How to determine the degree of heart failure

StageP
– pronounced long-term failure
blood circulation. Hemodynamic impairment
(stagnation in small and large circles
blood circulation), dysfunction
organs and metabolism are expressed in
peace, disability is severely limited.

Stage
PA – signs
circulatory failure expressed
moderately. Hemodynamic disorders only
in one of the departments of the cardiovascular
systems (in a small or large circle
blood circulation).

Stage
PB – ending
long stage. Deep violations
hemodynamics in which all
the cardiovascular system
(hemodynamic disturbances as in
large and in small circles of blood circulation).

Stage
W – final,
severe dystrophic stage
hemodynamic disorders. Persistent
irreversible metabolic changes
changes in the structure of organs and tissues,
complete disability.

First
stage
detected by a variety of
physical exercise tests – using
bicycle ergometry. Samples of the Master, on
treadmill and others. The decrease is determined
MOS is also detected by
rheolipocardiography, echocardiography.

The second
stage.
Symptoms of HF become apparent
show up at rest. Disability
drops sharply or patients become
incapable of work. 2nd stage is divided
into two periods: 2a and 2B.


stage can go to stage 1B or
full compensation may even come
hemodynamics. The degree of reversibility 2B
stage less.
В
the healing process occurs or decreases
symptoms of heart failure or temporary transition 2B
stages in 2A and only very rarely in 1B
stage.

The third
dystrophic stage,
cirrhotic, cachectic, irreversible,
terminal.

Chronic heart failure develops gradually due to compensatory mechanisms. It begins with an increase in the rhythm of heart contractions and an increase in their strength, the arterioles and capillaries expand, which facilitates the emptying of chambers and improves tissue perfusion. As the underlying disease progresses and the compensatory mechanisms are depleted, the volume of cardiac output is steadily decreasing.

The ventricles cannot be completely emptied and during diastole turn out to be full of blood. The heart muscle tends to push the blood accumulated in the ventricles into the arterial system and provide an adequate level of blood circulation, compensatory myocardial hypertrophy is formed. However, over time, the myocardium weakens.

Dystrophic and sclerotic processes occur in it, associated with a lack of blood supply and the supply of oxygen, nutrients and energy. The stage of decompensation is approaching. At this stage, the body uses neurohumoral mechanisms to maintain hemodynamics. Maintaining a stable level of blood pressure with significantly reduced cardiac output is ensured by the activation of the mechanisms of the sympathetic-adrenal system.

In this case, a spasm of the renal vessels (vasoconstriction) occurs and renal ischemia develops, which is accompanied by a decrease in their excretory function and interstitial fluid retention. The secretion by the pituitary gland of the antidiuretic hormone increases, which increases the water retention in the body. Due to this, the volume of circulating blood increases, the pressure in the veins and capillaries increases, the sweating of the fluid into the interstitial space is enhanced.

According to different authors, chronic heart failure is observed in 0,5–2% of the population. With age, the incidence increases, after 75 years, pathology occurs in 10% of people.

Heart failure is a serious medical and social problem, as it is accompanied by high rates of disability and mortality.

Given the wide variety of causes of heart failure, there are different options for its development. In the table below, we described all the main changes in the heart muscle that lead to heart failure. Diseases are also indicated there, which lead to impaired myocardial structure.

