Factors that provoked the development of the syndrome can be past or ongoing diseases that are related to myocardial damage. Reasons for development are characterized by:
- ventricular myocardial hypertrophy;
- myocardial ischemia;
- high blood pressure in the pulmonary vessels;
- heart valve disease;
- renal failure;
- congenital heart disease or mitral disease;
- lung diseases (chronic respiratory diseases) or wounds, infections. The disease develops due to contraction of the ventricles and contraction of the myocardium.
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- Varieties of Heart Failure
- Types and stages
- General characteristics and development mechanism
- Symptoms of heart failure in men
- When to seek help: the main symptoms of the disease
- I stage
- II stage
- How to identify heart failure?
- Heart failure treatment
- First aid
- First aid for a person with an attack
- Influence of age and risk factors
- Nutrition and daily routine
With the development of this disease, the child has increased fatigue, difficulty breathing or shortness of breath, loss of consciousness, dizziness, darkening in the eyes, the skin turns pale, lips, toes and hands darken, tachycardia, restless sleep, cough with wheezing, vomiting. In babies, frequent regurgitation, specific swelling of the limbs are observed.
The development of the acute form occurs under the influence of:
- Diseases that reduce the contractility of the heart muscle, damaging or stunning it. This occurs with myocardial infarction, when a violation of the blood flow to the area of the heart causes cell death, with inflammation of the heart muscle, as well as after surgical interventions on the heart or as a result of the use of a cardiopulmonary bypass.
- Decompensation of chronic insufficiency, as a result of which the heart can not prov >
There are also extracardiac causes of the disease. Acute cardiovascular failure can be caused by:
- infectious processes;
- a developing circulatory disturbance in the brain, in which tissues are damaged, and organ functions are impaired;
- extensive surgical interventions;
- severe brain injuries;
- toxic effects on the heart muscle with drugs or alcohol;
- electric pulse therapy, injuries resulting from exposure to an electric current.
In the vast majority of cases, heart failure is a natural outcome of many diseases of the heart and blood vessels (valvular heart disease, coronary heart disease (CHD), cardiomyopathy, arterial hypertension, etc.). Only occasionally, heart failure is one of the first manifestations of a heart disease, such as dilated cardiomyopathy.
With hypertension, it can take many years from the onset of the disease to the onset of the first symptoms of heart failure. Whereas as a result of, for example, acute myocardial infarction, accompanied by the death of a significant part of the heart muscle, this time can be several days or weeks.
In addition to cardiovascular diseases, the onset or exacerbation of manifestations of heart failure is promoted by fever, anemia, increased thyroid function (hyperthyroidism), alcohol abuse, etc.
For a condition such as acute heart failure, pathogenesis may include complications from various ailments in which circulatory disturbances occur due to a weakening of the pumping function of the heart and its lower blood filling.
It should be emphasized that in such a pathological condition as acute heart failure the causes of occurrence, as well as the mechanisms of its development, may vary, moreover, it can develop against the background of other diseases, seriously aggravating their course. What causes acute heart failure? These may be cardiological causes and situations that are not related to the heart.
Etiology of acute heart failure associated with cardiac problems:
- Cardiological ailments leading to a sharp decrease in the contractility of the myocardium (as a result of its “stunning” or damage) – among them myocarditis, acute myocardial infarction, the consequences of connecting to a cardiopulmonary bypass, the consequences of cardiac surgery.
- Decompensation (accruing phenomena) of chronic heart failure, that is, a condition in which the heart is not able to adequately provide the body with blood.
- Heart tamponade.
- Violation of the integrity of the heart chambers or valves.
- Hypertensive crisis.
- Severe hypertrophy (thickening of the walls) of the myocardium.
- Diseases leading to an increase in pressure in the pulmonary circulation: acute diseases, pulmonary embolism.
- Cardiac arrhythmias (tachycardia or bradycardia).
The causes of acute heart failure may not be of a cardiological nature:
- extensive surgical intervention;
- cerebral stroke (lack of blood circulation, leading to the death of certain parts of the brain and the disruption of its functioning);
- myocardial poisoning with alcohol or with an overdose of drugs;
- severe brain injury;
- the consequences of electric pulse therapy – electric trauma resulting from exposure to a patient’s body with an electric current.
The causes of chronic heart failure are as follows:
- Pathology of the heart valves. They lead to the ingress of excess blood into the ventricles, which causes their congestion.
- Hypertension. Consists in chronically high pressure due to dysfunction of the regulation of blood flow.
- Dilated cardiomyopathy is a distension of the heart cavity that reduces the discharge of blood into the arteries.
- Aortic stenosis. The aortic lumen is narrowed, resulting in blood accumulating in the left ventricle.
- Tachyarrhythmia is a rapid heartbeat.
- Myocarditis is an inflammation of the heart muscle that causes a reduction in its conductivity.
- Bazedova’s disease is the content in the blood of an impressive number of thyroid hormones that affect the functioning of the heart.
- Myocardial infarction, ischemic disease lead to the fact that the myocardium is not supplied with blood in the required volumes.
- Pericarditis – inflammation of this lining of the heart prevents the normal filling of the heart chambers.
- Hypertrophic cardiomyopathy – hypertrophy of the walls of the ventricle, due to which its volume inside is narrowed.
All these diseases lead to a weakening of the heart.
The causes of acute heart failure are usually divided into two large groups:
- pathologies and heart defects;
- diseases that are not related to the heart.
