Decompensation of the cardiovascular diseases

✅ Decompensation of the cardiovascular diseases

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Decompensation of the cardiovascular system: pathophysiology and clinical implications The decompensation of cardiovascular disease no longer constitutes a critical condition in which the heart is able to provide adequate blood to the body to meet its metabolic needs. This process often occurs in patients with pre-existing congestive heart failure, but can also occur in other cardiovascular diseases, such as hypertensive heart disease, cardiomyopathy, or valvular heart disease. Pathophysiological Mechanisms The main cause of the decompensation is located in a decrease in the systolic or diastolic function of the heart. In the case of systolic dysfunction of the left ventricle loses its ability to pump efficiently, which leads to a decrease in Cardiac output. In the case of diastolic dysfunction, however, can not relax, the ventricles adequate and complete, allowing the blood to flow to the heart is impeded. As a response to decreased cardiac output, the body activates compensatory mechanisms: Activation of the sympathetic nervous system, which leads to an increase in heart rate and vasoconstriction; Activation of the Renin‑Angiotensin‑aldosterone system (RAAS), which leads to Retention of water and sodium in the body and the blood volume increases; Myocardial hypertrophy as an attempt to increase the Capacity of the heart. In the long term, these mechanisms lead to a deterioration of the cardiac function, and of encouraging the development of a decompensation. Clinical Symptoms The clinical signs of decompensation are varied and can include the following symptoms: Shortness of breath, especially during physical exercise or at rest (orthopnea); Paroxysmal nocturnal dyspnea; Edema of the lower extremities; Fatigue and decrease the load-carrying capacity; Tachycardia; Increased Jugular Vein Pressure; Rattling in the lungs as a sign of pulmonary congestion. Diagnostics The diagnosis of decompensation is multimodal: History and physical examination. Laboratory parameters: in particular, the level of BNP (B‑typical Natriuretic peptide) and NT‑proBNP is increased in heart failure. Echocardiography for the assessment of ventricular function and structure of the heart. Chest x‑ray for the detection of pulmonary congestion, or pleural effusion. Electrocardiogram (ECG) to the exclusion of the diagnosis of acute coronary events. Therapeutic Approaches The goal of treatment in the case of a decompensation is the stabilization of the hemodynamic status and the reduction of the symptoms. The therapy may include the following measures: Diuretics to reduce Edema and fluid retention. Vasodilators (e.g., nitrates) for the reduction of vascular resistance. Inotropa (e.g., dobutamine) in the case of severe systolic dysfunction. Optimization of the antagonists, long‑term medication: ACE inhibitors, beta-blockers, mineralocorticoid receptor. In the case of need for mechanical support systems, or heart transplant. Forecast and prevention The prognosis in the case of a failure depends on the underlying disease, the date of diagnosis and the effectiveness of the therapy. Early treatment and stringent aftercare can slow down the progression of the disease. Preventive measures include regular monitoring of the blood pressure, the treatment of risk factors (Diabetes, hyperlipidemia) and the adherence to a low-salt diet. Would you like me to make a certain section in more detail, or to add more information about an aspect?

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