Decompensated heart failure what is it

Unfortunately, the origin of this ailment by scientists is not fully understood. However, studies in this area indicate that decompensated heart failure can occur if there are provocative factors. These factors can be the root cause of the disease. Among them:

  • Myocardial hypertrophy.
  • A change in the structural integrity of the myocardium caused by a heart attack, trauma, ischemia, or myocarditis.
  • Hypertensive crisis.
  • Arrhythmic phenomena.
  • Cases of a sharp increase in pressure in the pulmonary circulation.

This is how decompensated heart failure manifests itself. What is it that interests many.

Along with the above, also the root causes of the disease can be various kinds of stagnant processes of the respiratory system. In all these cases, there is a general rule: SDS, like other types of heart failure, occurs as a result of critical overloads, as well as excessive fatigue of the heart muscle.

The clinical presentation and varieties of decompensated heart failure are described below.

Before you begin to study the symptoms of SDS, it should be noted that the clinical picture of the disease depends entirely on the type of heart failure. Specialists distinguish two forms – chronic and acute. Let us dwell on each of them.

Depending on the origin of the failure, the disease is usually divided into several forms:

  • Myocardial The problem is localized in the heart wall. Myocardial energy metabolism is disturbed, as a result of which there is a violation of the period of contraction and relaxation of the myocardium – systole and diastole.
  • Reloading. It is provoked by excessive stress on the heart. This pathology can be caused by heart disease, or in violation of the blood supply to the body.
  • With combined insufficiency, a combination of both forms is observed: damage to the heart muscle and excessive heart load.

Damage to the heart, as well as a violation of the functions of pumping blood, provoke heart failure. These reasons may arise in the following circumstances:

  • hypertonic disease;
  • ischemia;
  • congenital heart defects.

It is curious that the causes of the failure have a “sexual characteristic.” In women, the disease most often develops against a background of increased pressure. And men suffer from the disease as a result of the ischemic problem of the main organ.

Among the other causes of the disease are:

  • diabetes;
  • disruptions in the heart rhythm – arrhythmias;
  • cardiomyopathy;
  • drinking and smoking;
  • chronic obstructive pulmonary disease;
  • suffered an acute violation of the blood supply to the brain.

Causes of heart failure can be:

  • Heart diseases: coronary artery disease, heart rhythm disturbances;
  • Hypertensive crisis – excessive pressure, which causes a strain on the myocardium;
  • Disorders in the kidneys and liver;
  • Strong cardiac output: with anemia, thyroid disease;
  • Infectious disease and inflammatory processes;
  • Surgical intervention;
  • Errors in treatment, in which the drugs are prescribed incorrectly or the dosage is violated;
  • Frequent use of alcohol and stimulants.

Heart failure in the decompensation stage does not have pronounced symptoms. To date, the disease is under study.

The acute form of heart failure has various causes, which depend on the area that has been affected:

  • An acute left ventricular form develops with myocardial damage. Symptoms also provoke lung tissue lesions: as a result of excessive filling of the respiratory organs with blood, they swell.
  • The right ventricular form, on the contrary, develops as a result of disorders in the organs of the respiratory system: pulmonary embolism. It can also cause rupture of the interventricular septum as a result of heart muscle infarction. In the circulatory system there is an uneven accumulation of blood, after which the liver increases.

What is and how is decompensated heart failure treated?

Decompensated heart failure is a disease of the cardiovascular system and is characterized by an inability to supply tissues and organs with the necessary amount of blood for normal functioning.

This is the very last stage of the pathological process in which changes of a pathofunctional nature occur. With the progression of the disease, the heart does not cope with its main function either during the normal course of life and physical activity, but also at rest.

This diagnosis says that the heart can no longer supply other organs with necessary blood, decompensated insufficiency is already a condition when the compensatory mechanism and reserves can not compensate for the lack of blood supply. Heart damage at this stage is already so serious and irreversible that the body cannot replace this deficiency with anything.

It is decompensated heart failure that is the result of the acute and rapid development of pathology, when the body does not have time to rebuild and adapt to forced changes.

What is the danger of acute form?

Unfortunately, the acute form is characterized by a high level of deaths due to the fact that the heart muscle is unable to drive the right amount of blood and there is no compensation function (or is insufficient), as well as due to pulmonary edema or myocardial infarction. In the case of the manifestation of an acute form of SDS, urgent intervention of specialists is required, who will put the patient in a hospital and carry out a number of necessary resuscitation actions.