Pathophysiological causeMechanismWhat pathologies are characteristic and why
Overload of the left ventricle (hereinafter LV) volumeIn diastole (the period of relaxation of the heart) in the LV there is an excessive amount of blood, which leads to dilatation (overstretching) of its wallsAortic insufficiency, impaired renal function
LV overload resistanceThe occurrence of obstruction to the flow of blood from the left ventricle. To overcome it, the heart needs to contract more, which leads to myocardial wearArterial hypertension, aortic stenosis
Primary myocardial damageCardiomyocytes due to a violation of their structure cannot provide normal pumping function of the heartCoronary heart disease: myocardial infarction and scars after it, angina pectoris and hibernation (transient state of “sleep” of cardiomyocytes after a violation of their blood supply)
Violation of the left ventricular or right ventricular fillingThe period of relaxation of the heart is shortened, the blood does not have time to completely fill the chambers of the heart. Because of this, a volume that is less than planned is pushed out in the systole.Tachycardia (due to an increase in the frequency of contractions of the heart per minute, diastole naturally decreases – the gap between them); pericarditis, atrioventricular stenosis, tumor (mechanical obstruction to blood flow), concentric hypertrophy (characteristic of arterial hypertension)
Increasing metabolic tissue needsHeart cells weaken from oxygen and energy hungerHypoxia, anemia, chronic pulmonary diseases (impaired blood oxygen saturation in the capillaries of the lower respiratory tract), increased metabolic activity (with hyperthyroidism, pregnancy)

And to summarize, the occurrence of heart failure can be summarized in several paragraphs:

  • some specific causes violate the structure of the muscle tissue of the heart or pose unbearable tasks;
  • healthy cells begin to “plow” for three to ensure the body’s needs for blood;
  • for some time, active cardiomyocytes save the situation, which does not allow the symptoms of the disease to manifest (this is called the compensation stage);
  • after a certain period of time, the work of the heart is disrupted and the person enters the decompensation phase when the signs of heart failure become apparent.

Based on the mechanism of the development of the disease, there are:

  • systolic variant – due to myocardial dilatation, the contractility of the heart muscle is impaired;
  • diastolic variant – due to cardiomyocyte hypertrophy, they lose the ability to fully relax.

According to the rate of development of the disease, they are divided into:

  • acute heart failure – develops within a few days, hours;
  • chronic heart failure is a slowly progressive variant, symptoms have been building up over several years.

Heart failure is classified depending on the degree of decrease in left ventricular function (by signs of ultrasound) on:

  • HF with systolic LV dysfunction (ejection fraction is less than 45%);
  • HF with preserved LV activity (PV exceeds 45%).

The most important in practice is the classification of CH by functional classes. It allows you to clearly control the dynamics of the patient’s condition and the effectiveness of the therapy used.

ClassSymptoms: shortness of breath, fatigue, palpitations
ІOccurs with intense physical exertion
IIAppears in the case of the usual level of motor activity (necessary to continue life in a normal rhythm)
IIIWith minimal physical effort (it is difficult to service yourself, walk around the room)
ІVIn a state of complete rest

This classification is dynamic, the patient under the influence of treatment can move to a class higher.

But the stages of heart failure reflect structural myocardial damage, which can no longer regenerate under the influence of therapy.

StageCirculatory failureThe essence of violations
ІInitialAt rest, the clinical picture is normal
ІІАModerateOnly the functioning of the heart (the entire myocardium or its individual parts) is impaired
ІІБSignificantThe whole circulatory system suffers
IIIFully decompensatedSevere hemodynamic disturbances lead to irreversible damage to organs and systems

a) stagnation in a small or large circle of blood circulation

b) clearly marked edema due to stagnation in both circles of blood circulation. Hemodynamics are disturbed

Signs of heart failure

Severe heart failure is accompanied by:

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

Slowing blood flow in the microvasculature doubles the uptake of oxygen by tissues. As a result of this, the difference between oxygen saturation of arterial and venous blood increases, which contributes to the development of acidosis. Under-oxidized metabolites accumulate in the blood, activating the rate of basal metabolism.

With stagnation of blood in the circulatory system and a deterioration in its oxygenation (oxygen saturation), central cyanosis occurs. Increased oxygen utilization in the tissues of the body and a slowdown in blood flow cause peripheral cyanosis (acrocyanosis).

