The development of acute heart failure is often observed against the background of myocardial infarction, acute myocarditis, severe arrhythmias (ventricular fibrillation, paroxysmal tachycardia, etc.). In this case, a sharp drop in the minute release and blood flow into the arterial system occurs. Acute heart failure is clinically similar to acute vascular failure and is sometimes referred to as acute cardiac collapse.
In chronic heart failure, the changes developing in the heart are compensated for a long time by its intensive work and adaptive mechanisms of the vascular system: an increase in the force of contractions of the heart, an increase in rhythm, a decrease in pressure in the diastole due to the expansion of capillaries and arterioles, facilitating the emptying of the heart during systole, and an increase in perfusion tissues.
A further increase in the phenomena of heart failure is characterized by a decrease in the volume of cardiac output, an increase in the residual amount of blood in the ventricles, their overflow during diastole, and overstretching of the myocardial muscle fibers. Constant overstrain of the myocardium, trying to push blood into the vascular bed and maintain blood circulation, causes its compensatory hypertrophy.
At this stage, neurohumoral mechanisms are included in the pathological process. Activation of the mechanisms of the sympathetic-adrenal system causes vasoconstriction on the periphery, which helps to maintain stable blood pressure in the mainstream of a large circle of blood circulation with a decrease in cardiac output. Renal vasoconstriction that develops with this leads to renal ischemia, which contributes to interstitial fluid retention.
Increased pituitary secretion of antidiuretic hormone increases the processes of water reabsorption, which entails an increase in the volume of circulating blood, an increase in capillary and venous pressure, and increased transudation of fluid in the tissue.
T.O., severe heart failure leads to gross hemodynamic disorders in the body:
When the blood flow slows down, tissue uptake of oxygen from the capillaries increases from 30% normal to 60-70%. The arteriovenous difference in blood oxygen saturation increases, which leads to the development of acidosis. The accumulation of under-oxidized metabolites in the blood and the increase in the work of the respiratory muscles cause activation of the main metabolism.
A vicious circle arises: the body experiences an increased need for oxygen, and the circulatory system is unable to satisfy it. The development of the so-called oxygen debt leads to the appearance of cyanosis and shortness of breath. Cyanosis in heart failure can be central (with congestion in the pulmonary circulation and impaired blood oxygenation) and peripheral (with slower blood flow and increased oxygen utilization in tissues).
Edema develops as a result of a number of factors: interstitial fluid retention with increasing capillary pressure and slowing blood flow; delays in water and sodium in violation of water-salt metabolism; violation of oncotic blood plasma pressure in the disorder of protein metabolism; decrease inactivation of aldosterone and antidiuretic hormone with a decrease in liver function.
Edema in heart failure is initially hidden, expressed by a rapid increase in body weight and a decrease in the amount of urine. The appearance of visible edema begins with the lower extremities if the patient is walking, or from the sacrum if the patient is lying. In the future, abdominal dropsy develops: ascites (abdominal cavity), hydrothorax (pleural cavity), hydropericardium (pericardial cavity).
Congestion in the lungs is associated with impaired hemodynamics of the pulmonary circulation. They are characterized by stiffness of the lungs, a decrease in the respiratory excursion of the chest, limited mobility of the pulmonary edges. It manifests itself as congestive bronchitis, cardiogenic pneumosclerosis, hemoptysis. Congestive events of a large circle of blood circulation cause hepatomegaly, which is manifested by heaviness and pain in the right hypochondrium, and then cardiac fibrosis of the liver with the development of connective tissue in it.
The expansion of the cavities of the ventricles and atria in heart failure can lead to relative insufficiency of the atrioventricular valves, which is manifested by swelling of the veins of the neck, tachycardia, and expansion of the borders of the heart. With the development of congestive gastritis, nausea, loss of appetite, vomiting, a tendency to constipation, flatulence, loss of body weight appear. With progressive heart failure, a severe degree of exhaustion develops – cardiac cachexia.
Stagnant processes in the kidneys cause oliguria, an increase in the relative density of urine, proteinuria, hematuria, and cylindruria. Violation of the functions of the central nervous system in heart failure is characterized by rapid fatigue, decreased mental and physical activity, increased irritability, sleep disturbance, and depressive states.
- Causes of Vascular Failure
- By origin
- Forms and stages of heart failure and their symptoms
- How fast is the problem developing
- Chronic heart failure: symptoms and diagnosis
- I stage
- II A stage
- II B stage
- III stage
- Diagnosis of chronic heart failure
- Treating Chronic Heart Failure
- ACE Inhibitors
- Heart medications
- Patient training
- Cost of medicines
- Oat broth
- Hawthorn fruit
- Aldosterone receptor antagonists
- Hawthorn fruit
- Complications of heart failure and treatment methods
- Prognosis and prevention of heart failure
- Prognosis and prevention of heart failure
Causes of Vascular Failure
The pathogenesis of chronic heart failure can be associated with various factors, but, as a rule, the onset of the disease is the outcome of progressive heart diseases. Sometimes the appearance of pathology is caused by febrile conditions, metabolic disturbances, alcoholism, thyroid diseases, anemia. The most common causes of heart failure:
- heart rhythm failure with developing arrhythmia;
- overload of the heart muscle, which is often caused by pulmonary hypertension, hypertension, stenosis of the aorta or pulmonary trunk;
- damage to the heart muscle, which is caused by a heart attack, myocarditis, angina pectoris and some systemic diseases (lupus, rheumatism, etc.);
- pathologies associated with filling the heart with blood (fibroelastosis, pericarditis, etc.).
