The classic gradation of dyspnea in heart failure is a physiological and pathological form. The first is the body’s response to exercise, exercise. Such shortness of breath passes after a short rest. The second is a symptom of the disease, which sometimes occurs even in a state of complete rest. Pathological dyspnea is divided into several types:
- inspiratory – difficulty breathing;
- expiratory – difficulty breathing out;
- mixed – breathing is difficult both on inhalation and on exhalation.
The severity of pathological shortness of breath will depend on the stage of heart failure, determined by the symptoms of pathology. From this point of view distinguish:
- zero degree – respiratory failure is possible only with excessive physical exertion;
- first or easy – when climbing stairs, walking fast, intense exercise;
- second or middle – occurs during normal physical exertion;
- third or severe – normal walking requires frequent stops (every 2-3 minutes), combined with chronic fatigue, swelling of the legs;
- fourth or extremely difficult – breathing is difficult at rest, a person is not able to dress independently, loses working capacity.
The shape of heart dyspnea is classified into:
- emergency – develops against a background of acute conditions in case of myocardial failure in normal blood pumping;
- orthopnea – the inability to lie as the patient suffocates;
- paroxysmal nocturnal – apnea, confused breathing with waking up;
- bendopnea – respiratory failure when leaning forward.
The latter term was first coined in 2014.
Classification of this disease is caused by a violation of the respiratory rate, its rhythm, depth. Dyspnea may be:
- subjective – there is a lack of air, compression and soreness in the chest;
- objective – when examining a patient, external signs are visible.
Often there is a condition when, with severe symptoms of shortness of breath, she does not manifest herself externally. Shortness of breath can be:
- physiological – a healthy person does not have enough air after hard physical labor or intense sports exercises;
- pathological – this condition is caused by various types of diseases.
The pathological state of respiratory disturbance manifests itself in various types of shortness of breath.
- Central – with respiratory depression caused by a lack of oxygen, with increased pressure inside the skull, with a stroke, edema or brain tumor;
- Neuromuscular muscle – in case of violation of the respiratory muscles after injury, with infectious or inflammatory diseases;
- Diaphragmatic – with fracture of the ribs, bloating, obesity;
- Bronchopulmonary – if obstruction of the pulmonary tract is manifested.
With bronchopulmonary obstruction, the pathological process complicates the passage of air. Such shortness of breath accompanies bronchial asthma, pneumonia, lung cancer, other diseases, and also occurs when a foreign body enters the lungs, bronchi.
- External manifestations
- First signs
- Against the background of acute CH
- First aid
- Diet and Regimen
- Causes of Heart Disease
- Cardiac dyspnea – causes, symptoms, diagnosis and treatment
- Differences in heart dyspnea from other dyspnea options
- Folk remedies
- Surgical intervention
- helpful hints
Shortness of breath in heart failure indicates impaired gas exchange, with a number of specific symptoms.
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Conventionally, the first clinical manifestations can be divided into those provoked by increasing respiratory failure and cardiac dysfunction. In the debut of pathology, both factors matter, manifesting in:
- asthenia – a syndrome of chronic fatigue due to a lack of normal oxygen supply to the brain;
- retrosternal discomfort;
- tachypnea – an increase in respiratory movements up to 20/minute;
- decreased resistance to physical activity;
- disturbance of the rhythm of the heart;
Frequent syncope (fainting) is a sign of a developing stroke.
Against the background of acute CH
Dyspnea against the background of acute heart failure is a symptom of pulmonary edema. Manifested cardiac dyspnea in the form of:
- severe headache;
- increase in chest pain;
- increase in blood pressure;
- feelings of lack of air;
- the number of breaths reaches 40-60/minute;
- there is a cough;
- bubbling rales in the lungs are heard from a distance;
- frothy sputum appears mixed with blood.
This condition requires emergency assistance, procrastination is fatal.
In chronic heart failure, dyspnea occurs in 100% of cases. She has a number of features:
- occurs against a background of high blood pressure;
- amplified under load, disappears at rest;
- symptoms of shortness of breath increase with the duration of the onset of heart failure;
- dyspnea does not allow a person to lie horizontally, always on high pillows or half-sitting, sitting;
- there is pastiness;
- the skin becomes cyanotic;
- constant coughing appears;
- attacks of cardiac asthma develop at night – the inability to breathe wakes a person, causing fear, fear of death.
In any case, dyspnea increasing in severity accompanying any heart failure is a poor prognostic sign indicating decompensation of the process.
The bottom line is heart failure therapy. To do this, use different methods, means. Treatment is always combined or complex.
The life of a person depends on the timeliness of first aid, therefore, with pronounced dyspnea, it is important to follow these rules:
- call an ambulance;
- provide fresh air;
- loosen tight clothing;
- to put a person in a pose with legs down;
- if there is an oxygen cushion, use it;
- in the absence of varicose veins, it is not tight, while maintaining blood flow, bandage with an elastic bandage of the arms and legs;
- under the tongue – Nitroglycerin;
- You can give a tablet of Furosemide, drops of Corvalol.