The development of edema on the background of heart failure lead to:

  • slowing down blood flow and increasing capillary pressure, which helps to increase plasma transudation into the interstitial space;
  • violation of water-salt metabolism, leading to a delay in the body of sodium and water;
  • protein metabolism disorder that violates the osmotic pressure of plasma;
  • decreased inactivation by the liver of ant >

In the initial stage of heart failure, edema is hidden and manifests itself as a pathological increase in body weight, a decrease in diuresis. Later they become visible. First, the lower extremities or the sacral region swell (in bedridden patients). Subsequently, fluid accumulates in the body cavities, which leads to the development of hydropericardium, hydrothorax, and / or ascites. This condition is called abdominal dropsy.

Hemodynamic disorders in the pulmonary circulation lead to the development of congestion in the lungs. Against this background, the mobility of the pulmonary edges is limited, the respiratory excursion of the chest is reduced, and stiffness of the lungs is formed. Patients have hemoptysis, cardiogenic pneumosclerosis, congestive bronchitis develops.

Congestive events in a large circle of blood circulation begin with an increase in the size of the liver (hepatomegaly). In the future, hepatocytes die with their replacement by connective tissue, i.e., cardiac fibrosis is formed.

In chronic heart failure, the cavities of the atria and ventricles gradually expand, which leads to relative insufficiency of atrioventricular valves. Clinically, this is manifested by the expansion of the borders of the heart, tachycardia, swelling of the cervical veins.

Signs of congestive gastritis are loss of appetite, nausea, vomiting, flatulence, a tendency to constipation, weight loss.

With long-term chronic heart failure, patients develop cardiac cachexia – an extreme degree of exhaustion.

The clinical manifestations of heart failure are also determined by its type.

Acute heart failure may be due to a decrease in the pumping function of the right ventricle, left ventricle, or left atrium.

Acute left ventricular failure develops as a complication of myocardial infarction, aortic defect, and hypertensive crisis. A decrease in the contractile activity of the left ventricular myocardium leads to an increase in pressure in the veins, capillaries and arterioles of the lungs, and an increase in the permeability of their walls. This becomes the cause of blood plasma sweating and the development of pulmonary edema.

Clinically acute left ventricular failure is manifested by symptoms of cardiac asthma or alveolar pulmonary edema.

The development of an attack of cardiac asthma usually occurs at night. The patient wakes up in fear from sudden asphyxiation. Trying to alleviate his condition, he assumes a forced position: sitting, with his legs down (position of orthopnea). During the inspection, the following symptoms attract attention:

  • pallor of the skin;
  • acrocyanosis;
  • cold sweat;
  • severe shortness of breath;
  • hard breathing in the lungs with single moist rales;
  • low blood pressure;
  • deaf heart sounds;
  • the appearance of a gallop rhythm;
  • expansion of the borders of the heart to the left;
  • the pulse is arrhythmic, frequent, weak filling.

With a further increase in stagnation in the pulmonary circulation, alveolar pulmonary edema develops. Its symptoms are:

  • sudden choking;
  • cough with pink foamy sputum (due to an admixture of blood);
  • bubbling breathing with a lot of wet wheezing (symptom of a “boiling samovar”);
  • facial cyanosis;
  • cold sweat;
  • swelling of the neck veins;
  • a sharp decrease in blood pressure;
  • arrhythmic, threadlike pulse.

If the patient is not provided with urgent medical care, then against the background of an increase in heart and respiratory failure, a fatal outcome will occur.

With mitral stenosis, acute left atrial insufficiency is formed. Clinically, this condition manifests itself in exactly the same way as acute left ventricular heart failure.

Acute right ventricular failure usually develops as a result of pulmonary embolism (pulmonary embolism) or its large branches. The patient forms stagnation in a large circle of blood circulation, which manifests itself:

  • pain in the right hypochondrium;
  • swelling of the lower extremities;
  • swelling and pulsation of the veins of the neck;
  • pressure or pain in the heart;
  • cyanosis;
  • shortness of breath;
  • expansion of the borders of the heart to the right;
  • increased central venous pressure;
  • a sharp decrease in blood pressure;
  • threadlike pulse (frequent, weak filling).

Chronic heart failure develops in the right and left atrial, right and left ventricular types.