In young men, chronic heart failure often occurs as a result of experienced acute myocardial infarction. For women, the key risk factor for the development of pathology is arterial hypertension (hypertension), which manifests itself against the background of diabetes mellitus. Chronic heart failure syndrome in a child is a consequence of abnormal organ development.
The pathogenesis of chronic heart failure is very extensive, but comes down to such damage or impaired heart activity that limits its ability to pump blood to the required volume. The following organic myocardial lesions can lead to heart failure:
- congenital or acquired heart valve defects, their insufficiency or stenosis;
- ischemic transformation of myocardial tissue (secondary cardiomyopathy, stunning myocardium, postinfarction cardiosclerosis);
- inflammatory or autoimmune types of diseases (pericarditis, endocarditis, myocarditis);
- hypertension, leading to hypertrophy and thickening of the walls of the myocardium;
- the harmful effects of chronic alcohol intoxication;
- hereditary hypertrophic or dilated cardiomyopathy.
CHF may also have functional causes, for example, idiopathic arrhythmia not related to organic lesions.
According to statistics, chronic heart failure in men is most often caused by coronary heart disease (CHD), while in women, hypertension often leads to heart failure.
In addition to the above, there are other typical reasons for the development of heart failure:
- smoking and alcohol abuse;
Myocardial infarction, cardiosclerosis and a number of other causes of heart failure can also cause another dangerous disease, accompanied by asthma attacks – cardiac asthma.
Among the most common causes of heart failure that occur in 60-70% of patients are called myocardial infarction and coronary heart disease. They are followed by rheumatic heart diseases (14%) and dilated cardiomyopathy (11%). In the age group over 60, in addition to coronary heart disease, heart failure also causes hypertension (4%). In elderly patients, type 2 diabetes and its combination with arterial hypertension are a common cause of heart failure.
Factors that provoke the development of heart failure, cause its manifestation with a decrease in the compensatory mechanisms of the heart. Unlike causes, risk factors are potentially reversible, and their reduction or elimination can delay the aggravation of heart failure and even save the patient’s life.
These include: overstrain of physical and psycho-emotional capabilities; arrhythmias, pulmonary embolism, hypertensive crises, progression of coronary heart disease; pneumonia, SARS, anemia, renal failure, hyperthyroidism; taking cardiotoxic drugs, drugs that promote fluid retention (NSAIDs, estrogens, corticosteroids) that increase blood pressure (isadrine, ephedrine, adrenaline) .;
Treatment of chronic heart failure should be based on diagnostic data. Doctors strongly do not recommend self-medication if they detect characteristic signs of the disease. To determine which method of therapy will be most effective, the form, stage and degree of pathology should be established. For this purpose, the doctor conducts a comprehensive diagnosis and only then prescribes the patient appropriate medications and care.
Depending on the severity of the patient’s condition, the pathology is classified into four classes:
- First grade. It is characterized by the absence of restrictions on physical activity.
- Second class. Indicates that there are slight restrictions on physical activity.
- Third class. It is characterized by a pronounced decrease in human performance.
- Fourth grade. Indicates a significant decrease in performance both at rest and during physical exertion.
Chronic pathology of the heart can have several stages of progression:
- First one. The main symptoms of the disease appear during physical exertion.
- The second one. Signs of pathology are manifested not only during physical exertion, but also in a calm state.
- The third. Geodynamics are disturbed, structural and pathological changes in organs and tissues develop.
In our country, the classification of CHF by N.D. Strazhesko and V.Kh. Vasilenko. It involves a conditional division of it into three stages. Stage I – initial (latent, hidden). The inferiority of the work of the heart is manifested only during exertion. Stage II – hemodynamic disturbance manifests itself at rest. At stage II A, the hemodynamics are mildly disturbed, mainly the right or left parts of the heart suffer.
At stage II B, blood circulation in both circles is impaired, marked pathological changes in the work of the heart are noted. Stage III – terminal (final). Severe circulatory failure is accompanied by a pronounced change in metabolism, damage to the structure of internal organs and a violation of their functions.
Currently, the classification of the severity of heart failure in accordance with the tolerance of loads. There are 4 functional classes (FC) of CHF. With I FC, the patient tolerates normal physical activity well. Significant physical activity may be accompanied by shortness of breath or fatigue. In CHF II FC, normal physical activity is moderately limited; in FC III, there is a significant limitation of habitual activity due to shortness of breath and other symptoms.
IV FC is accompanied by the inability to perform physical activity without complaints, symptoms appear at rest. Functional classes of heart failure may vary depending on the treatment. There is no complete correlation between the functional classes and stages according to Strazhesko-Vasilenko. Systolic and diastolic heart failure (a primary violation of contractility or myocardial relaxation) are additionally highlighted. Sometimes distinguish right and left ventricular failure, depending on the most affected part of the heart.
- Chronic heart failure of 1 degree. It is characterized by shortness of breath when lifting the patient up the stairs to the third floor or higher, at the same time, his physical activity continues to remain normal.
- 2 degree of heart failure. Shortness of breath appears in a person after climbing one floor or simply when walking fast. A decrease in physical activity becomes more noticeable, and with a normal load, signs of the disease appear.
