| disease | Cardiac Dysfunction |
| alias | Post-burn Cardiac Complications |
Cardiac complications after burns are associated with shock, stress, electrolyte imbalances, and invasive infections. Common conditions include arrhythmias, heart failure, myocardial infarction, and myocarditis. Arrhythmias encompass sinus tachycardia, paroxysmal supraventricular tachycardia, ventricular tachycardia, sinus bradycardia, and atrial fibrillation, with sinus tachycardia being the most prevalent.
bubble_chart Etiology
1. Sinus tachycardia
(1) Stress response: Pain after burns, shock, infection, surgery, and other stimuli cause sustained elevation of catecholamines, increasing myocardial irritability.
(2) Myocardial ischemia and hypoxia: Inappropriate fluid resuscitation during the shock phase, insufficient blood volume, decreased cardiac output, and inadequate coronary blood supply can lead to myocardial ischemia and hypoxia. Severe inhalation injuries and respiratory infections can also cause myocardial ischemia and hypoxia.
(3) Water, electrolyte, and acid-base imbalances: Such as dehydration, fluid overload, hypokalemia, hypomagnesemia, and alkalosis.
(4) Invasive infections: During sepsis, the heart rate can reach 140 beats per minute, with electrocardiogram indicating sinus tachycardia.
(5) Others: Causes such as carbon monoxide poisoning, uremia, high fever, and anemia.
2. Heart failure
(1) Shock: Severe burns cause capillary dilation, increased permeability, massive fluid leakage, and reduced cardiac output, leading to poor peripheral circulation perfusion.
(2) Infection: In severe burns, bacteria and their toxins interact with tissues to produce kinins, reducing opsonin C2 glycoprotein and impairing the ability to maintain microvascular integrity, permeability, and repair, severely affecting heart function.
(3) Others: Conditions such as inhalation injuries, pneumonia, excessive fluid infusion, and acidosis can also cause heart failure.1. Sinus tachycardia
The diagnosis of sinus tachycardia mainly relies on heart rate and electrocardiogram (EKG). In adults, the heart rate exceeds 100 beats per minute. EKG examination shows a P wave frequency of more than 100 beats per minute, with the P wave often blending with the T wave, followed by a QRS wave after the P wave. Patients often exhibit symptoms of flusteredness and discomfort in the precordial area.
2. Heart failure
Grade I: Poor peripheral circulation perfusion, hypotension, systolic blood pressure below 10.7 kPa lasting for more than one hour.
Grade II: Congestive heart failure occurs, manifested as paroxysmal nocturnal dyspnea, jugular vein distension; rales at the base of both lungs; cardiomegaly; acute pulmonary edema; gallop rhythm of the first heart sound and increased venous pressure.
bubble_chart Treatment Measures
1、Sinus tachycardia
⑴ Disease cause Treatment: Actively treat shock, control infection, improve effective blood volume, reduce cardiac load, and maintain water and electrolyte balance.
⑵ In cases of severe burns, the heart rate may reach around 120 beats per minute. If there is no palpitation or change in heart sounds, no treatment is necessary.
⑶ If the heart rate reaches 140 beats per minute or cardiac output decreases (weak heart sounds, narrow pulse pressure), sedatives, β-blockers (e.g., propranolol 2.5–5mg added to 5% GS 1000ml for intravenous drip), or cedilanid may be used.
2、Heart failure
⑴ Maintain effective blood volume Monitor various indicators of the patient's circulatory system, including continuous measurement of central venous pressure (CVP) and pulmonary artery wedge pressure (PWP), heart rate, and peripheral stirred pulse pressure. A decrease in CVP indicates hypovolemia, requiring supplementation with crystalloid and colloid solutions, and whole blood if necessary.
⑶ Reduce cardiac load Commonly used diuretics include furosemide, and vasodilators such as sodium nitroprusside.
⑷ Administer glucose-insulin-potassium (GIK) to provide energy to the myocardium.
