Chronic heart failure – symptoms, causes, treatment

Chronic heart failure

In a healthy heart, atrial and ventricular contractions occur sequentially and synchronously. Against the background of various diseases, his cavities dilate (expand) and lose the ability to synchronously contract. The resulting dysynchrony leads to a decrease in the pumping function of the heart and the progression of heart failure.

Heart failure is a condition in which the heart has lost the ability to pump blood in the right amount and does not satisfy the body’s oxygen demand. Such ineffective work can lead to the development of congestion (edema of the lower extremities), as well as to disruption of other organs and systems – lungs, liver, and kidneys.

Chronic heart failure can develop in people with the following diseases:

  • coronary heart disease (CHD);
  • myocarditis, cardiomyopathy, myocardial dystrophy;
  • heart rhythm disturbances (arrhythmia);
  • congenital and acquired heart defects;
  • arterial hypertension;
  • violation of interventricular and intraventricular conduction, and, as a result, mechanical dyssynchrony of the heart.

All these diseases can lead to the development of heart failure due to a decrease in the contractility of the heart muscle, insufficient filling of the heart with blood, overfilling of the heart with too much blood.

Causes and development of the disease

The term “Chronic heart failure” should be understood in a narrow and broad sense. On one side – this is a medical diagnosis, which is characterized by a decrease in the functional abilities of the myocardium and the presence of ischemic changes in it. In a broad sense, this concept is implied as a consequence of most cardiovascular pathologies.

Moreover, this is a terminal condition, since pathology can no longer progress: heart defects, consequences of coronary heart disease, arterial hypertension, cardiomyopathy, as well as chronic lung pathologies – all this leads to such a disease as chronic heart failure in the vast majority of cases.

Moreover, the treatment of these diseases should assume a risk of developing such complications, and therefore a competent correction of the condition is necessary even at the stage when cardiovascular failure does not manifest, that is, it does not manifest itself with the main signs. Most often, the list of symptoms is expressed by the following set of disorders:

  • Edema syndrome;
  • Objective sensations of weakness, dizziness, nausea, periodic or prolonged episodic loss of consciousness;
  • Shortness of breath mixed;
  • Cyanosis of the skin.

These signs accompany such a pathology as chronic heart failure and are common suggestive diagnostic criteria. Clarification of the morphological substrate of heart failure is carried out using instrumental research methods.

To clarify the diagnosis can be used:

  • ECG and echocardiography;
  • Phonocardiography
  • Roentgenography;
  • Angiography;
  • Computed tomography with intravenous contrast.

These diagnostic methods allow you to clarify the following critical data:

  1. Excitability and contractility of the heart, cicatricial changes in the myocardium, impaired functioning of the cardiac conduction system (performed by ECG).
  2. Sizes of chambers and cavities of the heart, holes. The directions of blood flow are recognized, zones of hypokinesia (areas of the myocardium with weak contractile activity) or zones of akinesia (areas of large focal cardiosclerosis (performed by echocardiography) are detected.
  3. Radiography is more likely a measure of disease recognition. Most often, this method is presented in the form of fluorography, on which you can notice a change in the configuration of the heart, a violation in the lung tissue, the ratio of the size of the cavities and the heart

Angiography. This method is best used to recognize coronary heart disease, or rather, its causes. By analyzing the state of the vascular bed, narrowing of atherosclerotic plaques can be clarified, and then surgery can be performed.

This method has many common features with computed tomography, as it allows you to assess the condition of the vessels. At the same time, computed tomography is a method of recognizing the configuration of the heart in volumetric measurement. Due to this, you can get reliable information about the condition of the heart and its vessels.

Based on the interpretation of these methods, it is worth saying that with such a pathology as chronic heart failure, the diagnosis should consist of several instrumental methods that are prescribed after a physical (general) examination. The diagnostic value is the highest in computed tomography, angiography, as well as in echocardiography.

These methods provide visual information about the state of the heart, the degree of progression of a defect or dilatation of the left ventricle, as well as other secondary data, for example, the size of the focus of cardiosclerosis in the area of ​​akinesia or hypokinesia.

Moreover, the value of the ECG is also very high, because only through this method it is possible to assess the development of complications, because heart failure manifests itself in various arrhythmias, in addition to the main symptoms indicated above. Recognizing them, as well as identifying patterns of provocation, is the task of electrocardiography.