Chronic left ventricular failure is formed as a complication of coronary heart disease, arterial hypertension, mitral valve insufficiency, aortic defect and is associated with blood stasis in the pulmonary circulation. It is characterized by gas and vascular changes in the lungs. Clinically manifested:

  • increased fatigue;
  • dry cough (rarely with hemoptysis);
  • palpitations;
  • cyanosis;
  • attacks of suffocation, which often occur at night;
  • shortness of breath.

In chronic left atrial insufficiency in patients with mitral valve stenosis, congestion in the circulatory system is even more pronounced. The initial signs of heart failure in this case are cough with hemoptysis, severe shortness of breath and cyanosis. Gradually, sclerotic processes begin in the vessels of the small circle and in the lungs.

Chronic right ventricular failure usually accompanies pulmonary emphysema, pneumosclerosis, mitral heart defects and is characterized by the appearance of signs of stagnation of blood in the circulatory system. Patients complain of shortness of breath during physical exertion, an increase and bursting of the abdomen, a decrease in the amount of urine released, the appearance of edema of the lower extremities, heaviness and pain in the right hypochondrium. During the inspection revealed:

  • cyanosis of the skin and mucous membranes;
  • peripheral and cervical vein swelling;
  • hepatomegaly (enlarged liver);
  • ascites.

Insufficiency of only one part of the heart cannot remain isolated for a long time. In the future, it necessarily goes into general chronic heart failure with the development of venous stasis in both the small and large circles of blood circulation.

Studying the classifications, the attentive reader has already figured out in his mind the main symptoms of the presence of HF. However, these iconic manifestations are not the only ones for this pathology.

With severe heart failure, the patient takes a pose under the code name “orthopnea”: he sits, covered with pillows. The head and upper back are tilted back a little. The limbs are down. This position ensures the deposition (accumulation) of blood in the arms and legs, which minimizes the load on the weakened heart.

The skin may be pale, with acrocyanosis (turning blue of the peripheral parts: tip of the nose, fingers, auricles). Also characterized by congestive edema, which:

  • are ascending in nature (first occur on the feet and legs);
  • appear in the evening, and in the early stages pass over night;
  • cold and dense to the touch;
  • can wear a bluish tint.

Perhaps the appearance of ascites (fluid in the stomach) or even anasarca (edema throughout the body).

Signs of heart failure are manifested by characteristic complaints:

  • fatigue (it takes longer to restore the initial state after physical exertion than before);
  • drowsiness (but even sleeping normally in the later stages is obtained only in a sitting position);
  • shortness of breath (according to the functional class);
  • coughing (often at night);
  • possible nausea and vomiting;
  • loss of appetite;
  • feeling of heartbeat;
  • dizziness.
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Pulse change

Since the LV pump function suffers, the pulse will often be weakened (the artery wall is shaken by the pulse wave with less force) and faster (more than 90 per minute).

In a situation when the phenomenon of heart failure is preceded by hypertension, high numbers of blood pressure are characteristic. But in acute conditions, intoxications, heart failure can be accompanied by hypotension and even shock or collapse (a critical decrease in blood pressure).

I. Stage of initial manifestations. At rest, hemodynamic disturbances in the patient are absent. During physical exertion, excessive fatigue, tachycardia, shortness of breath occur.

II. Stage of pronounced changes. Signs of long-lasting hemodynamic disturbances and circulatory failure are well expressed and at rest. Stagnation in the small and large circles of blood circulation cause a sharp decrease in disability. During this stage, two periods are distinguished:

  • IIA – moderately severe hemodynamic disturbances in one of the departments of the heart, working capacity is sharply reduced, even normal loads lead to severe shortness of breath. The main symptoms: hard breathing, slight enlargement of the liver, swelling of the lower extremities, cyanosis.
  • IIB – severe hemodynamic disturbances both in the large and in the pulmonary circulation, disability is completely lost. The main clinical signs: severe edema, ascites, cyanosis, dyspnea at rest.