Chronic decompensated heart failure also occurs. What it is? About it further.

CHF development mechanism

  1. The throughput (pumping) capacity of the heart decreases – the first symptoms of the disease appear: intolerance to physical exertion, shortness of breath.
    Compensatory mechanisms are connected to preserve the normal functioning of the heart: strengthening the heart muscle, increasing the level of adrenaline, increasing blood volume due to fluid retention.
  2. Heart malnutrition: muscle cells became much larger, and the number of blood vessels increased slightly.
  3. Compensatory mechanisms are exhausted. The work of the heart deteriorates significantly – with every push it pushes out not enough blood.

Chronic SDS

Chronic decompensation is divided into two varieties:

  • Left ventricular is provoked by a decrease in myocardial contraction or as a result of overload of the left ventricle. The situation can be triggered, for example, by a violation of the integrity of the heart muscle, in which the balance between the small and large circle of blood circulation is lost: in the small circle, blood is delayed, and insufficient blood enters the large circle.
  • The right ventricular type has the opposite picture: stagnation occurs in a large circle, and a lack of blood in a small circle. The problem is provoked by painful changes in the lungs, as a result of which an overstrain of the right ventricle is observed.

There are several mechanisms of the pathogenetic type leading to the onset of the disease:

  • myocardial failure due to damage or excessive load;
  • mechanical obstruction of the cardiovascular system;
  • arrhythmias;
  • a combination of several mechanisms is also possible.

In 1934, a classification of heart failure was developed and adopted. The following stages of the disease were identified:

    1st stage. It is cons >

One sign of a disease is shortness of breath

Causes of the acute form of pathology

Consider what decompensated heart failure is, and therefore it occurs. There is a certain set of factors provoking this phenomenon:

  • Congenital heart defect;
  • heart surgery;
  • inflammation of the heart muscle – myocarditis;
  • ischemic disease;
  • brain injury;
  • hypertensive crisis;
  • increased pressure in the pulmonary circulation;
  • hypertrophic cardiomyopathy;
  • arterial hypertension;
  • aortic stenosis;
  • bradyarrhythmia, tachyarrhythmia.

The main causes of heart failure are:

  • coronary heart disease and myocardial infarction;
  • dilated cardiomyopathy;
  • rheumatic heart diseases.

In elderly patients, the causes of heart failure are often type II diabetes and hypertension.

There are a number of factors that can reduce the compensatory mechanisms of the myocardium and provoke the development of heart failure. These include:

  • pulmonary embolism (pulmonary embolism);
  • severe arrhythmia;
  • psycho-emotional or physical overstrain;
  • progressive coronary heart disease;
  • hypertensive crises;
  • acute and chronic renal failure;
  • severe anemia;
  • pneumonia;
  • severe SARS;
  • hyperthyroidism;
  • long-term use of certain medications (adrenaline, ephedrine, corticosteroids, estrogens, non-steroidal anti-inflammatory drugs);
  • infective endocarditis;
  • rheumatism;
  • myocarditis;
  • a sharp increase in the volume of circulating blood with an incorrect calculation of the volume of intravenously injected fluid;
  • alcoholism;
  • fast and significant weight gain.

Elimination of risk factors helps prevent the development of heart failure or slow its progression.

Why is CHF developing, and what is it? The cause of chronic heart failure is usually damage to the heart or impaired ability to pump the right amount of blood through the vessels.

The main causes of the disease are called:

  • coronary heart disease;
  • arterial hypertension;
  • heart defects.

There are other provoking factors for the development of the disease:

  • diabetes;
  • cardiomyopathy – a myocardial disease;
  • arrhythmia – a violation of the heart rhythm;
  • myocarditis – inflammation of the heart muscle (myocardium);
  • cardiosclerosis – damage to the heart, which is characterized by proliferation of connective tissue;
  • smoking and alcohol abuse.

Diagnostics

If you consult a doctor at the first symptoms, then the problem can be eliminated in a fairly short time. Sometimes diagnostic methods can be complicated. For example, with a disease with two different ailments with similar symptoms.

It is important to understand that during heart disease it is impossible to immediately make an accurate diagnosis. This will take more time. It is important to monitor the patient’s condition in the daytime and at night.

To date, the diagnosis of edema, which provokes the cardiac disease in question, is simple. But, for some reason, many patients are treated only if severe edema is already present. In connection with the delay – the treatment is significantly complicated.