Symptoms of acute heart failure caused by pathologies and heart defects are as follows:
- Thromboembolism of small branches of the pulmonary artery. High pressure in the pulmonary vessels leads to severe overstrain of the right ventricle.
- Hypertensive crisis. A spasm of the small arteries that feed the heart is due to increased pressure. Thus, ischemia occurs. At the same time, the number of heart contractions quickly increases, leading to overload of this organ.
- Problems with intracardiac movement of blood. There may be several reasons for this pathology: damage to the heart valve, rupture of the chord, and the valve retaining walls.
- Acute heart rhythm disturbances. Heartbeat becomes frequent, hence, congestive heart failure.
- Pathology “tamponade of the heart.” Excess fluid accumulates between the leaves of the pericardium, while the cardiac cavities are not squeezed and nothing prevents its full reduction.
- Acute severe myocarditis. Often in humans, myocardial inflammation leads to a sharp decrease in the pumping function of the heart, malfunctions in heart rhythms.
- Myocardial infarction. It can lead to the death of cardiac myocardial cells due to acute circulatory disorders.
- Bradycardia or tachycardia, lead to a decrease in the contractile function of the heart, there is a violation of the rhythm of the heartbeat.
- Rupture of the aorta. This disease leads to problems in the outflow of blood from the left ventricle and the functioning of the heart.
In addition, AHF can trigger physical stress or emotional shock by joining in chronic heart failure.
Varieties of Heart Failure
According to the classification of insufficiency, there are two forms of the rate of development of the disease according to myocardial lesions. The acute form has a rapid development, manifested in the form of cardiac asthma and cardiogenic shock. Causes – rupture of the walls of the left ventricle, myocardial infarction. The chronic form develops gradually, over several weeks, months, years. Causes – heart valve defects, chronic respiratory failure, anemia, lowering blood pressure.
There are four functional stages of this disease:
- At the first stage, when playing sports, there is no weakness, an accelerated heartbeat, and any pain in the chest area.
- In the second stage of the disease, the patient has moderate restrictions on playing sports. At rest, the patient feels well, but shortness of breath manifests itself during sports.
- At the third stage of the disease, the patient feels comfortable at rest.
- At the fourth stage of the disease, discomfort is observed with any activity, load. Angina pectoris syndrome is observed only at rest.
There are several options for the course of the disease.
If the blood movement is stagnant, then the development is observed:
- Right ventricular failure, in which venous blood stagnates in all organs and tissues.
- Left ventricular failure with blood stasis in the pulmonary circulation.
- Cardiac asthma. The condition is characterized by a sharp onset of shortness of breath, turning into choking.
- Pulmonary edema. In this case, intravascular fluid accumulates in the lung tissue.
For the hypokinetic type of hemodynamics, development is observed:
- Cardiogenic shock. At the same time, myocardial contractility abruptly decreases, and blood flow to all organs and tissues stops.
- Arrhythmic shock associated with impaired heartbeat.
- Reflex shock. It occurs as a result of severe pain and is quickly eliminated with painkillers.
- True cardiogenic shock. The problem is observed if half the muscles of the left ventricle are affected. Usually, this occurs in people after 60 years with a repeated heart attack and in the presence of hypertension and diabetes.
A sharp deterioration in the course of chronic heart failure can also occur. At the same time, adequate blood supply to organs and tissues becomes impossible.
According to the phases of the heartbeat, where a violation occurs:
- systolic (inability of the heart to throw out the necessary amount of blood from the ventricle);
- diastolic (inability of the ventricles to completely fill with blood).
For the reason that caused the disease:
- failure that occurred in humans for the first time, and in which previously no cardiac pathologies were observed;
- acute failure, which was the result of acute decompensation of previously existing chronic heart failure.
In the predominantly affected part of the heart:
Two types of OCH are known to medicine:
- Right ventricular failure. It is caused by problems in the right ventricle, often resulting from congenital malformations or heart attacks.
- Left ventricular failure. The pathology of the left ventricle is its cause, while the right one continues normal functioning. The left half does not cope with the flow of blood that comes from the right. Therefore, blood stagnates in the pulmonary circulation.
With myocardial infarction, biventricular insufficiency may occur if both ventricles are affected or an interventricular septum ruptured.
The following features of the course of acute heart failure are highlighted:
- Pulmonary edema. It is a filling of the respiratory organs with a fluid that seeps through the capillary walls, which causes a lack of air and shortness of breath.
- Cardiogenic shock. This is a significant decrease in myocardial contractility. The level of minute and stroke blood volume is reduced, which is not able to compensate even the increase in vascular resistance. Symptoms are as follows: an earthy skin color, a frequent pulse, a feeling of fear, a sharp chest pain that passes into the neck, arms, shoulder blades. The patient needs urgent help.
- Hypertensive crisis . Increased pressure leading to organ damage. If the patient already has heart defects, then the risk of death is great.
- Acute decompensation of CHF. In such a case, the symptoms of AHF are implicitly presented.
- DOS with high cardiac output. Signs of heart failure are as follows: tachycardia, stagnation of blood in the lungs, often high blood pressure.
It is characterized by a sudden, dynamic and to some extent unpredictable development. An attack can develop in 3-5 minutes or 3-5 hours. There is a violation of the contractile function of the heart, therefore, blood circulation suffers, and the load on the heart tissue (either on the left or right ventricle) increases dramatically.