Heart failure is also called the endpoint of the development of cardiovascular disease. In fact, chronic heart failure can be an independent phenomenon, but more often it complicates certain heart diseases. Usually it develops as a result of a heart attack, other forms of coronary heart disease, defects, arterial hypertension.

All this violates the anatomy of the heart and the quality of its work, which causes the corresponding symptoms. There are also certain factors that contribute to increasing symptoms and increasing the severity of heart failure. These are phenomena such as:

  • Significant physical exertion, overstrain.
  • Emotional experiences, frequent stresses.
  • Irregular medication, non-compliance with the doctor’s recommendations regarding existing diseases of the heart and blood vessels.
  • The presence of heart rhythm disturbances.
  • Thromboembolic complications.
  • Exacerbation of concomitant diseases and the occurrence of acute, even as minor as acute respiratory viral infections.
  • Anemia.
  • Kidney disease.
  • Drinking alcohol, smoking.
  • Drinking too much fluid.
  • Improper diet, excessive salt intake.
  • The use of medications that have a negative effect on the work of the heart or cause the accumulation of fluid in the body. Examples of such drugs are corticosteroid hormones, estrogens, steroid hormones, ephedrine-based products, etc.
  • Overweight.

As you can see, most of these factors are reversible, that is, their negative impact can be prevented or stopped. Every patient with chronic heart failure should do just that. This will significantly improve both the well-being of a person and the prognosis of his illness.

Symptoms

The main symptoms by which a person’s condition and the severity of the situation are assessed first are three. It:

But in fact, there are much more possible manifestations of heart failure. Let’s talk about them in more detail.

It occurs in 98,4% of patients with heart failure, that is, in almost all. It occurs due to stagnation of blood in the pulmonary circulation (in the lungs) and gas exchange disorders.

At first, it manifests itself only with increased loads, then it starts to bother with normal activity and even minimal stress, for example, when lifting from a chair, tying shoelaces on boots, etc.

In severe cases, dyspnea also occurs at rest, especially when the patient is lying (with a horizontal position, blood stasis in the lungs increases).

Sometimes with CHF people are disturbed by the following symptom complex: an attack of shortness of breath, coughing, even suffocation that occur at night, cause the patient to wake up, fright and the need to take a sitting position (the so-called orthopnea position).

In fact, cardiac asthma is a borderline state between chronic and acute heart failure, experts even believe that this is the initial manifestation of acute heart failure. In some cases, if this condition is not treated at all, it passes into pulmonary edema.

It may be a symptom unrelated to cardiac asthma, sometimes it also worries patients with a stable course of heart failure.

In this case, it is dry, rare, short, arises due to the fact that the walls of the alveoli and small bronchi “swell” due to fluid stagnation, come into contact with each other, and this irritates the coughing receptors of the respiratory tract.

Fatigue occurs in chronic heart failure in 94,3% of cases. Their appearance is due to a number of reasons. Due to the deterioration of blood circulation, organs and, in particular, skeletal muscles, are not adequately supplied with blood, less oxygen is supplied to them.

The disease also causes metabolic disorders, in which electrolyte metabolism is disrupted, the processes of energy production by cells and other phenomena that are “responsible” for endurance and resistance to stress.

Almost a mandatory symptom in heart failure with right ventricular failure. Their appearance indicates a stagnation of blood in a large circle of blood circulation, which, recall, supplies blood to all organs and tissues of the body, with the exception of the lungs.

Due to stagnation of blood in the veins, pressure increases. The latter leads to a partial exit of the liquid part of the blood into the surrounding tissue. Initially, edema with CHF appears on the legs, occur in the afternoon.

Then they become more common and already exist permanently. Accordingly, in a patient with increasing edema, weight increases. In severe heart failure, the entire body begins to “swell”.

The fluid accumulates not only in the subcutaneous tissue, but also in the organs (which leads to an increase in the liver), as well as body cavities (pleural, abdominal). All this causes the appearance of new symptoms: an increase in the size of the abdomen, indigestion, kidney function, etc.

  • Dyspepsia. Dyspepsia is a complex of symptoms that combines various signs of impaired digestion. Due to stagnation of blood in the liver and poor blood supply to the digestive tract, patients have abdominal pain, constipation, nausea, flatulence.
  • Urinary dysfunction.