III. Stage of dystrophic changes (terminal or final). Persistent circulatory failure is formed, leading to serious metabolic disorders and irreversible disturbances in the morphological structure of internal organs (kidneys, lungs, liver), and exhaustion.

The classification was adopted in 1935 and is applied to this day with some refinements and additions. Based on the clinical manifestations of the disease during CHF, three stages are distinguished:

    I. Hidden circulatory failure without concomitant hemodynamic disturbances. Symptoms of hypoxia occur with unusual or prolonged physical activity. Possible shortness of breath, severe fatigue, tachycardia. There are two periods A and B.

Stage Ia is a preclinical version of the course in which dysfunctions of the heart almost do not affect the patient’s well-being. An instrumental examination reveals an increase in the ejection fraction during physical exertion. At stage 1b (latent heart failure), circulatory failure manifests itself during physical exertion and passes at rest.

II. In one or both circles of blood circulation, stagnation is observed, which does not pass at rest. Period A (stage 2a, clinically expressed CHF) is characterized by symptoms of stagnation of blood in one of the circles of blood circulation.

The patient manifests acrocyanosis, peripheral edema, dry cough and others, depending on the location of the lesion. In period B (stage IIb, severe), the entire circulatory system is involved in pathological changes.

Stage 3a is treatable; with adequate complex therapy of heart failure, partial restoration of the functions of the affected organs, stabilization of blood circulation and partial elimination of congestion are possible. Stage IIIb is characterized by irreversible metabolic changes in the affected tissues, accompanied by structural and functional disorders.

The introduction of additional gradations is partly due to the development and implementation of new treatment methods that significantly increase the chances of patients to improve the quality of life.

The use of modern drugs and aggressive treatment methods quite often eliminates the symptoms of heart failure, corresponding to stage 2b to the preclinical state.

Methods of diagnosing the disease

During the survey, special attention should be paid to such symptoms of heart failure as excessive fatigue and shortness of breath, a feeling of lack of air during physical exertion.

On examination, it is worth paying attention to the position of orthopnea (differential diagnosis with an asthma attack is necessary) and characteristic edema. Swelling and pulsation of veins on the neck can be detected (this symptom is easier to notice if the patient is lying on his back).

HF in the general blood test can be manifested by anemia (hemoglobin below 120 hl). If corrected, the ability of the blood to carry oxygen will improve, which slightly compensates for pumping heart dysfunction. Hematocrit (ratio of formed elements to plasma) may increase if severe dyspnea is present.

Such an analysis does not bear diagnostic value.

CH on the cardiogram

ChangeElectrocardiographic picture
Sinus tachycardiaNormal complexes, but with a frequency of more than 90 per minute
Sinus bradycardiaThe shape of the teeth meets the standards, but less than one contraction per second is recorded on the electrocardiogram (ECG)
Atrial fibrillationInstead of the P wave – small waves, electrical processes in the myocardium of other parts of the heart are not disturbed
Ventricular arrhythmiaWith a frequency of less than 60 per minute, expanded and deformed ventricular complexes are recorded on the ECG
Myocardial ischemia or myocardial infarctionIn the presence of abnormal Q wave and ST segment deviations relative to the contour
LV hypertrophyAn increase in the R wave in the left chest leads, a deviation of the electrical axis of the heart to the left
Low voltageThe registered complexes are normal, but the height of all teeth is reduced several times

To diagnose heart failure, it is necessary to detect a fall in the pump function of the left ventricle. Assess hemodynamic processes in the heart will help his ultrasound (echocardiography, or Echocardiography). This method is considered the gold standard for diagnosing heart failure.

Some signs of heart failure with cardiac echocardiography

SignChangeClinical significance
LV ejection fractionDecrease (below 45%)Determines the severity of the patient’s condition
LV functionDyskinesia, akinesia, hypokinesia (abnormal movement of the heart muscle)Indicates a violation of the structure of the myocardium
End diastolic sizeIncreases to 60 mm and moreIndicate volume overload
Course systolic sizeGrows to 45 mm and above
LV wall thicknessMore than 11-12 mmHypertrophy. Perhaps due to overload resistance

When conducting echocardiography, much more indicators are analyzed. However, those described are the most obvious.