Various types of acute form are characterized by:
- stagnation of blood in various large veins or pulmonary circulation;
- a sharp decrease in the frequency of heartbeat, which causes a deterioration in the blood supply to organs and tissues of the body;
- sudden deterioration in the condition of a patient suffering from a chronic form of the disease.
The most common form. It is characterized by a progressive course, an increase in the functional problems of the heart. The disease has several stages.
Initially, the heart muscle compensates for the insufficient amount of blood ejected, increasing the number of contractions. At this time, myocardial hypertrophy gradually occurs, the vessels begin to narrow reflexively, and the patient feels periodic ailments.
This condition lasts until the compensation mechanism has exhausted its resources. Organs and tissues are more deficient in oxygen delivered to the blood, and metabolic products are excreted worse. Dystrophic phenomena develop in the body.
- First . The patient is physically active and does not feel any obvious signs of the disease.
- Second one. The patient experiences good peace, but physical activity causes the onset of symptoms of the disease.
- Third . The patient is comfortable at rest, however, for the appearance of signs of the disease, much less physical activity is needed.
- Fourth. Already at rest, the patient feels discomfort, and with a minimal load, the symptoms sharply increase.
Types and stages
In medicine, 4 stages (degrees) of heart failure are known.
- First one. Light manifestations of the disease during physical exertion (fatigue, shortness of breath, increased heartbeat), which most patients usually do not pay attention to. When calm, the symptoms go away.
- The second one. There are quite long, increasing changes in the functions of the heart. The patient begins to feel interruptions in the heart rhythm and shortness of breath is already at rest, however, their degree still remains moderate. Moreover, symptoms may appear suddenly, for example, when trying to get out of bed.
- The third. In the end, interruptions in the work of other organs, blood vessels, accompanied by pathological changes in their tissues, and the circulatory system make themselves felt.
General characteristics and development mechanism
The timing of the onset of apparent heart failure is individual for each patient and his cardiovascular disease. Depending on which ventricle of the heart suffers more as a result of the disease, distinguish between right and left ventricular heart failure.
In cases of right ventricular heart failure, excess fluid is retained in the vessels of the pulmonary circulation, resulting in swelling, initially in the area of the feet and ankles. In addition to these basic signs, right ventricular heart failure is characterized by rapid fatigue, due to low oxygen saturation of the blood, as well as a feeling of fullness and pulsation in the neck.
Left ventricular heart failure is characterized by fluid retention in the pulmonary circulation, as a result of which the amount of oxygen entering the blood decreases. As a result, shortness of breath occurs, intensifying during physical exertion, as well as weakness and fatigue.
The sequence of occurrence and severity of symptoms of heart failure are individual for each patient. In diseases accompanied by damage to the right ventricle, symptoms of heart failure appear faster than in cases of left ventricular failure. This is due to the fact that the left ventricle is the most powerful part of the heart.
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.
Symptoms of heart failure in men
In addition to general symptoms, in women, the disease manifests itself:
- chest pains (burning nature);
- weight loss due to lack of appetite;
- increased blood pressure;
- swelling of the limbs and blue fingertips.
Symptoms that are most often observed in men are as follows:
- chest pain (of a pressing nature) that gives to the left hand;
- cough, accompanied in some cases by hemoptysis;
- swelling of the extremities;
- respiratory failure with redness of the skin on the chest.
When to seek help: the main symptoms of the disease
Heart failure syndrome has several types of clinical symptoms that are divided into stages. Shortness of breath is observed, which is accompanied by a cough with blood. You can find them during sports. The patient may complain of general weakness, fatigue. Some patients complain of a decrease in urine during night visits to the toilet. With the disease, a blue tint on the skin of the hands, feet, tip of the nose, earlobes can be observed.
Symptoms of acute heart failure are associated with impaired functions of the left or right ventricles.
The development of left ventricular failure is observed with pathologies that increase the load on the left heart. This is possible if a person suffers from hypertension, aortic defect, suffered myocardial infarction.
If the left ventricle cannot perform its functions, then there is an increase in pressure in large and small vessels of the lungs, their permeability increases, due to which the liquid part of the blood flows through their walls. Interstitial, and gradually alveolar edema develops.
The clinical picture of this condition is represented by cardiac asthma and alveolar pulmonary edema. An attack occurs if a person is subjected to physical or emotional stress. Patients usually suffer from sudden asphyxiation at night, which causes them to wake up.
Cardiac asthma is characterized by the appearance of a feeling of lack of air, palpitations, cough with sputum, severe weakness, cold sweat. An attack forces a person to crouch and lower their legs.
With the development of stagnation in the pulmonary circulation, pulmonary edema progresses. During a sharp asphyxiation, the patient begins to cough and foamy pink sputum is released, this is due to the appearance of blood impurities in it.
The patient breathes like a boiling samovar, is in a sitting position with his legs down, his face turns blue, the neck veins swell, the skin is covered with cold sweat.
In the presence of pulmonary edema, it is necessary to urgently deliver the patient to the intensive care unit and provide medical care, since the likelihood of a fatal outcome is very high.
Left atrial insufficiency is found in mitral stenosis. Clinical manifestations are similar to left ventricular pathology.
The development of right ventricular failure occurs in connection with a thrombus blockage of large branches of the pulmonary artery.