    With a strong decrease in cardiac output, kidney function deteriorates. This leads to a decrease in the amount of urine excreted. It often happens that little urine is formed during the day, and at night, patients, on the contrary, often go to the toilet.

    Depression, brain disorders.

    Unpleasant symptoms, decreased quality of life in heart failure are often accompanied by depression. According to statistics, it is detected in 14-36% of patients in a hospital with heart failure!

    Interestingly, the severity of depressive disorders is directly proportional to the severity of complaints of fatigue and fatigue. In severe heart failure and serious circulatory disturbances in the brain, patients may also have headaches, memory disorders, even psychosis and confusion.

    Classification of Chronic Heart Failure

    In some patients with heart failure, the signs of the disease are barely noticeable: they live a normal life and only with increased stress complain of shortness of breath. Others cannot lift anything heavier than a cup — before they have weakness, shortness of breath, and other symptoms. Some patients of all the signs of CHF have only shortness of breath, but it does not allow them to live normally; others have many complaints right away, but they don’t particularly bother them.

    As can be seen from these examples, chronic heart failure can have a very different course. In order to characterize the condition of each patient with heart failure as accurately as possible, doctors simultaneously use two classifications: by stage and by functional class.

    The first speaks of the objective severity of the situation, the second speaks of the subjective well-being of the patient.

    As a rule, the more “advanced” the stage of the disease in a person, the worse he feels. But sometimes it’s not so. A very important note: the stages can only get heavier, sometimes – even despite the treatment. The reverse development of the disease is impossible. As for functional classes, they are able to change in both directions.

    Classification by stages:

    1. The first (I) stage. The patient has latent heart failure. He leads a normal life, does not complain about anything, and only with high loads can he show signs of circulatory failure. At rest they are absent.
    2. Stage IIA. Damage to the heart is already more serious, the patient has the first signs of a hemodynamic disorder (blood circulation). It is disturbed in one circle of blood circulation – as a rule, in small, which is manifested by shortness of breath.
    3. Stage IIB. Serious heart damage, there is stagnation of blood in both circles of blood circulation. In a patient with stage IIB, very often there is a whole set of possible symptoms of the disease.
    4. Stage III is also called final, terminal, dystrophic. The patient’s cardiac function is severely impaired, and this causes irreversible changes in his general condition and the state of vital organs: brain, k >

    Heart failure develops as a result of long-term increasing changes in the myocardium, leading to a decrease in its function (primarily contractile) and the development of compensatory-adaptive changes in the cardiovascular system and in the body as a whole. After the depletion of compensatory-adaptive mechanisms, decompensation of cardiac activity occurs.

    A key link in the development of heart failure is a decrease in cardiac output due to myocardial damage (with the death of some cardiomyocytes), leading to the activation of the sympathic-adrenal and renin-angiotensin-aldosterone systems (RAAS). As a result of hemodynamic and neurohumoral factors, systemic vasoconstriction develops and, accordingly, an increase in afterload.

    This leads to an increase in the energy expenditure of the myocardium and enhances its damage. Due to the activation of the renin-angiotensin-aldosterone system, a delay in electrolytes and water occurs, which also leads to an increase in pre- and post-load. Insufficient contractile activity of the heart leads to stagnation of blood in the venous system and, as a result, the release of fluid into the interstitial space with the development of edema.

    Myocardial damage can occur due to overload of the heart with pressure and volume, as well as due to direct damage to the myocardium. Pressure overload develops with stenosis of the aortic orifice, mitral stenosis, and arterial hypertension. Volume overload occurs with aortic and mitral valve insufficiency, as well as in some other conditions.

    Primary myocardial lesions are observed with dilated cardiomyopathy, myocarditis, ischemic heart disease. Both types of overload lead to the development of hypertrophy:

    1. As a result of pressure overload of the heart, concentric hypertrophy occurs (hypertrophy, characterized by a thickening of the wall and a decrease in the cavity of the organ), which compensates for the maintenance of systolic ejection at a sufficiently high level (even during physical exertion).
    2. When the heart is overloaded with volume, eccentric hypertrophy occurs (hypertrophy, in which a thickening of the wall is accompanied by an expansion of the organ cavity), since in this case the expansion of the corresponding part of the heart occurs relatively early, and in accordance with the Frank-Starling law, the contractility of the myocardial fibers does not exceed their initial degree stretching. Due to damage and death of cardiomyocytes in the myocardium, connective tissue develops, i.e. cardiosclerosis is gradually forming (one of the important factors determining the decrease in myocardial compliance).