The primary examination is mainly carried out by a general practitioner. But, more serious actions that require special skills and certain special equipment are carried out by cardiologists and other specialists.

Research methods during the diagnosis of heart edema:

  • blood test;
  • monitoring the state of pressure at different times of the day (CVP);
  • obtaining anthropometric data;
  • conducting the Kaufman experiment;
  • Analysis of urine;
  • research using ultrasound;
  • the use of electrocardiography (ECG);
  • echocardiographic examinations (echocardiography);
  • radiography;
  • physical examination of the patient (visual examination, percussion, history taking, auscultation and other methods).

A characteristic sign of decompensated insufficiency is a general weakness, as well as severe swelling of the limbs. Often, with a disease, patients dramatically gain weight.

The complex of diagnostic measures includes the study of the level of change of the beta-type urethic peptide, the H-neutral peptide, as well as conducting echocardiography and x-rays of internal organs, transcoronal echocardiography.

Specialists can obtain more accurate information about the force of blood pressure in the heart chambers by carrying out a special procedure during which a catheter is inserted into the central vein or pulmonary artery and the necessary measurements are made.

Also, the diagnosis of any form of heart failure involves a series of laboratory tests, including a blood test for creatinine and urea, electrolytes, transaminases and glucose, and other blood and urine tests; study of the presence and ratio of gases in the blood of arteries.

If you consult a doctor at the first symptoms, then the problem can be eliminated in a fairly short time. Sometimes diagnostic methods can be complicated. For example, with a disease with two different ailments with similar symptoms.

It is important to understand that during heart disease it is impossible to immediately make an accurate diagnosis. This will take more time. It is important to monitor the patient’s condition in the daytime and at night.

To date, the diagnosis of edema, which provokes the cardiac disease in question, is simple. But, for some reason, many patients are treated only if severe edema is already present. In connection with the delay – the treatment is significantly complicated.

The primary examination is mainly carried out by a general practitioner. But, more serious actions that require special skills and certain special equipment are carried out by cardiologists and other specialists.

A characteristic sign of decompensated insufficiency is a general weakness, as well as severe swelling of the limbs. Often, with a disease, patients dramatically gain weight.

The patient examination program includes the following required activities:

  1. Collecting a complete medical history is the first measure, meaning a thorough analysis of the patient’s medical history, assessment of the severity of symptoms at each stage of the process. The specificity of the diagnosis shows that the patient was already registered with a cardiologist, but either the therapy was ineffective, or the process was aggravated by an external factor. As a result, heart failure has passed into its extreme form. The specialist will need maximum attention to the treatment process and the search for errors in past appointments.
  2. A general blood test shows the content of glucose, creatinine, urea, electrolytes, transminase. It can also be used to evaluate the state of the thyroid gland and the level of pressure of blood gases in the arteries.
  3. ECG and echocardiography determine the thickness of the myocardium, the structure of the heart, find abnormalities and disorders.
  4. A chest x-ray visualizes the organ, helps determine the exact size, with the help of an X-ray, the diagnostician evaluates the condition of the lungs, determines the presence of pathology and the stage of the problem.
  5. Insertion of a catheter into the pulmonary artery or into the central vein. This method helps to measure the pressure level during the filling of the chambers, as a result of which cardiac output is determined.

Diagnosis of the disease involves conducting instrumental studies. To this end, the following methods may be used:

  • electrocardiography;
  • chest x-ray;
  • determination of the B-type natriuretic peptide or N-neutral.

Varieties and clinical presentation

Decompensated heart failure is characterized by the presence of symptoms:

  • Myocardial damage;
  • Difficulty breathing with loads and without them, regardless of the time of day;
  • General weakness of the body as a result of oxygen starvation of the body;
  • Weight gain;
  • Edema;
  • As a result of fluid stagnation in the lungs, a wet cough appears;
  • An increase in heart size leads to a rapid heartbeat: in order to push the right amount of blood, the organ begins to contract more often.

Chronic heart failure, the stages of which sometimes do not have vivid symptoms, are often detected during the progression of the disease. The main part of the symptoms provokes stagnation of fluid in the tissues and organs, as well as their insufficient blood supply. Some signs of fluid buildup:

  • shortness of breath during physical exertion – climbing stairs, lifting weights;
  • coughing and wheezing in the lungs;
  • sharp causeless weight gain;
  • swelling of the extremities in the ankles.

Insufficient blood supply to organs and tissues provokes the appearance of a number of symptoms:

  • dizziness, fainting, “darkening” in the eyes;
  • general weakness;
  • cardiopalmus;
  • frequent urination at night;
  • loss of appetite.

