Clinical manifestations of decompensated heart failure

Model:Heart Model withThree Valves

Acute heart failure (AHF), also known as acute decompensated heart failure (ADHF), is a clinical syndrome characterized by acute onset and/or exacerbation due to various causes. Symptoms and signs rapidly occur or worsen, accompanied by a significant rise in plasma levels of natriuretic peptides. It is classified into acute de novo or decompensated chronic heart failure, representing a severe critical condition where the timeliness and appropriateness of rescue efforts are closely linked to prognosis. Past data indicates a 3% in-hospital mortality rate for AHF patients, a 50% readmission rate within six months, and a 60% mortality rate over five years, significantly threatening patients' life safety and quality of life. Heart failure signifies the progression of cardiovascular disease to a severe stage where there is diminished myocardial contractility or diastolic dysfunction, resulting in reduced cardiac output and/or inadequate venous return, leading to circulatory failure. This is primarily evidenced by symptoms such as dyspnea, fatigue, and peripheral edema due to fluid retention.

Common causes of heart failure include myocardial damage and increased cardiac workload. Myocardial damage encompasses primary and secondary causes, such as ischemic cardiomyopathy from conditions like coronary artery disease and myocardial infarction, dilated cardiomyopathy, myocarditis, hypertrophic cardiomyopathy, and congenital cardiomyopathies, all culminating in heart failure. Secondary myocardial damage involves endocrine-induced myocardial damage, seen in conditions like thyrotoxic cardiomyopathy and diabetic cardiomyopathy, as well as other factors like high-output states such as anemia, which can precipitate heart failure and lead to acute respiratory distress, systemic fatigue, cardiac arrest, or life-threatening conditions.

Clinical Manifestations of Acute Heart Failure

The earliest indicators of an AHF episode in patients with previously normal cardiac function include unexplained fatigue, chronic reduction in exercise tolerance, and an increase in heart rate by 15-20 beats per minute. Major clinical presentations include: 1) Dyspnea, which can be exertional, paroxysmal nocturnal, or orthopnea; 2) Cardiomegaly; 3) Early diastolic gallop rhythm; 4) Accentuated P2 heart sound; 5) Crackles in the lungs; and 6) Signs of systemic congestion.

In clinical settings, AHF can present as acute left heart failure, pulmonary edema, or cardiogenic shock.

Acute Pulmonary Edema

Sudden severe shortness of breath, orthopnea; 2) Marked increase in respiratory rate to 30-50 breaths per minute; 3) Anxiety, impending sense of doom, profuse sweating; 4) Coughing, pink frothy sputum; 5) Tachycardia, gallop rhythm; 6) Auscultation of wet crackles and wheezing in the lungs.

Cardiogenic Shock

In the presence of adequate blood volume, when systolic blood pressure is <90 mmHg for more than 30 minutes, or if under the maintenance of vasoactive drugs systolic blood pressure remains difficult to sustain at 90 mmHg, with evidence of peripheral tissue hypoperfusion showing cold, clammy extremities, altered consciousness, urine output <0.5 ml/(kg·h), blood lactate >2 mmol/L, metabolic acidosis (pH<7.35), invasive hemodynamic monitoring indicating pulmonary capillary wedge pressure (PCWP) >18 mmHg, and cardiac index (CI) <2.2 L/(min·m2).

The heart model with three valves is a sophisticated and anatomically accurate representation of the human heart, specifically designed to mimic the functionality of the heart's valves. This model typically includes the mitral valve, tricuspid valve, and aortic valve, crucial components that regulate blood flow within the heart chambers. Each valve plays a vital role in ensuring proper circulation by opening and closing at specific times to maintain unidirectional blood flow. Such a detailed model provides a valuable tool for medical professionals, students, and researchers to study the intricate workings of the heart's valve system in a hands-on and visual manner.

Utilizing the heart model with three valves in medical simulations offers a dynamic platform to simulate various heart conditions and diseases, aiding in the understanding and treatment of cardiovascular ailments. Medical practitioners can utilize this model to simulate scenarios such as valve stenosis, regurgitation, or prolapse, allowing them to visually demonstrate the effects of these conditions on blood flow and cardiac function.