Stagnation develops in a large circle of blood circulation, due to which the lower extremities swell, it hurts on the right under the ribs, the veins in the neck are bursting and pulsating, shortness of breath occurs, the surface of the skin turns blue, pressing pains appear in the heart area.
There is also a weakening of the peripheral pulse, a sharp decrease in blood pressure.
If the right ventricular pathology develops in the stage of decompensation, then the signs appear earlier than in acute left ventricular failure. This is due to the fact that the latter has a large set of compensatory capabilities, as it is the most powerful part of the heart.
Heart failure can manifest itself with different symptoms, depending on which part of the heart is more affected. Shortness of breath, arrhythmias, dizziness, darkening in the eyes, fainting, swelling of the cervical veins, pallor of the skin, swelling of the legs and pain in the legs, enlarged liver, ascites (free fluid in the abdominal cavity) may occur.
Symptoms of heart failure depend on which side of the heart, right, left, or both, is ineffective. If the right side of the heart does not work well, blood overflows the peripheral veins and as a result seeps into the tissues of the legs and abdominal cavity, including the liver. This causes swelling and enlarged liver.
If the left side is affected, then the blood overflows the vessels of the pulmonary circulation and heart and partially passes into the lungs. Rapid breathing, coughing, frequent heart rate, bluish or pale skin color are characteristic of this case of heart failure. Symptoms can be of varying severity, death is possible.
Edema is one of the first symptoms of right ventricular heart failure. Initially, patients are concerned about minor edema, usually affecting the feet and lower legs. Edema evenly affects both legs. Swelling occurs in the late afternoon and passes in the morning. With the development of insufficiency, edema becomes dense and does not completely pass by the morning.
Then, fluid accumulates in the abdominal cavity (ascites). With the development of anasarca, the patient usually sits, as in the supine position there is a sharp lack of air. Hepatomegaly develops – an enlargement of the liver due to the overflow of its venous network with the liquid part of the blood. Patients with an enlarged liver often notice discomfort (discomfort, heaviness) and pain in the right hypochondrium.
Fatigue is a symptom characteristic of both right and left ventricular failure. At first, patients noted a lack of strength when performing previously well-tolerated physical activity. Over time, the duration of periods of physical activity decreases, and pauses for rest increase.
Shortness of breath is the main and often the first symptom of chronic left ventricular failure. During shortness of breath, patients breathe more often than usual, as if trying to fill their lungs with the maximum amount of oxygen. At first, patients notice shortness of breath only when performing intense physical exertion (running, fast climbing stairs, etc.).
A paroxysmal cough, which occurs mainly after an intense exercise is performed, is often perceived by patients as a manifestation of chronic lung disease, for example, bronchitis. Therefore, when interviewing a doctor, patients, especially smokers, do not always complain of coughing, believing that it is not related to heart disease.
Heart palpitations (sinus tachycardia) are perceived by patients as a sensation of “fluttering” in the chest, which occurs with some kind of motor activity and disappears after a while after its completion. Often, patients get used to heart palpitations, not fixing their attention on it.
Manifestations of circulatory failure depend on its severity. Three stages are traditionally distinguished.
In the initial stage of the disease, fatigue, shortness of breath, excessive heart rate during physical exertion occur. Even several squats cause respiratory depression in one and a half to two times. The restoration of the initial heart rate occurs no earlier than 10 minutes of rest after exercise. With intense physical exertion, slight choking may appear.
Local symptoms are mild. Sometimes short-term acrocyanosis may appear (blue skin of the hands, feet). After significant loads, drinking large amounts of water or salt in the evenings, small swelling of the legs or pasty skin in the ankles appear.
The size of the liver is not increased. Sometimes there is a periodic nocturia – frequent urination at night.
After limiting the load and correcting the use of salt and liquid, these phenomena quickly disappear.
In the second stage of the disease, local symptoms of heart failure appear. First, there are signs of damage mainly to one of the ventricles of the heart.
With right ventricular failure, blood stasis occurs in a large circle of blood circulation. Patients are concerned about shortness of breath during physical exertion, for example, when climbing stairs, walking fast. There is a rapid heartbeat, a feeling of heaviness in the right hypochondrium. Quite often there is nocturia and thirst.
This stage is characterized by swelling of the legs, which do not completely pass in the morning. Acrocyanosis is determined: cyanosis of the legs, feet, hands, lips. The liver enlarges, its surface is smooth and painful.
With left ventricular failure, symptoms of stagnation in the pulmonary circulation prevail. Patients feel worse than with right ventricular failure. Shortness of breath during exercise is stronger, occurs during normal walking. With a significant load, as well as at night, choking, dry cough, and even slight hemoptysis occur.
Outwardly, pallor of the skin, acrocyanosis, in some cases a peculiar cyanotic blush (for example, with mitral heart defects), are determined. Dry or small bubbling rales can be heard in the lungs. No swelling on the legs, the size of the liver is normal.
Limiting the load, correcting the use of water and salt, proper treatment can lead to the disappearance of all these symptoms.
Congestive heart failure is gradually increasing, both circles of blood circulation are involved in the pathological process. There is stagnation of fluid in the internal organs, which is manifested by a violation of their function. There are changes in the analysis of urine. The liver thickens and becomes painless. Changes in the biochemical analysis of blood, indicating impaired liver function.