The patient can conduct such instrumental and laboratory studies:

  • X-ray of the chest organs (you can see the expansion of the shadow of the heart and the leakage of the lung parenchyma exudate – the liquid part of the blood);
  • biochemical blood test (including determination of hormone levels);
  • stress echocardiography (the use of a provoking factor will help diagnose latent disorders);
  • magnetic resonance imaging of the heart (the parameters of all structures are visualized);
  • computed tomography (especially with suspected coronary heart disease);
  • radionuclide ventriculography (to establish the ejection fraction and the level of blood supply to the myocardium);
  • coronary angiography (to determine the degree of patency of coronary vessels).

Heart failure, as mentioned above, is a complication of a number of diseases of the cardiovascular system. Therefore, in patients with these diseases, it is necessary to carry out diagnostic measures to detect heart failure at the earliest stages, even before the appearance of obvious clinical signs.

When collecting an anamnesis, special attention should be paid to the following factors:

  • the presence of complaints of dyspnea and fatigue;
  • indication of the presence of arterial hypertension, coronary heart disease, rheumatism, cardiomyopathy.

Specific signs of heart failure are:

  • expanding the boundaries of the heart;
  • the appearance of III heart tone;
  • rapid low-amplitude pulse;
  • edema;
  • ascites.

If there is a suspicion of heart failure, a series of laboratory tests are performed, including biochemical and clinical blood tests, determination of the gas and electrolyte composition of the blood, and the characteristics of protein and carbohydrate metabolism.

It is possible to detect arrhythmias, ischemia (insufficient blood supply) of the myocardium and its hypertrophy by specific changes in the electrocardiogram. Various stress tests based on ECG are also used. These include the treadmill test (“treadmill”) and bicycle ergometry (using an exercise bike). These tests evaluate the reserve capacity of the heart.

Ultrasound echocardiography allows evaluating the pumping function of the heart, identifying a possible cause of the development of heart failure.

For the diagnosis of acquired or congenital malformations, coronary heart disease and a number of other diseases, magnetic resonance imaging is indicated.

Radiography of the chest in patients with heart failure reveals cardiomegaly (an increase in heart shadow) and congestion in the lungs.

To determine the volumetric capacity of the ventricles and assess the strength of their contractions, radioisotope ventriculography is performed.

In the late stages of chronic heart failure, an ultrasound scan is performed to evaluate the state of the pancreas, spleen, liver, kidneys, and to detect free fluid in the abdominal cavity (ascites).

Heart failure treatment

This disease is very common. For example, about two million Americans are diagnosed with chronic heart failure (CHF). Every 10 out of 1000 people has a risk of its development. Moreover, the number of patients is increasing in almost all countries of the world, without discounts on their level of development, with the exception of Tibet, Japan and China. For residents of these countries, mortality due to cardiovascular problems is rare.

Given this fact, it is logical to assume that Tibetan medicine knows an effective approach to the treatment of heart disease. Indeed, for centuries, accumulated knowledge allows the use of an effective set of measures of internal and external effects for the reasonable treatment of heart rhythm disturbances.

Traditional phyto-collections, the recipe of which is transmitted only to the student from the teacher, remove the excitation of the nervous system, eliminate arrhythmia, harmonize energy constitutions. Far from superfluous will be the change in the habitual way of eating and living. For example, products with a bitter taste are useful for the heart, but starvation is strictly contraindicated.

  • Acupuncture
  • Acupressure
  • Wormwood cigars warming (moxotherapy)
  • Mongolian herbal oil massage “Jorma”
  • Dentistry
  • Auriculotherapy and others

Separately, I would like to highlight the energy massage conducted by our specialists in a special technique. It helps regulate emotions, eliminates the energy of aggression, establishes internal balance, helping the heart to function without failures.