- 3 degree of CHF. Her symptoms begin to appear even with walking and normal exertion, but in a calm state they pass.
- Chronic heart failure stage 4. Even at rest, it retains its signs, and with the slightest increase in physical activity, the shortcomings of the cardiovascular system are sharply manifested.
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- Myocardial CHF. occurs in the case of direct damage to the heart walls due to a violation of energy metabolism in the myocardium. This type of heart failure leads to systolic and diastolic disorders in the work of the heart.
- Overload heart failure is the result of prolonged increased cardiac load. It can occur against a background of heart defects or blood flow problems.
- Combined heart failure appears due to excessive load on the heart with a damaged myocardium.
- Left ventricular heart failure is caused by a decrease in myocardial contractile function or overload of the left ventricle. Aortic stenosis often leads to such an overload, and a decrease in contractile function may be a consequence of myocardial infarction. This type of heart failure leads to a decrease in the release of blood into a large circle of blood circulation and the formation of stagnation in a small circle of blood circulation.
- With right ventricular heart failure, blood begins to stagnate in a large circle of blood circulation, while the release of blood into a small circle of blood circulation decreases due to overload of the right ventricle. Pulmonary hypertension often leads to this condition. The dystrophic form of right ventricular heart failure is the most severe and at the same time its last stage. With it, the patient’s body is depleted, the skin becomes flabby, thinner, persistent edema appears.
- The mixed form of heart failure is due to the simultaneous overload of both heart ventricles.
Acute and chronic heart failure are distinguished by the rate of increase in signs of decompensation.
The development of acute heart failure can occur in two types:
- on the left type (acute left ventricular or left atrial insufficiency)
- acute right ventricular failure
I (initial) stage – hidden signs of circulatory failure, manifested only in the process of physical exertion by shortness of breath, palpitations, excessive fatigue; at rest hemodynamic disturbances are absent.
II (expressed) stage – signs of prolonged circulatory failure and hemodynamic disturbances (congestive phenomena of the small and large circles of blood circulation) are expressed at rest; severe disability:
- Period II A – moderate hemodynamic disturbances in one part of the heart (left or right ventricular failure). Dyspnea develops with normal physical activity, working capacity is sharply reduced. Objective signs are cyanosis, swelling of the legs, the initial signs of hepatomegaly, hard breathing.
- Period II B – deep hemodynamic disorders involving the entire cardiovascular system (large and small circle). Objective signs – shortness of breath at rest, severe edema, cyanosis, ascites; total disability.
III (dystrophic, final) stage – persistent insufficiency of blood circulation and metabolism, morphologically irreversible disturbances in the structure of organs (liver, lungs, kidneys), exhaustion.
Forms and stages of heart failure and their symptoms
The stages of heart failure according to the classification of cardiologists Strazhesko and Vasilenko are divided according to the development of heart failure.
Stage 1 – initial. The first signs of heart failure appear. The patient is constantly freezing, periodically cooling extremities, swelling of the lower body (feet, legs). In the first period, edema is unstable, occurs in the afternoon and leaves after a long night’s rest.
There is also the presence of a constant feeling of fatigue, rapid fatigue, which is explained by a gradual decrease in blood flow velocity in the skin and skeletal muscles. Even with small physical exertion on the body (long walks, walking up the stairs, cleaning the room), shortness of breath appears, a sharp attack of dry cough is possible, the heartbeat is quickening.
Stage 2 (A) – the appearance of blood stasis. The study revealed a violation of the blood flow of a small or large circle of blood circulation. Periodic asthma attacks or pulmonary edema begin to manifest themselves. This is due to venous congestion in the lungs.
- Constant bouts of dry cough.
- A sharp feeling of anxiety.
With pulmonary edema, the patient has a cough with sputum, noisy breathing.
Stage 2 (B) – venous congestion progresses. Violation is already present in 2 main circles of blood circulation.
Stage 3 – a clear manifestation of the presence of heart failure, degenerative changes are already irreversible.
- The constant presence of shortness of breath.
- The inability to perform even a small physical activity.
- Cirrhosis of the liver.
- Education of edema.
- Lowering blood pressure.
If you do not urgently consult a specialist and do not start treatment, then the heart muscle is quickly depleted, the liver, kidneys, and brain are “affected”. Lethal outcome is possible.
The New York Heart Association has developed its functional classification and identified the following stages of heart failure:
- Functional class 1 – the patient feels difficulties only in those cases when his physical activity is at a high level. There are no signs of heart disease, only an ultrasound machine can fix the changes.
- Functional class 2 – shortness of breath and pain occur periodically with a standard level of physical activity.
- Functional class 3 – the patient’s condition can be considered positive only if he observes a pastel regime and limits physical activity as much as possible.
- Functional class 4 – even a minimal set of movements can cause an attack, all kinds of loads are excluded.
There is left ventricular and right ventricular heart failure. Also, if you follow the pathological irreversible changes, you can distinguish the systolic and diastolic type of ventricular dysfunction. In the first case, the cavities of the left ventricle noticeably expand, and the blood flow becomes smaller.
It is very important that the specialist correctly diagnose the type of ventricular dysfunction by examining the signs of heart failure. The course of treatment also looks different, since the physiological pathology of the above forms of pathologies is radically different.
The treatment regimen is drawn up only after revealing the full clinical picture of the disease. The appearance and development of pathologies directly depends on the age of the patient, the stage of development of the disease. Also, the patient must provide his medical history. In this case, it will be easier for the cardiologist to trace the history of the development of the disease and its approximate temporary presence.