    As a result of these processes, the pumping function of the heart is disrupted, which leads to a decrease in cardiac output. As a result of its decrease, hypoperfusion of the heart, kidneys, and peripheral muscles develops. A decrease in heart perfusion leads to the activation of the sympotic-adrenal system and an increase in heart rate.

    Reduced renal perfusion causes stimulation of RAAS. The production of renin increases, while there is an excessive production of angiotensin II, leading to vasoconstriction, water retention (edema, thirst, an increase in bcc) and a subsequent increase in preload on the heart.

    A decrease in perfusion of peripheral muscles causes the accumulation of under-oxidized metabolic products in them, which, together with hypoxia, leads to severe fatigue.

    When to consult a doctor for chronic heart failure?

    A person with heart failure should seek medical help if the following symptoms appear:

    • Worsening shortness of breath.
    • Dyspnea that disturbs sleep.
    • Waking up at night from labored breathing.
    • The best dream in a half-sitting position.
    • Shortness of breath, which develops with mild exertion.
    • Extreme fatigue, not passing during rest.
    • Dry cough that does not go away.
    • Swelling on the legs that do not go away.

    It should be remembered that pain in the region of the heart, developing against the background of heart failure, can be a sign of myocardial infarction or angina pectoris. In this case, you should also consult a doctor.

    Diagnosis and treatment

    In order to diagnose CHF, doctors use both clinical diagnosis (assess the symptoms and condition of the person), and laboratory and instrumental methods. “Suspicious” of heart failure is all people who have suffered some kind of acute cardiovascular disease (myocardial infarction, especially complicated by pulmonary edema and other serious disorders).

    Heart failure is also purposefully sought in patients with long-term heart and vascular diseases: coronary heart disease, myocarditis, etc. From laboratory tests, general and biochemical blood tests, urinalysis, daily urine output (sometimes) are performed.

    Such tests do not indicate CHF directly, but changes in their results (for example, an increase in potassium in the blood, the appearance of protein in the urine) indirectly indicate a disease and / or its severity. In some clinics, blood levels of a natriuretic peptide are measured.

    This is a special indicator, the values ​​of which are closely related to the diagnosis of heart failure and its prognosis, so the test for natriuretic peptide is very important. Among instrumental studies, the following are carried out.

    1. Electrocardiography is done for all patients, it helps to “see” cardiac conduction disturbances, a scar after a heart attack, ventricular hypertrophy and other pathological changes that could lead to heart failure.
    2. A very valuable study is dopplerochocardiography, or ultrasound of the heart. During this diagnostic procedure, the doctor sees on the screen a working heart of a person, can examine and measure all its structures, evaluate myocardial function, calculate important indicators of heart function, such as cardiac output, pressure level in the pulmonary artery, etc.
    3. To determine if there are congestive changes in the lungs, a chest x-ray is taken.
    4. To detect fluid accumulation in the abdominal cavity and liver enlargement, which occur during stagnation in a large circle of blood circulation, ultrasound of the abdominal organs is performed.
    5. Sometimes they resort to other diagnostic methods: stress tests, coronary angiography, radioisotope methods, heart MRI, etc.

    Heart MRI is a versatile and very accurate non-invasive study, which makes it possible to visualize ventricular volumes, assess overall function, contractility of the walls, myocardial viability, myocardial thickness, thickening, myocardial and tumor masses, heart valves, to identify congenital malformations and pericardial changes.

    1. CT scan.
    2. CT angiography is used in patients with coronary artery disease with exercise or stress test.
    3. Radionuclide Ventriculography. Radionuclide ventriculography is recognized as a relatively accurate method of establishing LVEF and is often performed to determine myocardial blood supply, which, in turn, provides information about myocardial viability and the presence of ischemia.
    4. Determination of lung function. It is used to identify or exclude pulmonary causes of dyspnea and assess the role of respiratory diseases in the patient’s dyspnea.