Patients are concerned about shortness of breath with minimal physical exertion, a frequent pulse, a feeling of heaviness in the right hypochondrium. Urine output decreases, swelling of the feet and legs appears. At night, a cough may appear, sleep is disturbed.
- One of the most common symptoms in heart failure is shortness of breath. With the development of the disease, its intensity increases.
- Due to insufficient oxygen supply to the tissue, oxygen starvation develops, which is expressed in rapid fatigue, chronic fatigue.
- Stagnant fluid in the lungs, associated with worsening hemodynamics in the pulmonary circulation, causes a wet cough.
- An increase in ventricles leads to the fact that the heart needs to contract more often in order to push out the right amount of blood – the heartbeat increases.
How to identify heart failure?
Functional diagnosis of this disease is as follows. Doctors conduct a clinical examination, use instrumental examination methods. At the initial study, the specialist determines the severity of the symptoms and the condition of the patient. To do this, check the symptoms of the disease during physical activity and during rest, check the objective signs of heart failure during rest.
At the stage of instrumental methods, an ECG is used, measuring the dimensions of the cavity of the left and right atria, both ventricles, and the size of the ejection fraction. An obligatory examination criterion is Doppler echocardiography, which allows you to determine blood flow velocity, pressure, the presence of pathological discharge of blood. With negative assessments by doctors, the patient is sent for treatment to cardiology.
Heart failure is a consequence of various diseases and conditions, both cardiovascular and others. To establish the presence of heart failure, sometimes a routine medical examination is enough, while a number of diagnostic methods may be required to clarify its causes.
Electrocardiography (ECG) helps doctors detect signs of hypertrophy and inadequate blood supply (ischemia) of the myocardium, as well as various arrhythmias. As a rule, these ECG signs can occur in various diseases, i.e. not specific for heart failure.
Based on the ECG, so-called exercise tests have been created and are widely used, consisting in the fact that the patient must overcome gradually increasing levels of exercise. For these purposes, special equipment is used to dose the load: a special modification of the bicycle (bicycle ergometry) or a treadmill (treadmill). Such tests provide information on the reserve capabilities of the pumping function of the heart.
The main and generally available method for diagnosing diseases that occur with heart failure is ultrasound of the heart – echocardiography (echocardiography). Using this method, you can not only establish the cause of heart failure, but also evaluate the contractile function of the ventricles of the heart.
An X-ray examination of the chest organs in heart failure reveals stagnation of blood in the pulmonary circulation and an increase in the size of the cavities of the heart (cardiomegaly). Some heart diseases, for example, valvular heart defects, have their own characteristic radiological “picture”.
This method, as well as echocardiography, can be useful for monitoring treatment. Radioisotope methods for examining the heart, in particular, radioisotope ventriculography, allow highly accurate assessment of the contractile function of the ventricles of the heart in patients with heart failure, including the volume of blood they hold. These methods are based on the introduction and subsequent distribution of radioisotope drugs in the body.
One of the latest achievements of medical science, in particular, the so-called nuclear diagnostics, is the method of positron emission tomography (PET). This is a very expensive and yet rare study. PET allows using a special radioactive “tag” to identify areas of viable myocardium in patients with heart failure in order to be able to adjust the treatment.
Obviously, the diagnosis of acute heart failure, which includes the following measures, is of paramount importance.
- Analysis of patient complaints and medical history.
- An analysis of the history of life in order to determine the possible causes of AHF, as well as previous cardiovascular diseases.
- An analysis of the family history to determine whether relatives had a cardiac disease.
- Examination to detect heart murmurs, wheezing in the lungs, blood pressure and hemodynamic stability in the vessels.
- Removing an electrocardiogram, with which you can detect an increase in size (hypertrophy) of the ventricle, signs of its overload, as well as some more specific signs indicating a violation of the myocardial blood supply.
- Conducting a general blood test, on the basis of which it is possible to determine leukocytosis (an increase in the level of leukocytes), an increase in ESR, which is a non-specific sign of the presence in the body of inflammation due to the destruction of myocardial cells.
- A biochemical blood test to determine the levels of total and “bad” cholesterol, responsible for the formation of atherosclerotic plaques on the walls of blood vessels, as well as “good” cholesterol, which, on the contrary, prevents the formation of plaques. The level of triglycerides and blood sugar is also determined.
- Conducting a general analysis of urine, through which you can detect an elevated level of red blood cells, white blood cells and protein, which may be a consequence of AHF.
- Echocardiography makes it possible to detect potential violations of myocardial contractility.
- Determination in the blood of the level of biomarkers – bodies that indicate the presence of a lesion in the body.
- An x-ray of the chest organs in order to determine the size of the heart, the sharpness of its shadow and determine the stagnation of blood in the lungs. Radiography is useful not only as a diagnostic method, but also as a way to evaluate the effectiveness of the treatment.
- Assessment of arterial blood for its gas composition and determination of its characteristics.
- Heart angiography is a study that allows you to accurately find the place of narrowing of the coronary arteries that feed the heart, determine its degree and nature.
- Multispiral computed tomography of the heart with the introduction of a contrast agent allows you to visualize defects of the heart valves and walls, evaluate their work, and find places of narrowing of the coronary vessels.
- Pulmonary artery catheterization helps not only in the diagnosis, but also in the process of tracking the results of treatment of AHF.
- Using magnetic resonance imaging, images of internal organs can be obtained without the use of harmful x-rays.