Phases of the development of pathologies:
- Systolic heart failure. Violated the time intervals of ventricular contraction.
- Diastolic heart failure. Violated the time intervals of relaxation of the ventricles.
- A mixed form of violation. The normal functioning of both systoles and diastoles is disrupted.
How fast is the problem developing
Depending on how quickly the symptoms of heart failure increase, they talk about its acute or chronic variants.
- Acute heart failure rises within hours or even minutes. It is preceded by various heart catastrophes: acute myocardial infarction, pulmonary thromboembolism. In this case, the left or right ventricle of the heart may be involved in the pathological process.
- Chronic heart failure is the result of long-term illnesses. It progresses gradually and is aggravated from minimal manifestations to severe multiple organ failure. It can develop in one of the circles of blood circulation.
Chronic heart failure: symptoms and diagnosis
Among the main signs of the disease are the following:
- shortness of breath, at first appears only during physical exertion, then it can disturb at rest;
- the patient begins to complain of severe fatigue, cannot fully perform the previous volumes of work, he is given physical work and sport hard;
- due to shortness of breath and poor saturation of tissues with blood and oxygen, tachycardia is noted;
- the appearance of edema, which begin to move from bottom to top, affecting the feet first, and then moving to the abdominal region;
- the appearance of a cough, which at first has a dry nature, but sputum gradually begins to stand out, in severe cases with traces of blood;
- in a horizontal position, the patient constantly needs to maintain a certain shape, which provides for an elevated position of the head.
The patient complains of fatigue, shortness of breath, palpitations during exercise (climbing stairs, brisk walking). On examination, acrocyanosis (cyanosis of the hands, feet) can be seen. Often there are small edema (pastiness) of the ankles, legs in the evening. During exercise, a rapid increase in heart rate.
II A stage
Symptoms at rest are not very pronounced; they intensify only during exercise. With pathology of the left heart, left ventricular failure develops, manifested by a violation of hemodynamics in the pulmonary circulation. It is accompanied by complaints of shortness of breath when walking, climbing stairs. Attacks of suffocation at night (cardiac asthma), dry cough, sometimes hemoptysis may appear.
The patient quickly becomes tired after normal physical exertion. On examination, you can see pallor, acrocyanosis. No swelling. There is a shift in the left border of the heart, often heart rhythm disturbances, dull tones. The liver is not enlarged. Dry wheezing is heard in the lungs, with severe stagnation – small bubbling rales.
With pathology of the right heart, there are signs of stagnation in a large circle of blood circulation. The patient complains of severity and pain in the right hypochondrium. Thirst appears, swelling, diuresis decreases. There is a feeling of fullness of the abdomen, shortness of breath during normal physical activity. On examination, acrocyanosis, swelling of the cervical veins, swelling of the legs, and sometimes ascites are visible.
II B stage
Signs of circulatory failure in a large and small circle are characteristic. There are complaints of shortness of breath with a slight load and at rest. Characterized by a heartbeat, interruptions in the work of the heart, swelling, pain in the right hypochondrium. Disturbed by severe weakness, sleep is disturbed. On examination, edema, acrocyanosis, and in many cases ascites, are determined.
There is a patient’s forced position – orthopnea, in which the patient cannot lie on his back. The borders of the heart are widened in all directions, there is tachycardia, extrasystole, and a gallop rhythm. In the lungs, hard breathing, dry and wet rales are determined, in severe cases, fluid accumulates in the pleural cavity. The liver is enlarged, dense, with a smooth surface, a pointed edge.
The dystrophic stage is manifested by severe hemodynamic disorders, metabolic disorders. The structure and functions of internal organs are irreversibly disturbed. The condition of patients is severe. Pronounced shortness of breath, swelling, ascites. There is hydrothorax – accumulation of fluid in the pleural cavity. Congestion develops in the lungs.
Manifestations of chronic heart failure are clearly related to which of the heart departments does not cope with its functions.
In the case of insufficiency of the right ventricle in a large circle of blood circulation, stagnation occurs, and the patient shows the following signs of chronic heart failure:
- due to stagnation of blood in the hepatic veins, pain occurs in the right hypochondrium;
- swelling of the extremities begins.
If there is a failure of the left ventricle, then stagnation of blood begins in the lungs and pulmonary circulation. Then for chronic heart failure the following symptoms are characteristic:
- shortness of breath, in severe cases, capable of occurring at rest;
- blue areas of the body (cyanosis), with the first places farthest from the heart turning blue – fingers and toes, lips;
- dry rales;
With CHF of any type, a common symptom is increased fatigue.
Chronic heart failure is manifested by symptoms that depend on the extent of damage to the heart muscle.
The main symptoms of the disease include:
- Shortness of breath, which is strongly manifested in a lying state. The patient has to sleep, almost half sitting, placing several pillows under his head.
- A strong cough with sputum in which blood particles can be detected. When lying down, the cough is simply unbearable.
- Great weakness even without physical exertion. The body weakens, since oxygen is not supplied to the brain in sufficient quantities.
- Severe swelling, especially in the evening. The liquid is not excreted from the body and settles in the tissues of the legs, so you need to adjust the water balance.
- Abdominal pain due to abdominal edema.
- Renal and hepatic failure.
- Blue skin, especially fingers and lips. This is due to the fact that venous blood circulates poorly and does not saturate tissue with oxygen.