    Cardiac catheterization. Cardiac catheterization is not needed for routine diagnosis and treatment of heart failure patients (CHF), but may indicate the etiology and prognosis after revascularization.

    Angiography of the heart. The use of coronary angiography is considered in patients with heart failure and angina pectoris or with suspected ischemic LV dysfunction. Coronary angiography is also indicated for patients with refractory heart failure with unknown etiology and patients with confirmed severe mitral regurgitation of the blood or aortic defect, which can be removed surgically.

  • Right heart catheterization (CPOS). KPOS provides valuable hemodynamic information about filling pressure, vascular resistance, and cardiac output. Monitoring hemodynamic changes makes it possible to evaluate the effectiveness of treatment in patients with severe heart failure, refractory to treatment.
  • Ambulatory ECG monitoring (according to Holter). Ambulatory ECG monitoring is valuable in the presence of symptoms of arrhythmia (e.g., palpitations or syncope) and for controlling the frequency of ventricular contractions in patients with atrial fibrillation.
  • The earlier treatment of heart failure begins, the better the patient’s prognosis. Therefore, it is in the interest of each patient with chronic heart failure to take drugs on an ongoing basis and to comply with all the doctor’s recommendations.

    Therapy of heart failure consists of following a special diet, dosed physical activity, taking medications. Sometimes, according to indications, surgical treatment is also carried out. More information about all types of treatment for chronic heart failure can be found in the corresponding article.

    When the disease worsens (decompensation of heart failure), a person is put in a hospital. With a stable condition of the patient, therapy is carried out on an outpatient basis, that is, a person independently controls his treatment and conducts it according to the prescribed scheme. Cardiorehabilitation in a sanatorium also plays an important role in the treatment.

    During a specially designed treatment program, the patient is selected the best medication regimen, physiotherapy and exercise therapy are performed. This stabilizes and improves the patient’s condition, helps him expand his physical capabilities, slow down the development of the disease, and improve the prognosis.

    Medication

    Drug treatment allows not only to maintain an adequate quality of life, but also stops the development of heart failure, and also, according to numerous studies, prolongs life. The most important groups of drugs in the treatment of heart failure:

      Diuretics (diuretics) are the most important group of drugs in the treatment of heart failure, diuretics allow you to remove fluid retained in the form of edema from the body, which reduces the load on the heart. Separately, reservations that the drugs of this group should be taken daily. It is widely believed that diuretics “wash out” (removing in a significant amount) potassium from the body.

    The fact is that some drugs of the diuretic group actually remove potassium, but this is well known to doctors, as well as how to resist this action.

    Other drugs in this group are not able to remove potassium in significant volumes. In any case, if necessary, the doctor may recommend monitoring the potassium content in the blood, if he suggests a possible negative effect of the drugs.

    Angiotensin-converting enzyme inhibitors (ACE inhibitors) and angiotensin II receptor blockers (ARBs) – allow you to control blood pressure, and, reducing it, reduce the load on the heart.

    In some cases, they can cause coughing, this side effect is less pronounced in ARB drugs. As a result of many studies, it was proved that these groups of drugs prolong the life of patients with heart failure.

    The main drugs in these groups are warfarin and acetylsalicylic acid (aspirin). It should be noted that an effective dose of acetylsalicylic acid is not less than 75 mg. Therefore, the use of drugs in a dose of 50 mg common in our country seems unjustified.

    We recall once again that the most important factor in the successful treatment of heart failure is the control of the diseases that led to this complication. Therefore, attention should be paid to controlling blood pressure, cholesterol, treating diabetes, etc.

    Three classes of drugs are used: diuretics, vasodilators and inotropic drugs, antiarrhythmic drugs are additionally prescribed.

    1. When treating with diuretics (thiazide, loopback, potassium-sparing), they control the water-electrolyte balance, the patient’s body weight and urine output.
    2. ACE inhibitors (captopril, enalapril, perindopril, etc.), which have a vasodilating effect with a decrease in pre- and post-load, a beneficial effect on neurohumoral shifts in the patient’s heart failure, are prescribed as the main means of pathogenetic action for a long period (almost lifetime).
    3. For the same purpose, effects on neurohumoral disorders are used in p-blockers (atenolol, metoprolol, bisoprolol, carvedilol, etc.).
    4. Cardiac glycosides (digoxin) in order to increase myocardial contractility and increase cardiac output. Drugs of this group are especially important for use in combination with heart failure and atrial fibrillation.