- Detection of ventricular natriuretic peptide – this protein is produced in the ventricles of the heart at the time of overload, and with increasing pressure and stretching the ventricle, it is ejected from the heart. The stronger the heart failure, the more this peptide appears in the blood.
Among the main features include the following:
Having noticed such basic symptoms, you should undergo examination and, if necessary, treatment.
Symptoms of right ventricular acute heart failure are due to the presence of stagnant blood in the pulmonary circulation. Manifestations of heart failure will be as follows:
- Rapid heartbeat. It occurs when blood enters the coronary heart vessels. People are characterized by shortness of breath, a feeling of heaviness behind the sternum, dizziness, and tachycardia attacks.
- Swelling. They arise due to several factors: the permeability of the capillary walls increases, blood circulation slows down, fluid is retained in the tissues, accumulates in the limbs and body cavities. Edema can also cause an imbalance of water-salt metabolism.
- Swollen cervical veins – swelling increases with inspiration, which is associated with increased intrathoracic pressure and problems with blood flow to the heart.
- Low blood pressure caused by a decrease in cardiac output. It can be recognized by excessive sweating, pallor and loss of strength.
Symptoms are quite serious, but there is no congestion in the lungs.
Left ventricular acute heart failure can be determined by the following symptoms:
- During sleep, attacks of cardiac asthma are noted: shortness of breath with wheezing, shortness of breath, panic. The patient has to sit down and start breathing with his mouth in order to feel improvement. But the lack of air is felt for some time – from several minutes to two hours.
- Cough. At first it’s very dry, then pink sputum production begins, which does not bring improvement.
- The development of pulmonary edema. The pressure in the capillaries of the lungs becomes high, causing fluid and blood cells to leak into the space around the lungs and alveoli. This leads to a deterioration in gas exchange, due to which the blood does not receive the necessary amount of oxygen. The patient begins to wheeze, his breathing becomes bubbling, occurs with difficulty, the number of breaths increases. The tension of the respiratory muscles is palpable.
- Foam forms in the lungs. The fluid that gets into the alveoli begins to foam with each breath, which leads to distention of the lungs, with cough, foamy sputum is released, which can be released from the mouth and nose.
- Heartache Patients may experience pain behind the sternum, often cramping in the neck, shoulder blades, elbow.
- Perceptual problems and arousal. Circulatory problems affect the brain, which is why the patient may begin to behave inappropriately. Such people are characterized by panic attacks, fear of imminent death, they often faint, which indicates the onset of oxygen starvation.
The combination of these signs indicates that heart failure develops and treatment cannot be delayed.
If the patient is suspected of acute heart failure, the determination of its type and symptoms is carried out using a comprehensive examination, which consists of several stages:
- At the first stage, an initial examination is carried out, allowing the doctor to identify cyanosis, and the pulse rate and pressure are also checked.
- The next step is listening to the heart. Often it is difficult and is accompanied by wheezing and noise.
- Further, an ECG (electrocardiography) is performed, which allows to detect abnormalities in cardiac function.
- ECHO-KG with dopplerography helps to obtain detailed information about the patient’s heart condition.
- X-ray It allows to detect an increase in blood pressure in the vessels and an increase in the heart.
- A study of blood plasma helps determine the level of hormones that are produced by myocardial cells.
Heart failure treatment
There are two types of treatment for this disease – drug and non-drug therapy. During treatment with drugs, the patient is prescribed drugs after diagnosis. Drug-free treatment of heart failure is a diet, physical rehabilitation, bed rest. Diet should be strict, without salt.
Physical activity consists of walking or exercising on exercise bikes. On the day, the patient should exercise for 25 minutes. In this case, doctors should monitor the patient’s well-being and pulse (increase or decrease the frequency). Regarding bed rest. Experts do not recommend absolute rest and bed rest to patients, since the heart needs movement. Treatment of chronic heart failure occurs through physical activity.
With the manifestation of shortness of breath, cough, noisy breathing, the presence of fear, anxiety, the patient must provide first aid:
- A person should be placed in a comfortable position, while the back should be raised as much as possible.
- Hands and feet can be dipped in hot water.
- Then you should call an ambulance, the dispatcher needs to describe all the symptoms.
- After this, sit the patient closer to the open window, take off your breathing clothing. Then measure the pressure and support the person.
- For low systolic blood pressure (above 90 mm), give the patient a tablet of Nitroglycerin and a tablet of a diuretic.
- 20 minutes after you have placed the patient, place a tourniquet on one thigh. When cardiac arrest is necessary to do an indirect heart massage, artificial respiration, precardial beat, that is, a set of measures for cardiopulmonary resuscitation.
Angiotension inhibitors affect the work of renin-angiotensin-aldosterone. They slow the progression of the disease. These include captopril and quinapril. Captopril cannot be used for severely impaired liver function, cardiogenic shock, arterial hypotension, pregnancy, lactation, and children under 18 years of age. It is taken 1 hour before a meal, each dosage is individual. To eliminate the symptoms – shortness of breath or suffocation – the patient is prescribed Morphine.
Β-blocker reduces the risk of death from a lack of cardiac activity and blocks the transmission of impulses to organs, body tissues. These include non-cardioselective carvediol. This tool can not be used for arterial hypotension, severe bradycardia, cardiogenic shock and bronchial asthma. First, the patient is given 6,25 mg per day, gradually increasing the dose to 50 mg in 14 days.