- Tachycardia and arrhythmia.
The diagnosis of chronic heart failure is made by the doctor based on patient complaints. With the disease, weak heart tones are heard well, the heart rate malfunctions, noise and wheezing in the lungs are heard.
During the examination, an ultrasound of the heart is performed, which shows a pathology, as a result of which heart failure began to develop. Also, during ultrasound, you can look at the contractile function of the myocardium.
Laboratory tests are also prescribed, with their poor results, an electrocardiogram can be prescribed to determine ischemic disease, signs of post-infarction cardiosclerosis, heart rhythm. With serious ECG deviations, they can perform a daily ECG, blood pressure measurement, treadmill test, bicycle ergometry. This allows you to identify the stage of angina pectoris and heart failure.
X-rays are prescribed to determine myocardial hypertrophy. Also in the picture you can see the pathology of the lungs that appeared as a result of venous stasis or edema.
In the presence of coronary heart disease, a patient can undergo coronary angiography to determine the patency of venous arteries and prescribe surgical treatment. If blood stasis in the liver and kidneys is suspected, an ultrasound of these organs is done.
The disease requires a thorough diagnosis, which should be prescribed by a doctor.
Factors that can lead to aggravation of heart failure:
- The development of a major heart disease that is not treatable.
- The development of additional diseases of the cardiovascular system.
- The development of diseases of other organs.
- Physical work, poor nutrition, lack of vitamin, constant nervous tension.
- Taking certain medications.
Acute heart failure is a syndrome in which the clinical signs of the disease appear quickly and very brightly, as a result of worsening systolic function of the heart.
All these malfunctions of the heart lead to hemodynamic disturbances and irreversible changes in the blood circulation of the lungs.
Acute heart failure is a violation of the heart, as a result of which cardiac output worsens, pressure in the pulmonary circulation increases, weak microcirculation of blood in the tissues and stagnation are observed.
This is a pathological condition that appears due to the development of CHF for its decompensation, although there are cases of the development of pathology without heart diseases.
DOS requires immediate medical attention, as it is a frequent condition that poses a threat to human life.
Acute heart failure is a critical condition of the patient, which can lead to cardiac arrest. If you suspect a syndrome, you should immediately call an ambulance with a team of cardioreanimation.
Symptoms of right ventricular failure include:
- Dyspnea at rest. It appears as a result of bronchospasm.
- Pain behind the chest.
- Blue or yellow skin, especially lips.
- Cold perspiration on the forehead.
- The protrusion and palpation of the veins on the neck.
- Enlarged liver and pain in the area.
- Swelling in the legs.
The symptoms of left ventricular failure include the following:
- Shortness of breath with a choking effect.
- Heart palpitations and arrhythmias.
- Weakness to fainting.
- Blanching of the skin.
- Cough with foam and blood impurities.
- Wheezing in the lungs.
Acute heart failure can be fatal, so medical help is needed. Do not put off and wait until the attack passes, you need to urgently call an ambulance with cardiologists. Upon arrival, doctors will help restore heart rate and blood flow to damaged vessels. For this, thrombo-solvents are injected into a vein.
Upon arrival at the hospital, an urgent operation to restore the heart muscle can be performed if there was a break.
Doctors also relieve an asthma attack that caused congestive failure, remove thromboembolism and carry out oxygen therapy. Narcotic analgesics are most often used for pain relief of AHF. And glycosides and cardiotonics help normalize myocardial contractility.
You need to know that for any signs of DOS, you should immediately call an ambulance. Remember that if you have the slightest suspicion of developing DOS, you must immediately call an ambulance.
Diagnosis of chronic heart failure
The diagnosis of heart failure is made on the basis of complaints from the patient, his medical history and medical examination.
- Diagnosis of chronic heart failure begins with auscultation of the chest, during which an irregular heart rhythm is heard in case of impaired conduction and heart rhythm, weakening of heart sounds, with heart defects – pathological noises and tones, wet or dry rales in the lungs with stagnation of blood in them.
- Echocardiography, with the help of which it is possible to assess the general contractility of the myocardium, to detect the pathology that gave impetus to the development of insufficiency. It also makes it possible to differentiate systolic and diastolic myocardial dysfunction, since in the first case the ejection fraction is reduced (less than 40%), and in the second it is either normal or exceeds 50%.
- Laboratory tests of blood and urine (general, immunological, biochemical, hormonal).
- An electrocardiogram, which, if necessary, can be changed into Holter daily monitoring, recording ECG and blood pressure data, or ECG under load (bicycle ergometry, treadmill – to determine the degree of progression of heart failure and angina pectoris).
- Chest x-ray.
- Coronary angiography is prescribed to patients with coronary artery disease in order to assess the degree of patency of the coronary vessels and decide on cardiac surgery.
- Ultrasound of the kidneys and liver to detect structural changes in these organs under the influence of congestion and chronic hypoxia (secondary wrinkling of the kidneys, cardiac cirrhosis of the liver, hepatomegaly).
- Ultrasound of the thyroid gland is necessary to detect diffuse toxic goiter or nodular goiter – diseases that can cause heart damage.
The attending physician during a clinical examination determines a list of diagnostic methods that the patient has to go through.
Since heart failure is a secondary syndrome that develops with known diseases, diagnostic measures should be aimed at its early detection, even in the absence of obvious signs.