The management of a patient with heart failure should begin (if possible) with the elimination of the etiological factor. Otherwise, symptomatic treatment acts as the first line.

GroupRepresentativesDaily Dose (mg)
Angiotensin Converting Enzyme InhibitorsCaptopril150
Enalapril40
Lisinopril60
Ramipril10
Beta-blockersBisoprolol10
Carvedilol50
Metoprolol200
Nebivalol10
Mineralcorticoid Receptor AntagonistsEplerenone50
Spironolactone50
Angiotensinogen Receptor BlockersCandesartan32
Valsartan320
Losartan150
If-channel inhibitorIvabradin15
Cardiac glycosidesDigoxin0,125
Loop diureticsFurasemide150
Torasemide15
Thiazide diureticsHydrochlorothiazide50
Indapamide5
AnticoagulantsRivaroxaban20
Acetylsalicylic acid75

The cardiologist selects, according to the recommended technique, a combination of several drugs, based on the characteristics of the course of heart failure in an individual patient.

There are tablets with a combination of several drugs from different groups.

In heart failure, therapy is aimed primarily at the underlying disease (myocarditis, rheumatism, hypertension, coronary heart disease). Indications for surgical intervention may be adhesive pericarditis, cardiac aneurysm, heart defects.

Strict bed rest and emotional rest are prescribed only for patients with acute and severe chronic heart failure. In all other cases, physical activity is recommended that does not cause a deterioration in well-being.

In the treatment of heart failure, a properly organized diet plays an important role. Dishes should be easily digestible. The diet should include fresh fruits and vegetables, as a source of vitamins and minerals. The amount of salt is limited to 1-2 g per day, and fluid intake to 500-600 ml.

To improve the quality of life and extend it allows pharmacotherapy, which includes the following groups of drugs:

  • cardiac glycosides – enhance the contractile and pumping function of the myocardium, stimulate diuresis, and increase the level of exercise tolerance;
  • ACE inhibitors (angiotensin-converting enzyme) and vasodilators – reduce vascular tone, expand the lumen of blood vessels, thereby reducing vascular resistance and increasing cardiac output;
  • nitrates – dilate coronary arteries, increase cardiac output and improve ventricular blood filling;
  • diuretics – remove excess fluid from the body, thereby reducing swelling;
  • β-adrenergic blockers – increase cardiac output, improve the filling of the heart chambers with blood, reduce the heart rate;
  • anticoagulants – reduce the risk of blood clots in the vessels and, accordingly, thromboembolic complications;
  • drugs that improve metabolic processes in the heart muscle (potassium preparations, vitamins).

With the development of cardiac asthma or pulmonary edema (acute left ventricular failure), the patient needs emergency hospitalization. Prescribe drugs that increase cardiac output, diuretics, nitrates. Oxygen therapy is mandatory.

Removal of fluid from body cavities (abdominal, pleural, pericardial) is carried out by puncture.

Prevention of heart failure

Primary: a healthy lifestyle, quitting nicotine and minimizing alcohol. Treatment of pathologies that can lead to the onset of heart failure. Periodic preventive studies in people at risk.

Secondary: drug correction of manifestations of heart failure in order to prevent progress and improve the well-being of the patient.

Prevention of the formation and progression of heart failure consists in the prevention, early detection and active treatment of diseases of the cardiovascular system that cause its development.

Patient prognosis: is it possible to influence the outcome of the patient and how to do it?

Since HF is often a manifestation of an extreme degree of a negative effect on a heart of a factor, the prognosis is disappointing: a person will not be able to recover completely. But correctly selected therapy will provide a warning of possible complications, increase life expectancy, and even improve the quality of life.

HF occurs against the background of some disease, complicating it. For example, a stroke with hypertension is terrible in itself, and even more so in combination with decompensation of heart failure. So the prognosis also depends on the degree of control of concomitant pathologies.

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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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