Drugs that improve muscle blood circulation and myocardial metabolism or cardiac glycosides. These include Erinit and Nitrosorbit:
- Erinitis is slowly absorbed. It is an effective remedy. To prevent attacks in chronic coronary insufficiency, they are taken orally.
- Nitrosorbitol has a similar effect and prolonged absorption.
If the patient is prescribed surgery to treat the disease, then they can do a heart transplant or cardiomyoplasty. Cardiomyoplasty consists in the fact that during the operation the surgeon cuts out a flap from the broad back muscle and envelops the patient’s heart with it to improve contractile function.
Acute heart failure is a condition that threatens a person’s life.
Therapy of the disease after first aid depends on the main reason:
- If the violation is caused by arrhythmia, then in order to stabilize the patient’s condition and establish blood circulation, restore the normal frequency of contractions.
- In the presence of myocardial infarction, systemic thrombolysis is used to restore normal blood flow, that is, thrombi are dissolved with the help of thrombolytic drugs. Medicines are administered intravenously.
- If acute failure occurs due to injuries, rupture of the myocardium, damage to the valve, it is necessary to urgently hospitalize the patient and provide him with surgical care.
Acute congestive right ventricular failure is treated with the method of correction of the conditions that caused it, that is, they eliminate thromboembolism, asthmatic status.
Direct heart failure is eliminated:
- Oxygen therapy.
- Sedation. Medications cause sleep, from which the patient can be woken up at any time.
- Cardiac glucosides, which have a stimulating effect on the heart.
- Cardiotonic to increase contractility of the heart muscle.
- Diuretics to remove excess fluid from the body.
- Vasodilator drugs.
- Antiplatelet agents to reduce platelet adhesion.
Unlike in previous years, the achievements of modern pharmacology have allowed not only to extend, but also improve the quality of life of patients with heart failure. However, before the drug treatment of heart failure begins, it is necessary to eliminate all possible factors that provoke its appearance (fever, anemia, stress, excessive consumption of salt, alcohol abuse, as well as taking medications that help retain fluid in the body, etc.). The main emphasis in treatment is made both on eliminating the causes of heart failure itself and on correcting its manifestations.
Among the general measures for the treatment of heart failure, peace should be noted. This does not mean that the patient must lie down all the time. Exercise is acceptable and desirable, but it should not cause significant fatigue and discomfort. If the tolerance of loads is significantly limited, then the patient should sit as much as possible, and not lie.
Sleeping with heart failure is more convenient with a raised head end of the bed or on a high pillow. Patients with leg edema are also recommended to sleep with a slightly elevated foot end of the bed or a thin pillow placed under their legs, which helps to reduce the severity of edema.
The diet should be low in salt; cooked foods should not be added. It is very important to achieve excess weight loss, as it creates a significant additional burden on a diseased heart. Although with advanced heart failure, weight can go down on its own. To control weight and timely detection of fluid retention in the body, daily weighing should be carried out at the same time of day.
Currently, the following drugs are used to treat heart failure, which contribute to: • increase myocardial contractility; • decrease in vascular tone; • reduce fluid retention in the body; • elimination of sinus tachycardia; • prevention of thrombosis in the cavities of the heart.
Among the drugs that increase myocardial contractility, the so-called cardiac glycosides (digoxin, etc.) that have been used for several centuries can be noted. Cardiac glycosides increase the pumping function of the heart and urination (diuresis), and also contribute to better tolerance of physical activity.
Among the main side effects observed during their overdose, I note nausea, the appearance of arrhythmias, and a change in color perception. If in past years cardiac glycosides were prescribed to all patients with heart failure, now they are prescribed primarily to patients with heart failure in combination with the so-called atrial fibrillation.
The drugs that lower the tone of blood vessels include the so-called vasodilators (from the Latin words vas and dilatatio – “vasodilation”). There are vasodilators with a predominant effect on arteries, veins, as well as mixed-action drugs (vein arteries). Arterial dilatation vasodilators help reduce the resistance created by arteries during cardiac contraction, resulting in increased cardiac output.
Vasodilators that expand the veins contribute to an increase in venous capacity. This means that the volume of blood contained by the veins increases, as a result of which the pressure in the ventricles of the heart decreases and the cardiac output increases. The combination of the effects of arterial and venous vasodilators reduces the severity of myocardial hypertrophy and the degree of dilatation of the heart cavities.
Mixed type vasodilators include the so-called angiotensin-converting enzyme (ACE) inhibitors. I will name some of them: captopril, enalapril, perindopril, lisinopril, ramipril. Currently, it is ACE inhibitors that are the main drugs used to treat chronic heart failure.
As a result of the action of ACE inhibitors, the exercise tolerance increases significantly, the blood supply to the heart and cardiac output improves, and urination increases. The most commonly reported side effect associated with the use of all ACE inhibitors is a dry irritating cough (“as if tickling with a brush in the throat”).
As an alternative to ACE inhibitors in case of cough, the so-called angiotensin II receptor blockers (losartan, valsartan, etc.) are currently used.
First aid for a person with an attack
In an acute attack, 3 minutes is enough for ventricular function to be impaired. If such a situation arises, immediate assistance should be provided. Hospitalization is required, so help should be called immediately after the first signs.
First of all, immediately call an ambulance, reassure the patient. They themselves should not panic either, since anxiety will only aggravate a person’s condition. If the attack occurs indoors, it is recommended to provide fresh air. To unfasten the upper buttons on clothes, thereby facilitating the patient’s breathing.