When collecting a clinical history, attention should be paid to fatigue and dyspnea, as the earliest signs of heart failure; the patient has coronary heart disease, hypertension, myocardial infarction and rheumatic fever, cardiomyopathy. Identification of swelling of the legs, ascites, rapid low-amplitude pulse, listening to the III cardiac sound and displacement of the borders of the heart are specific signs of heart failure.
If heart failure is suspected, the electrolyte and gas composition of the blood, acid-base balance, urea, creatinine, cardiospecific enzymes, and indicators of protein-carbohydrate metabolism are determined.
ECG for specific changes helps to detect hypertrophy and insufficient blood supply (ischemia) of the myocardium, as well as arrhythmias. Based on electrocardiography, various load tests are widely used with the use of an exercise bike (bicycle ergometry) and a treadmill (treadmill test). Such tests with a gradually increasing load level make it possible to judge the reserve possibilities of heart function.
Using ultrasound echocardiography, it is possible to establish the cause of heart failure, as well as evaluate the pumping function of the myocardium. With the help of heart MRI, IHD, congenital or acquired heart defects, arterial hypertension and other diseases are successfully diagnosed. Radiography of the lungs and chest organs in heart failure determines congestive processes in the small circle, cardiomegaly.
Radioisotope ventriculography in patients with heart failure allows a high degree of accuracy to assess the contractility of the ventricles and determine their volumetric capacity. In severe forms of heart failure, ultrasound of the abdominal cavity, liver, spleen, pancreas is performed to determine damage to internal organs.
Treating Chronic Heart Failure
Therapy of the disease is carried out using surgical intervention or a conservative technique. If the latter is used, patients are prescribed medication for heart failure and a suitable diet is selected. As a rule, the diet for each patient is compiled on the basis of individual indicators, taking into account the severity of his condition and the clinical picture of the pathology.
Medicines of this group stimulate the hemodynamic unloading of the myocardium, as a result of an increase in the volume of urine formed, vasodilation, and a decrease in left and right ventricular pressure. ACE inhibitors are prescribed in the diagnosis of clinical signs of the disease and a decrease in the ejection fraction of the left ventricle. The list of drugs in this group include:
Glycosides have a beneficial effect on the heart. Thanks to the positive inotropic effect, systole is shortened and increased, and the negative chronotropic effect helps to reduce the heart rate. Simply put, glycosides help calm the heartbeat and increase the strength of heart contractions. Congestive heart failure is treated with the following drugs:
The use of drugs of this type follows, given that there are several causes of puffiness (increased secretion of aldosterone, narrowing of the vessels of the kidneys, increase in venous pressure). Chronic pathology of the heart can be cured only with complex drug therapy. In this case, doctors first prescribe the use of loop or thiazide types of diuretics.
- Spirolonactone (has a weak effect);
- Ethacrylic acid;
As soon as the patient has been diagnosed, he needs to start treatment immediately, which consists not only of prescribing drugs.
- From the first day, it is necessary to limit salt, consuming no more than 3 g per day. At the same time, the drinking regime provides for the consumption of 1-1,5 liters of pure water per day. In chronic heart failure, you should consume high-calorie, but easily digestible food. Any product should be rich in protein and vitamins.
- Also be sure to weigh yourself daily. This will allow you to see how much fluid is retained in the body. If in 1-3 days the patient gains from 2 kg in weight, you should immediately contact a cardiologist. In the absence of therapy, the patient’s condition may deteriorate sharply, hospitalization will be required.
- Limit physical activity as much as possible. Moreover, for some patients, taking into account the causes of heart failure, an individual plan of possible training can be selected. It usually includes walking, swimming and cycling. At the same time, it is strictly forbidden to lift iron and perform exercises in a static form for a long time.
- The apartment should maintain optimal humidity and air temperature. Trips to the highlands and even a short stay in places where there is not enough oxygen are necessarily excluded.
- If you need a long flight or ride, you should do gymnastics every 30 minutes or just warm up, walking around the cabin.
Treatment of heart failure has such goals as preventing the development of symptoms (for the asymptomatic stage) or eliminating them; improving the quality of life; reduction in the number of hospitalizations; improved prognosis. The main directions of treatment of heart failure:
- rational physical activity;
- psychological rehabilitation, patient education;
- drug therapy;
- electrophysiological methods;
- surgical and mechanical methods.
Salt restriction is recommended. The more pronounced the symptoms, the more you need to limit the salt, up to refusing it. It is recommended to limit the liquid only with severe edema. Usually advised to drink from 1,5 to 2 liters of fluid per day. Food should be high-calorie, with sufficient protein and vitamins.
It is necessary to monitor the weight daily. An increase in body weight of more than 2 kg in three days indicates a fluid retention in the body and a risk of CHF decompensation. Weight monitoring should also be done to exclude the development of cachexia. Limiting alcohol intake is in the nature of general recommendations, except for patients with alcoholic cardiomyopathy. The use of a large volume of liquid, in particular beer, should be limited.
Physical activity is recommended for patients at any stage who are in a stable state. It is contraindicated only with active myocarditis, stenosis of heart valves, severe rhythm disturbances, frequent attacks of angina pectoris. Before determining the level of load, it is necessary to conduct a test with a 6-minute walk.