Some emotional ailments are often added to a number of physical ailments: feelings, depressive states.

In the acute form of the disease, symptoms occur quickly, sometimes with lightning speed. There are signs of failure manifesting in the right ventricle:

  • swelling of the neck veins;
  • blue fingers, limbs, tip of the nose and earlobes;
  • swelling of the arms and legs;
  • due to a sharp swelling of the liver, the skin becomes yellowish.

The left ventricle with pathology can be determined by the following signs:

  • respiratory failure: shortness of breath, suffocation, intermittent breathing;
  • sharp attacks of cough, in which sputum is released, sometimes foam;
  • when taking a sitting position, the patient becomes easier, he tries to let his legs go;
  • when listening to the lungs moist rales are detected.

Examination in a clinical setting may reveal the following symptoms:

  • increased blood pressure;
  • oxygen starvation, wheezing in the lungs;
  • signs of arrhythmia;
  • decreased urine output;
  • limb temperature decrease.

Radiography of the sternum makes it possible to diagnose venous congestion, as well as interstitial edema.

In women, heart failure is often manifested by a number of symptoms:

  • burning pain in the chest;
  • loss of appetite provokes a sharp decrease in body weight;
  • hypertension;
  • swelling of the extremities, as well as blue skin of the fingers.

For men, other symptoms are characteristic:

  • chest pain is oppressive, often also affecting the left arm;
  • a cough can be not only wet, but also the formation of hemoptysis;
  • swelling of the upper and lower extremities;
  • respiratory failure leads to redness of the skin in the chest area;
  • an acute form of the disease can cause loss of consciousness.

In contrast to the acute form of heart failure, which must be treated immediately, the chronic form often involves life-long therapy with a number of medications.

In order to diagnose decompensated heart failure, an examination is carried out, based on the results of which a final diagnosis is made. To confirm the presence of the disease, instrumental research methods are used.

The study uses electrocardiography, as well as chest x-ray. A blood test is performed. A urine test is also being studied. Based on indicators of the level of urea, glucose, as well as the number of electrolytes, a preliminary diagnosis is made. Creatinine levels are checked.

To study the contraction and relaxation of the heart muscle (systole and diastole), a study called transthoracic echocardiography is performed. Based on catheterization, cardiac output is examined, as well as pressure in the heart chambers and their filling with blood.

In order to start effective treatment, a quick diagnosis is necessary, which is possible in the presence of certain symptoms. The procedure is complicated by the fact that often on the clinical manifestations of one disease, signs of another are superimposed.

Attention! Due to the heterogeneous nature of heart failure of the last stage, there is no clear specific symptom that would 100% confirm the diagnosis.

Decompensated heart failure has the following symptoms:

  • a history of myocardial damage or heart failure;
  • shortness of breath in the daytime and at night, with physical exertion and at rest;
  • general weakness;
  • swelling, weight gain, or abdominal volume.

Using a physical examination, you can identify the following signs of the disease:

  • increased pressure in the jugular vein;
  • wheezing in the lungs, hypoxia;
  • arrhythmia in any of its manifestations;
  • decreased urine production;
  • cold lower limbs and hands.

Diagnosis is not possible without instrumental tests. For example, chest x-ray is performed to determine venous stasis and interstitial edema.

Before considering the symptoms of decompensated heart failure, it should be noted that the clinical picture directly depends on the type of disease. Two forms of SDS are distinguished – chronic and acute. Let’s consider each of them in more detail.

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Acute form

A diagnosis requires certain symptoms. However, it must be borne in mind that the symptoms of one disease overlap with the symptoms of other pathologies. In addition, there is no distinct sign that would make it possible to make a diagnosis with confidence.

The initial stages of chronic heart failure can develop according to the left and right ventricular, left and right atrial types. With a long course of the disease, there are impaired functions of all parts of the heart. In the clinical picture, the main symptoms of chronic heart failure can be distinguished:

  • fatigue;
  • shortness of breath, cardiac asthma;
  • peripheral edema;
  • heartbeat.

Complaints of fatigue show most patients. The presence of this symptom is due to the following factors:

  • low cardiac output;
  • insufficient peripheral blood flow;
  • tissue hypoxia;
  • the development of muscle weakness.