    At the same time, a decrease in heart rate with an increase in diastole is usually noted, which improves hemodynamic conditions.

  • Indirect anticoagulants (warfarin) with a history of atrial fibrillation and thrombosis.
  • Antiarrhythmic drugs (amiodarone) in the presence of paroxysms of atrial fibrillation, ventricular tachycardia.
  • Surgical intervention

    1. Coronary artery bypass grafting is performed when the vessels are noticeably affected by atherosclerosis.
    2. Surgical correction of valve defects – used for severe stenosis or insufficient number of valves.
    3. 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.
    4. 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.

    Timely treatment is the best prevention of these diseases. It is necessary to consult a doctor on time and succumb to medication or surgery.

    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.

    Folk treatment

    In case of cardiac abnormalities, weakening of the heart muscle, manifestations of heart failure, such folk remedies can help:

    • Honey. 1 tsp. 2-3 times a day with milk, cottage cheese, fruits. Honey with hot tea should not be taken. This leads to increased sweating and vigorous heart function. Such an additional burden on a diseased heart is undesirable.
    • Rosehip. 1 tbsp. l dry rosehips pour 2 cups boiling water, boil for 10 minutes, cool and add 1 tbsp. l honey. Drink 1/4 cup 2-3 times a day.
    • Cottage cheese. Eat 100 g of fresh cottage cheese per day.
    • Oats Pour oat grains with water in a ratio of 1:10, insist a day, strain. Drink 1/2 cup 2-3 times a day before meals.
    • Lemon. It is good to chew lemon peel – it is rich in essential oils.
    • Garlic. Eat on an empty stomach 1 large clove of garlic (put finely chopped clove on brown bread, salt and eat).
    • Tibetan medicine recommends: 30 g of walnut kernels, 2 g of raisins, 20 g of cheese. Grind the products and mix. This amount of mixture – at one time.
    • Try to eat more apricots or dried apricots!
    • One glass of viburnum fruit pour a liter of hot water, boil for 8-10 minutes, strain, add 3 tbsp. l honey. Drink 1/2 cup 3-4 times a day.
    • Cardamom, used in small doses as an additive in tea and vegetables, stimulates the heart, improves breathing, stimulates appetite, quenches pain and removes gases. Used in Indian medicine.
    • Pour one teaspoon of lily of the valley flowers with a glass of boiling water, boil for 10 minutes, cool, strain. Take 1 tbsp. l 3 times a day.
    • Pour 1 tablespoon of crushed valerian roots with 8 cup of cold water, leave for 12-1 hours. Take 3 tbsp. l 4- times a day.
    • 4 tbsp. l motherwort herbs pour 1 cup boiling water, heat in a water bath for 15 minutes, cool, strain. Press the raw materials. Bring the resulting infusion to the volume of a glass. Take 1/3 cup 2 times a day an hour before meals.
    • Brew one teaspoon of mint herb with a glass of boiling water, leave for 20 minutes, strain. Drink on an empty stomach half an hour before meals.
    • Pour 1-2 tsp. chicory herbs with a glass of boiling water, insist 20 minutes, strain. Drink 1/2 cup 2-3 times a day before meals.
    • 2-3 tbsp. l St. John’s wort herbs brew 2 cups boiling water. Insist. Take 1/2 cup 3-4 times a day before meals.
    • One tablespoon of dried hawthorn fruit – per glass of boiling water. Insist 2 hours in a thermos. Take 1-2 tbsp. l 3-4 times a day before meals.
    • Hawthorn flowers – 5 parts, mountaineer bird grass – 3 parts, field horsetail grass – 2 parts. 2 tsp brew the mixture with 1 cup boiling water, leave for 1-2 hours, strain. To drink during the day.
    • Motherwort herb – 15 g, mash grass – 15 g, hawthorn flowers – 15 g, chamomile inflorescences – 5 g. 1 tablespoon of the mixture, brew a glass of boiling water, leave for 8 hours. Drink 1/2 cup 3 times a day one hour after eating.
    • Valerian roots -1 part, anise fruits – 2 parts, yarrow grass – 1 part, lemon balm leaves – 1 part. Pour 1 tablespoon of the mixture with 30 cup boiling water, leave for minutes. Take during the day.
    • Yarrow grass – 5 parts, St. John’s wort grass – 4 parts, Arnica inflorescences – 1 part. Pour one tablespoon of the collection with 1 cup of cold water, leave for 3 hours. Then cook for 1 minutes, soak for 5 minutes. Have a drink during the day.
    • Grind the dry roots of Rhodiola rosea and pour 70% alcohol in a ratio of 1:10. Insist 7 days. Take 10-20 drops 3 times a day.
    • Dry crushed ginseng root pour 70% alcohol in a ratio of 1:10. Insist a week. Take 10-15 drops 2-3 times a day.