Prior to the arrival of specialists, it is recommended to lay the victim in a semi-sitting position, this will help the blood to move to the legs. After a couple of minutes, apply a tourniquet to the thigh area. Put nitroglycerin under the tongue, repeat the medicine every 10 minutes. If possible, control the pressure.
First aid for heart failure is mainly required for acute illness, when the risk of myocardial infarction increases. Only a team of resuscitators with special equipment can help qualified. Therefore, you need to urgently call an ambulance.
While you are waiting for doctors, provide first aid for acute heart failure:
- seat the patient by laying pillows;
- give him a nitroglycerin tablet;
- provide air access.
If the patient lost consciousness, an indirect heart massage is necessary.
Influence of age and risk factors
The prognosis for acute failure worsens if the heart rate is significantly impaired. Also affects the gender and age of the patient. Women recover faster than men. In addition, a favorable prognosis is observed in people under 65 years of age when compared with patients older than this age.
Up to 50 years, a man is more likely to suffer from heart disease than a woman. After this milestone, the probability is equalized. Heart attacks in people under 40 years of age are rare.
From the age of 45, in men, the leading cause of death is acute heart failure. In women, after 65.
Important! Coronary disease in parents, grandparents – a high probability of developing pathology in posterity.
It is noted that more than half of deaths due to heart failure is caused by such provocateurs as:
- Smoking. Such an exercise doubles the risk of developing a heart attack. Long-term smokers who quit smoking can significantly improve their health;
- Passive lifestyle. Physical activity is needed at any age. Exercises are selected individually, but according to the standard, a 30-minute walk per day is enough to maintain a person’s health;
- High cholesterol. With a slight increase in the level, the risk of developing pathology increases several times. In this case, it is recommended to balance the diet;
- Hypertension 50 million people have high blood pressure. The disease proceeds without pronounced signs, which is why it is dangerous;
- Diabetes People with this disease risk leaving this world more often than they are ill without a similar diagnosis. It is recommended to maintain sugar levels on an optimal scale, change lifestyle, take medication;
- Alcohol Moderate consumption of soft drinks reduces the development of acute heart failure by 40%;
- Obesity With excess weight more than 20%, the risk of heart disease doubles. The most dangerous place to store fat is the stomach.
To prevent complications of the disease, the preventive measures are as follows: you need to eat properly and varied, regularly exercise, maintain daily routines, give up bad habits, and often visit a cardiologist. Patients need to constantly physically move, for example, using fast walking for 30-50 minutes a day.
To avoid acute heart failure, you must:
- visit a doctor at least twice a year, especially if there are chronic diseases of the cardiovascular system;
- quit smoking and alcohol abuse;
- avoid psycho-emotional stress;
- maintain optimal body weight;
- provide yourself with regular physical activity;
- monitor blood pressure indicators;
- eat rationally and balanced, consume foods that contain more fiber, refuse fried foods, hot and spicy;
- monitor cholesterol.
Compliance with these recommendations will reduce the likelihood of developing acute heart failure.
Prevention and correction of lifestyle will help reduce the likelihood of developing acute heart failure.
A prerequisite is a visit to a cardiologist twice a year. So you can identify the problem at the initial stage.
You can not expose the body to intense physical exertion.
This is especially true for unprepared people. Avoid body fat, monitor nutrition and salt intake.
It is advisable to take a daily walk in the fresh air and start swimming. With a constant stay in the room, physical inactivity may develop.
What prognosis can be given for this disease depends entirely on its severity. With timely treatment, the use of modern means, mortality is reduced to 30%. In the early stages of the disease, medicine can help stabilize the symptoms; this is a chance to increase the patient’s lifespan. If you properly perform all the appointments of a specialist, the disease will slow down for months or many years.
According to statistics, in patients with insufficiency in the dangerous late stages, mortality rises to 70%. In the first stages, this disease can be cured. According to scientists, almost 50% of patients diagnosed with insufficiency live five or more years, playing sports and leading a normal lifestyle. However, you cannot completely get rid of this disease.
The prognosis of AHF is determined by the disease that provoked it. The prognosis of heart failure is always unfavorable, therefore, as a cause of death, acute heart failure is mentioned quite often.
Within a year after hospitalization with AHF, 17% of patients die, as well as 7% observed on an outpatient basis. Very often (30-50%) people with acute heart failure suddenly die from severe cardiac arrhythmias.
Therefore, it is very important for patients who are on an outpatient stage of treatment to regularly take prescribed drugs and maintain a healthy lifestyle.
Only a strict adherence to the recommendations of the attending physician will improve the quality of life and longer avoid repeated hospitalizations.
Have you or your loved ones been diagnosed with acute heart failure? How did you deal with this ailment? Tell us about it in the comments – help other readers!
Nutrition and daily routine
Meal should be fractional: 5-6 times a day in small portions. Limit the use of meat, salt, exclude smoked meats, chocolate, alcohol. To replenish strength, patients should eat foods high in potassium: buckwheat and oatmeal, bananas, dried apricots, Brussels sprouts, etc. Prescribe a protein and vitamin diet.
The regimen of the day depends on the form of the disease. In acute form, only peace is needed. In chronic, on the contrary, peace is contraindicated. The patient is recommended moderation in physical activity, a special system of exercises is developed for the prevention of the disease.