If the patient walks less than 6 meters in 150 minutes, it is necessary to begin exercises with breathing. You can inflate a balloon, swimming ring several times a day. After improvement, sitting exercises are joined. If the patient can walk from 150 to 300 meters in 6 minutes, physical activity is shown in the form of a normal walk with a gradual extension of the distance to 20 km per week.
If the patient can walk more than 300 meters in 6 minutes, he is assigned loads in the form of a brisk walk up to 40 minutes a day. Physical activity significantly increases the tolerance of the load, improves the effectiveness of treatment and prognosis. The effect of such workouts persists for 3 weeks after they are stopped. Therefore, rational load should be part of the life of a patient with heart failure.
A patient with heart failure should be able to get all the information he needs about his illness, lifestyle, and treatment. He must have the skills to control his condition. Therefore, it is necessary to organize “schools” for such patients and their relatives. A significant role in improving the quality of life of such a patient is played by medical and social work aimed at creating a healthy lifestyle, choosing a regime of physical activity, employment, and adapting the patient in society.
Auxiliary drugs can be prescribed based on the clinical situation:
- peripheral vasodilators (with concomitant angina pectoris);
- blockers of slow calcium channels (with persistent angina and persistent arterial hypertension);
- antiarrhythmic drugs (with severe ventricular arrhythmias);
- aspirin (after myocardial infarction);
- non-glycoside inotropic stimulants (with low cardiac output and hypotension).
The use of electrophysiological methods is indicated in patients with the most active, but not effective drug therapy, which can maintain a high quality of life. The main methods:
- implantation of a pacemaker;
- cardiac resynchronization therapy (a type of heart stimulation);
- staging a cardioverter-defibrillator for severe ventricular arrhythmias.
In severe cases of heart failure, heart transplantation, the use of assisted circulatory devices (artificial ventricles of the heart), heart wrapping with a special mesh frame to prevent its remodeling and progression of heart failure can be considered. The effectiveness of these methods is currently being studied.
Different methods are used in the treatment of chronic heart failure, but among the first recommended ones is limiting physical activity and following a certain diet. Quitting smoking and alcohol abuse is mandatory.
When chronic heart failure is being treated, drugs are prescribed primarily to combat the underlying disease that causes CHF.
Medicines for chronic heart failure are of great importance, and their task is to rid the body of excess fluid and increase the contractility of the heart.
Depending on the stage of CNS and the brightness of its symptoms, doctors prescribe drugs in the following groups:
- ACE inhibitors and vasodilators – captopril, enalapril, ramipril, perindopril, lisinopril, which reduce vascular tone, which leads to the expansion of arteries and veins and a decrease in their hydraulic resistance, that is, facilitate the work of the myocardium and contribute to an increase in blood flow.
- Cardiac glycosides are widely used in chronic heart failure (strophanthin, digoxin, etc.), which enhance the contractility of the myocardium and its pumping function, increase diuresis and cardiac tolerance of physical exertion.
- Nitro drugs (nitroglycerin, sustac, nitrong, etc.) contribute to filling the ventricles with blood, expand the coronary arteries, and increase cardiac output.
- In chronic heart failure, drugs are used – diuretics, which remove excess fluid from the body and prevent its stagnation, help restore the acid-base and water-salt balance in the body (furosemide, lasix, spironolactone).
- Beta-blockers (for example, carvedilol) reduce heart rate, increase the filling of the heart with blood and cardiac output.
- Very important drugs for chronic heart failure that improve myocardial metabolism (ascorbic acid, riboxin, B vitamins, potassium preparations).
- In chronic heart failure, anticoagulants (warfarin, acetylsalicylic acid) are used, which prevent vascular thrombosis.
One type of therapy is rarely used to treat CNS – the exception is the use of ACE inhibitors in the initial stage of CNS development.
Cost of medicines
To prepare a home medicine, you should take 100 ml of peeled oat grains, rinse them thoroughly and pour 500 ml of cold water. The mixture is brought to a boil and removed from the stove. After this, 1/3 of a glass of peeled and ground elecampane roots must be added to the water, only fresh rhizomes are taken.
After thoroughly stirring the broth, it is again placed on the stove and again brought to a boil. Insist the medicine under a tight lid for three hours. Thickening must be removed through cheesecloth and two tablespoons of natural honey are added to the broth. Use a decoction of oats should be 100 ml three times a day for 15-20 minutes before the main meal. Therapy lasts for 2 weeks.
This treatment not only significantly strengthens the heart muscle, but also eliminates pain and heaviness in the chest. To prepare the drug, you should take 500 g of hawthorn fruit, it is important to ensure that they are ripe. Hawthorn washed and filled with 1 liter of cold water.
The fruits are cooked from the moment of boiling for about 20 minutes in an enameled pan. After this, it is recommended to strain the decoction through cheesecloth and add 2/3 cups of sugar and the same amount of natural honey. The components are brought to uniformity and taken in 30 ml daily 30 minutes before meals. Therapy lasts for 30 days. The broth must be stored in a cold place.
As soon as the patient has noticed the first signs of chronic heart failure, an urgent need to contact a cardiologist to confirm the diagnosis. Early diagnosis of impaired cardiac function significantly prolongs the life of the patient. In this case, it is imperative to adhere to proper nutrition, abandon bad habits and reduce physical activity.
Aldosterone receptor antagonists
The drug is in the form of capsules. Veroshpiron taken against the background of puffiness due to the presence of chronic heart failure. With this pathology, the patient is recommended to take 0,1-0,2 g of the active substance, which should be divided into three doses. In this dose, the medication is taken for five days, after which it is necessary to switch to maintenance treatment. In this case, the dose of Veroshpiron per day is usually 25 mg. It is strictly forbidden to exceed the amount of the main component in 200 mg.