    Lifestyle and Diet Changes

    Chronic heart failure is a serious disease that requires professional medical attention to treat. However, even simple changes in lifestyle and diet can help relieve symptoms of heart failure.

    Changes in lifestyle and nutrition that doctors recommend for heart failure:

    1. Smoking cessation. Smoking damages blood vessels, increases blood pressure, reduces the amount of oxygen in the blood and makes the heart beat faster.
    2. Weighing. Weight gain can be a sign of flu >

    It is necessary to identify risk factors for the development of heart failure: age, male gender, hypertension, coronary heart disease, diabetes, obesity.
    It is necessary to treat patients with hypertension, in accordance with existing recommendations, to reduce the risk of developing heart failure. Treatment is indicated for all patients with elevated blood pressure (more than 130/90 mmHg).

    Patients with diabetes are shown aggressive treatment to reduce the risk of developing cardiovascular complications. Treatment is indicated for all patients with diabetes, in accordance with existing recommendations. To reduce the risk of cardiovascular complications in patients with diabetes and clinical manifestations of atherosclerosis or with one or more risk factors for the development of coronary artery disease, ACE inhibitors are indicated.

    It is necessary to control the level of blood pressure and blood lipids in patients with diabetes, in accordance with existing recommendations, to reduce the risk of coronary heart disease. Patients should be advised to avoid taking cardiotoxic substances, primarily alcohol, and also to stop smoking and using narcotic drugs, especially cocaine.

    It is necessary to treat hyperlipidemia in accordance with existing recommendations. Normal blood lipid levels should be maintained in all patients. Patients with elevated levels of blood lipids need treatment using lifestyle changes and, if necessary, drugs (PM).

    Adequate treatment of patients with proven coronary artery disease is necessary to prevent myocardial infarction. In patients with proven coronary artery disease, in the absence of contraindications, it is necessary to conduct active therapy, including lipid-lowering drugs (preferably from the group of statins), ACE inhibitors, β-blockers, acetylsalicylic acid.
    It is necessary to prescribe ACE inhibitors in patients after myocardial infarction.

    In an unstable state – conducting revascularization. It is necessary to identify and treat thyroid diseases (the goal is the normalization of serum levels of its hormones). Patients with hypothyroidism are shown hormone replacement therapy with regular laboratory monitoring of blood pressure.

    Adequate treatment of patients with hyperthyroidism with regular laboratory monitoring. It is necessary to regularly conduct a study of thyroid function in patients taking amiodarone. Adequate treatment of patients with supraventricular tachyarrhythmias and stable tachycardia at rest is necessary to prevent the development of left ventricular dysfunction.

    It is necessary to control heart rate in patients with AF and supraventricular tachyarrhythmias. If necessary, you need to consult a patient with a specialist to resolve the issue and restore sinus rhythm.

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    Tatyana Jakowenko

    Editor-in-chief of the Detonic online magazine, cardiologist Yakovenko-Plahotnaya Tatyana. Author of more than 950 scientific articles, including in foreign medical journals. He has been working as a cardiologist in a clinical hospital for over 12 years. He owns modern methods of diagnosis and treatment of cardiovascular diseases and implements them in his professional activities. For example, it uses methods of resuscitation of the heart, decoding of ECG, functional tests, cyclic ergometry and knows echocardiography very well.

    For 10 years, she has been an active participant in numerous medical symposia and workshops for doctors - families, therapists and cardiologists. He has many publications on a healthy lifestyle, diagnosis and treatment of heart and vascular diseases.

    He regularly monitors new publications of European and American cardiology journals, writes scientific articles, prepares reports at scientific conferences and participates in European cardiology congresses.

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