmHg in patients with essential hypertension.
Tissue hypoperfusion: the skin is wet, cold, pale and cyanotic with purple stripes; Tachycardia >: 1 10 beats per minute; Urine volume decreased significantly (
Hemodynamic disorder PCWP≥ 18mmHg, cardiac ejection index (CI)≤36.7ml/s.m2(≤2.2L/min.m2).
Metabolic acidosis and hypoxemia
In recent years, the theory of collateral diseases in traditional Chinese medicine has made great achievements in the treatment of cardiovascular and cerebrovascular diseases. Tongluo Chinese medicine has four advantages in treating heart failure, which can treat both the symptoms and root causes, effectively relieve the symptoms of heart failure, improve the long-term prognosis of patients with heart failure and alleviate their pain.
Understanding of heart failure in traditional Chinese medicine
On the surface, heart failure is the dysfunction of cardiac contraction and relaxation after myocardial injury, which leads to the decrease of cardiac output and edema and blood stasis in patients. In fact, the root of heart failure lies in the overactivation of neuroendocrine and ventricular remodeling. In recent years, with the in-depth study of heart failure, modern medicine has realized that ventricular remodeling is the basic mechanism of the occurrence and development of heart failure, and excessive activation of neuroendocrine will accelerate the process of heart failure, which has long been recognized by Chinese medicine.
According to the collateral disease theory of traditional Chinese medicine, the occurrence of heart failure is mainly due to the deficiency of both qi and yang and the inability to transport blood. When the heart qi is insufficient, the heart will contract, so that the blood in the vein cannot run smoothly. Body fluids either seep out of the vein and become edema, or stay in the vein and become blood stasis. After a long time, collaterals will accumulate, and pathological products such as blood stasis and edema will be cemented together, leading to heart deformation, further affecting the operation of yang and blood, leading to heart failure. Therefore, the application of collateral disease theory in the treatment of heart failure mainly focuses on warming yang and nourishing yin, supplemented by drugs that promote blood circulation, dredge collaterals and induce diuresis to reduce swelling, which means that drugs such as Qiliqiangxin capsule have four advantages in treating chronic heart failure.
Syndrome differentiation and treatment of TCM
1, heart-lung qi deficiency syndrome
Symptoms: palpitation, shortness of breath, weakness of limbs, increased activity, fatigue and cough, pale face, pale tongue or marginal teeth marks, and heavy or weak pulse.
Treatment: tonifying the heart and lungs.
Prescription: Yixin decoction. Radix Codonopsis 30g, Atractylodis Rhizoma 12g, Poria 15g, Radix Astragali 30g, Ganoderma lucidum 12g, Radix Salviae Miltiorrhizae 20g, Lily 12g, Ginkgo biloba 12g, Radix Platycodi 12g, Fructus Trichosanthis.
2. Deficiency of both Qi and Yin
Symptoms: palpitation, shortness of breath, fatigue, sweating when moving, spontaneous sweating or night sweats, dizziness, upset, dry mouth, dark red face and cheekbones, red tongue with little fur, weak or stagnant pulse.
Treatment: supplementing qi and nourishing yin.
Prescription: Shengmai Decoction. Ginseng 10g, Ophiopogon japonicus 12g, Schisandra chinensis 15g, Adenophora adenophora 12g, lentils 12g, Poria 15g, Alisma orientalis 12g, and Lycopi/kloc.
3. Heart-kidney yang deficiency syndrome
Symptoms: palpitation, shortness of breath, fatigue, wheezing when moving, cold body and limbs, scanty urine and edema, abdominal distension and loose stool, red face and dark cheekbones, red tongue with little coating, rapid pulse or stagnation.
Treatment: Warming the heart and tonifying the kidney.
Prescription: Buyang Decoction. Aconite 10g, cinnamon 10g, Evodia rutaecarpa 10g, dried ginger 12g, turmeric 12g, ginseng 10g, Atractylodes macrocephala 12g, Poria/.
4. Qi deficiency and blood stasis syndrome
Symptoms: palpitation, shortness of breath, chest and hypochondriac pain, neck blue veins exposed, hypochondriac swelling, lower limb edema, pale and blue face; The lips are blue, the tongue is purple and dark, or there are petechiae and ecchymosis, and the pulse is astringent or knotted.
Treatment: Yiqi Huoxue.
Prescription: Yiqi Huoxue Decoction. Codonopsis pilosula 30g, Atractylodes macrocephala 15g, Poria cocos 15g, Astragalus membranaceus 30g, Ganoderma lucidum 12g, Curcuma longa 12g, Lotus Seed 12g, Salvia miltiorrhiza 30g, Eupatorium adenophorum 12g and Gan Song/kloc-2g.
5, Yang deficiency and water flooding syndrome
Symptoms: palpitation, shortness of breath, inability to lie flat, frothy expectoration, edema of face and limbs, chills in limbs, irritability and sweating, gray forehead, cyanosis of mouth and lips, short and red urine, abdominal distension, or accompanied by pleural effusion, pale or dark red tongue, white and slippery tongue coating and rapid pulse.
Treatment: warming yang and promoting diuresis.
Prescription: Wenyang Decoction. Aconitum carmichaeli 12g, Cinnamomum cassia 12g, Ginseng 12g, Atractylodes macrocephala 15g, Poria cocos 15g, Polyporus umbellatus 15g, Alisma orientalis 12g, and wax gourd peel/.
6. Phlegm syndrome
Symptoms: palpitation, shortness of breath, cough, shortness of breath, inability to lie down, white or thick phlegm, chest tightness, dizziness, less edema in urine, or phlegm, or fever and thirst, white or yellow tongue coating, and slippery or slippery pulse.
Treatment: clearing lung and resolving phlegm.
Prescription: Xie Fei soup. Lepidium 12g, Perilla 12g, Mulberry 12g, Wax gourd 15g, Lycium barbarum 12g, Platycodon grandiflorum 15g, and white mustard seed. 3g of Asarum, 0/2g of Pinellia ternata/kloc-,0/5g of Fritillaria thunbergii/kloc-,0/0g of roasted ephedra/kloc-,6g of licorice, decocted in water.
(Chief Physician, Professor: Cao Yuancheng, Zibo Hospital of Traditional Chinese Medicine)