The medicine is available in the form of tablets for oral use. In case of puffiness against the background of heart failure, patients are advised to take 100 mg of the active substance in the first five days of treatment, after which, taking into account the severity of the patient’s condition, the specialist selects a maintenance dose. It can be equal to 25 or 200 mg of active ingredient per day. The duration of therapy is selected individually.
Complications of heart failure and treatment methods
CHF is often the result of many diseases of the internal organs and most heart diseases.
In chronic heart failure, the heart does not pump blood in the required volume, resulting in a shortage of nutrients in the organs.
The first and obvious signs of heart failure are the presence of edema and shortness of breath. Edema is the result of stagnation of blood in the veins. Shortness of breath is a sign of stagnation of blood in the vessels of the lungs.
In the treatment of heart failure, the patient must follow the prescribed diet. This food system is limited to salt and water. Foods should be selected nutritious and easily digestible. They must contain the necessary amount of protein, vitamins and minerals. The patient is also required to monitor his weight and perform dynamic loads on different muscle groups. The number and types of load in each case is determined by the attending physician.
Medications that are prescribed for CHF are the main, additional and auxiliary groups. The drugs of the main group prevent the development of the disease, as they protect the heart, internal organs and optimize blood pressure. These include ACE inhibitors, angiotensin receptor antagonists (Concor, Anaprilin), beta-blockers, diuretics (Amiloride, Furosemide) and cardiac glucosides.
Also, the doctor may prescribe benazepril-based drugs: this is a modern and effective development of scientists. Another drug can be prescribed as part of complex therapy – Ortomol Cardio.
It is often advisable to use electrophysiological methods of therapy.
These methods include:
- Artificial implantation, creating an electrical impulse for the heart muscles.
- Three-chamber implantation of a pulse of the right atrium and ventricles of the heart. This provides a simultaneous contraction of the ventricles of the heart on both sides.
- Implantation of a cardioverter-defibrillator – a device due to which not only an electrical impulse is transmitted to the heart, but also the risks of arrhythmia are minimized.
When drug treatment is ineffective and an attack of heart failure does not pass, surgical, surgical intervention is used.
Types of surgery for heart failure:
- Coronary artery bypass grafting is performed when the vessels are noticeably affected by atherosclerosis.
- Surgical correction of valve defects – used for severe stenosis or insufficient number of valves.
- Heart transplantation is a cardinal, but in some cases a necessary method. In the process of such an operation, the following difficulties often occur: rejection, lack of donor organs, damage to the blood channels of a transplanted heart.
- Protection of the heart with an elastic mesh frame. Thanks to this method, the heart does not increase in size, and the patient feels better.
The installation of artificial equipment and devices in the human body can also be used to improve blood circulation. Such devices are surgically injected into the patient’s body. Through the skin, they connect to the batteries located on his belt. However, in the process of such an operation, infectious complications, thromboembolism, and thrombosis are quite possible. The cost of such devices is very high, which also prevents their use.
If the treatment of the disease is not taken in time, then the patient may face acute myocardial insufficiency, pulmonary edema, frequent and protracted pneumonia, or even sudden cardiac death, heart attack, stroke, thromboembolism. These are the most common complications of heart failure.
If untreated, the prognosis for the patient is disappointing. Heart disease usually leads to complications and wear of this organ. With timely treatment, the prognosis is comforting – the disease begins to progress more slowly, or even recedes completely.
With CHF, one should strictly adhere to a certain lifestyle, namely:
- The mode of work and rest, a sufficient amount of sleep and time for walks in the fresh air.
- Proper nutrition is the key to the health of the whole organism. Food should be fractional – 5-6 small meals. The amount of salt should be minimized, limit the amount of fat in the diet, exclude alcohol and nicotine products, eat more seasonal fruits and vegetables, dairy products.
- Observe the regime of physical activity – as directed by a doctor should engage in physical therapy.
- Follow all the recommendations of the attending physician – this will help to avoid complications and slow down the progression of the pathology.
So that an attack of heart failure no longer bothers you, you should not only go to the doctor’s session in a timely manner, but also take medication.
Prognosis and prevention of heart failure
The five-year survival threshold for patients with heart failure is 50%. The long-term prognosis is variable, it is affected by the severity of heart failure, concomitant background, the effectiveness of therapy, lifestyle, etc. The treatment of heart failure in the early stages can fully compensate for the condition of patients; the worst prognosis is observed in stage III heart failure.
Prevention of heart failure is the prevention of the development of the diseases causing it (coronary heart disease, hypertension, heart defects, etc.), as well as factors contributing to its occurrence. In order to avoid the progression of already developed heart failure, it is necessary to observe the optimal regime of physical activity, taking the prescribed drugs, constant monitoring by a cardiologist.
Prognosis and prevention of heart failure
In the absence of proper treatment, the prognosis of chronic heart failure is always unfavorable, since any heart disease gradually wears out and causes serious complications.
But with adequate medical or surgical treatment, the prognosis can be quite favorable if the underlying disease can be radically cured or at least slow down the development of heart failure.
Have you or your loved ones encountered chronic heart failure? How did you treat her and is there any positive progress? Tell your story in the comments.Ask a Question