If we are dealing with hypodiastolic decompensation, then the decrease in minute volume is explained by insufficient filling of the ventricles. Hypodiastolic decompensation has not only a primary cardiac form: this also includes that form of peripheral circulatory failure, when the cause of the decrease in diastolic filling is primarily not in the heart, but in an imbalance in the peripheral factors that regulate blood circulation.

Hyposystolic decompensation. With hyposystolic decompensation, the primary cause of imbalance in blood circulation is a decrease in systolic myocardial strength.

The first (compensated) stage. In this situation, shortness of breath occurs, fatigue increases and the heart rate increases. During physical exertion, a state of suffocation appears. As for hemodynamics, it is not disturbed.

Second stage. Period II A (decompensated, reversible). If the patient is in a calm state, then pathological symptoms are expressed moderately. Under load, everything is complicated by tachycardia and shortness of breath. Often, there is the appearance of acrocyanosis and congestive wheezing in the lower parts of the lungs. After resting, in the morning, the liver remains enlarged. As for the feet and ankles, the swelling on them is slightly reduced, but not for long.

The second (irreversible decompensated failure) stage. Period II B. In a calm state, without the use of loads – from time to time an attack of shortness of breath may appear. When the patient is given a little load, then everything becomes complicated:

  • swelling spreads to the thighs and lower legs;
  • severe wheezing is observed in the lungs;
  • the size of the liver remains enlarged.

In some cases, an effusion of the pleural cavity is observed (even after rest – the symptoms do not decrease).

The third stage (irreversible decompensated failure). Severe asthma attacks occur, especially during sleep. Severe shortness of breath is constantly present in the form of asthma. Swelling develops, accompanied by expansion of the jugular veins. During the third stage, all symptoms can be complicated by the appearance of hydrothorax or hydropericardium.

According to the forecasts of cardiologists and other experienced specialists, chronic heart failure, which is in the stage of decompensation, in most cases has an unfavorable outcome. During the third irreversible stage, dangerous diseases such as ascites and anasarca develop.

Decompensated heart failure: treatment

According to statistics for 2010, about 1 million people die from heart failure in Russia every year. It is the occurrence of decompensation and cardiac arrhythmias that is called by specialists the main cause of high mortality. Decompensation often requires immediate medical attention.

In the treatment of decompensation, drug therapy is also used. Used drugs and their groups:

  • “Morphine” and its analogues. It is used to reduce heart rate and reduce pain.
  • Diuretics. Used for symptoms of flu >

However, only the attending physician can determine and compile the exact list of necessary medicines for stopping and treating SDS.

We examined what decompensated heart failure means.

When diagnosed with decompensated heart failure, the patient is hospitalized. Treatment is aimed at eliminating the diseases that provoked heart failure.

Medication for heart failure includes the following principles:

  • Detection and elimination of the cause of the disease. Often, in parallel with drug treatment, there is a need for prosthetic heart valves;
  • Identification and elimination of factors resulting in decompensation of heart failure;
  • Treatment of decompensation of heart failure: eliminating the accumulation of blood in the respiratory organs, improving the blood supply to organs, increasing cardiac output.

In severe forms of the disease, the doctor may prescribe a surgical operation. An indication for such an operation may be the risk of cardiac arrest on the background of a serious condition of the patient. Coronary angioplasty, bypass surgery, or implantation of an artificial stimulator or defibrillator may be prescribed.

In addition to drug treatment for heart failure, changes in diet are shown. The main point is about refusing salt.

Also used for treatment are diuretics that help to remove accumulated fluid from the body. Such therapy helps eliminate puffiness and lower blood pressure.

Inhibitors reduce the likelihood of disease progression. Beta blockers normalize heart rate.

Signs of heart failure

Severe heart failure is accompanied by:

  • gas exchange disorder;
  • edema;
  • stagnant changes in the internal organs.

Under-oxidized metabolites accumulate in the blood, activating the rate of basal metabolism. As a result, a vicious circle is formed, the body needs more oxygen, and the circulatory system cannot provide these needs.

A gas exchange disorder leads to symptoms of heart failure such as shortness of breath and cyanosis.

More about decompensation therapy

The main goal of therapy is to maintain a normal level of saturation of hemoglobin with oxygen, which allows for a normal supply of oxygen to tissues and organs and to avoid multiple organ failure.

One of the applicable methods is oxygen inhalation (as a rule, non-invasive ventilation (NSAID) is used at positive pressure), which allows you to refuse the use of endotracheal intubation. The latter is used for mechanical ventilation in case of impossibility to eliminate pulmonary insufficiency by NSAID.

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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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