Clinical features

The patients complain on the heaviness in right hypochondrium, thirst, loss of appetite, nausea, vomiting, and edema at the low extremities.

Objective examination. In patient there is a clinical sign of main pathology causing the heart failure. The features of congestion in greater circulation: swallowing of the neck veins, pulsation of the vena jugulars, and edema of the legs. Edema initially arises in the evening on feet, has ascending character and overspread on the subcutaneous tissue the whole body - anasarca.

Prolonged edema is accompanied by throphic skin disorders with redness, pigmentation and local ulcers.

The skin color is slightly yellow as a result of liver hypoxia and dysfunction.

Objective examination of the respiratory system may reveal the signs of main process. Due to the hydrothorax dullness and pathologically decreased or even absence of vesicular breathing are determined over one or both lungs.

Objective examination of the cardiovascular system. Cardiac beat and epigastric pulsation, which increased in deep inspiration, are determined. These signs are explained by hypertrophy and dilation of the right ventricle. The right border of the relative cardiac dullness displaced to the right. The heart sounds are decreased at the apex. Second sound over the pulmonary artery is accentuated.

Pulse is frequent. The change of blood pressure depends on main process.

In palpation of abdomen enlarged liver is revealed. In initial stage of chronic right ventricular heart failure liver is soft, with sharp edge, its surface is smooth, and with progression of heart failure liver becomes greater size, with high density. Prolonged venous congestion in greater circulation leads to development of ascites. Congestive kidneys are characterized by oliguria.

Additional methods of examination

Clinical blood analysis is without specific changes.

Clinical urine analysis: oliguria in edematous phase, proteinuria, cylindruria.

ECG - hypertrophy of right ventricle, right bundle branch block.

X-ray examination reveals the features of main process.

Echocardiography- hypertrophy of right ventricle.

Syndrome of vascular failure

Vascular failure is the pathological condition caused by decreasing of the vascular tone and diminishing of the volume circulating blood. Vascular failure includes: syncope, collapse, shock.

Syndrome of a syncope

Syncope - is a sudden transient loss of consciousness with rapid recovery not requiring electrical or chemical cardioversion.

Classification

Classification of syncope due to the etiology:

• neurally mediated syncopal syndromes vasovagal (carotid sinus, situational);

• orthostatic;

• cardiac arrhythmias as primary cause (bradycardia, tachycardia);

• structural cardiac or cardiopulmonary disease (acute myocardial infarction/ischemia, aortic dissection, pulmonary embolus).

The underlying mechanism of pathogenesis is a relatively abrupt cerebral hypoperfusion.

Clinical features

Presyncope is characterized by weakness, nausea, darkening in the eyes, noise in the ears. Syncope is characterized by loss of consciousness.

Objective examination. The person has a pallid skin, cold sweat, cold limbs, pupils are narrow, its reaction to light is present, pulse is thread, and arterial pressure is decreased.

Initial evaluation may lead to a certain diagnosis based on symptoms, signs or ECG finding. This applies to the following cases:

vasovagal syncope is diagnosed if precipitating events such as fear, severe pain, emotional distress, instrumentation or prolonged standing are associated with typical prodromal symptoms;

situational syncope is diagnosed if syncope occurs during or immediately after urination, defecation, cough or swallowing;

orthostatic syncope is diagnosed when there is a documentation of orthostatic hypotension (decrease of SBP >20 mmHg or to <90 mmHg) associated with syncope or pre-syncope;

syncope due to cardiac ischemia is diagnosed when symptoms are present with ECG evidence of acute ischemia with or without myocardial infarction;

syncope due to cardiac arrhythmia is diagnosed by ECG when there is:

• sinus bradycardia <40 beats/min or sinoatrial blocks or sinus pauses >3 s;

• atrioventricular block (2nd degree Mobitz's II or 3rd degree atrioventricular block);

• alternating left and right bundle branch block;

• rapid paroxysmal supraventricular tachycardia or ventricular tachycardia;

• pacemaker malfunction with cardiac pauses.