After this, you should wait until the doctor arrives without leaving the patient alone, reassuring him at the first sign of panic.
|Group of drugs, individual representatives||Effect of therapy|
|ACE Inhibitors: Prestarium, Captopril, Lisinopril||Drugs improve microcirculation, normalize blood flow, reduce heart rate, balance blood pressure|
|Vasodilators: Nitroglycerin, Molsidomin, Cardicet||Tablets dilate blood vessels, improve tissue nutrition|
|Cardiac Glycosides: Digoxin, Korglikon, Adonizid||Medications increase heart endurance, prevent the development of arrhythmias|
|Nitrates: Nitroglycerin, Nitrong, Sustak||Medicines eliminate hypoxia, normalize blood flow to the lesion|
|Adrenergic blockers: Concor, Prazosin, Metoprolol||Drugs reduce electrical instability in the myocardium, stop tachycardia|
|Diuretics: Furosemide, Lasix, Indapamide||Tablets reduce swelling, stagnation by removing excess fluid from the body|
|Anticoagulants, antiplatelet agents: Curantil, Cardiomagnyl, Heparin, Fraxiparin, Warfarin, Aspirin||Drugs reduce blood viscosity, prevent blood clots|
|Methylxanthines: Eufillin, Theophylline, Eufilong||Medications Prevent Repeated Choking Attacks|
|Vitamins, amino acids: C, E, group B, Riboxin, ATP||Pills improve metabolic processes, tissue nutrition|
Diet and Regimen
With the development of dyspnea, as an unfavorable prognostic sign, the diet boils down to limiting salt intake to 1,5 g/day, fluids to 0,5 l/day, and eliminating spicy, greasy, heavy foods. It is recommended that alcohol be completely eliminated and smoking cessation.
As for the regimen of the day, it is associated with physical activity and depends on the stage of the pathological process, the severity of symptoms. An attack of suffocation in the stage of decompensation of CH suggests bed rest. With preserved compensation mechanisms, it is recommended that physical loads be limited to feasible household manipulations.
Surgical intervention is carried out only in the absence of a result from conservative therapy of dyspnea or in the case of anatomical problems in the structure of the basic structures of the heart that cause heart failure (for example, mitral valve stenosis). Indications for surgery may be:
- the need to replace heart valves;
- elimination of congenital malformations;
- correction of acquired heart defects, aorta;
- angioplasty of the main vessels;
- organ transplant.
The goal of surgical treatment remains – to eliminate the root cause of the pathology.
A feeling like shortness of breath is familiar to many. With him, a person feels a lack of air, a cough, which causes fear. The condition is characterized as a violation of the rhythm, frequency or depth of breathing, which is a complex reflex act. Different body systems participate in it, which determines the type of shortness of breath and its clinical manifestations.
The condition is subject to serious treatment. Today there are effective folk and medical means to combat the disease. Most often, it is a symptom of lung and heart disease, respectively, two main types are distinguished – pulmonary and cardiac dyspnea.
The fact that the main organ is in danger, says shortness of breath of an appropriate nature. It develops due to insufficiency of the left heart. This is manifested by poor cardiac output or blood stasis in the lungs, these two conditions can be combined.
In the first case, brain nutrition is impaired, in the second – gas exchange, pulmonary ventilation conditions. In this case, the nature of respiration changes, orthopnea develops.
Shortness of breath is a frequent consequence of serious cardiological diseases – heart disease, heart failure, cardiosclerosis, and myocardial disturbances.
If there is heart failure, it can no longer bear the load, which is why the blood flow in the pulmonary vessels becomes slower. This causes the lungs to lose their ability to supply enough oxygen to the blood.
Any symptom starting to bother more and more must be treated promptly. However, you cannot prescribe medications yourself. Treatment should be prescribed by a doctor, the use of folk remedies is also recommended to coordinate with him. It is important to understand what exactly accompanies the occurrence of dyspnea of the heart type.
Shortness of breath can develop due to physical exertion and even eating.
At the initial stage of blood circulation failure, irritation of the respiratory center occurs, and pulmonary ventilation increases. Then shortness of breath begins to develop due to physical exertion and eating.
When heart failure develops further, the right amount of oxygen does not enter the blood, the partial pressure of O2 decreases, but the level of CO2 increases. Blood volume decreases, tissue hypoxia begins. Oxygen starvation with circulatory failure is very serious if the disease has reached the last stages.
Changes in hemodynamics and blood chemistry lead to reflex irritation of chemo and baroreceptors in the atria, vena cava and other areas. The functional state of the heart changes and shortness of breath begins.
It is noted that the symptom is most pronounced in patients suffering from mitral stenosis, which is associated with an increase in pressure in the pulmonary artery system and congestion in a small circle of blood circulation.
Cardiac dyspnea is characterized by difficulty breathing. First, it occurs after physical exertion. If there is no treatment, no effective remedy has been found to eliminate the cause, it manifests itself even when lying down. This suggests that shortness of breath has a heart character. In this case, there are other symptoms:
- swelling of the lower extremities, increasing in the evening;
- cooling of the skin of the hands, feet;
- medium-bubbling and small-bubbling rales in the lungs, arising from their edema.
Three forms of shortness of breath in heart failure can be distinguished:
- shortness of breath with a physical load;
- dyspnea at rest;
- acute attacks (sometimes with pulmonary edema).
Of course, not everyone who has run ten floors and is having difficulty breathing develops heart failure. It is important to distinguish physiological shortness of breath from pathological. In the first case, the condition is caused by an increased need for oxygen in the body. It is not dangerous, does not require treatment and special means.
Pathological dyspnea is one that occurs in situations that have not previously caused it. For example, a person rises to the second floor, but breathes as hard and often as when running to the tenth floor. This indicates the need for a visit to the doctor and the need for emergency treatment. This may be a sign of the congestive phase of heart failure.
Another symptom requiring attention is orthopnea (shortness of breath that occurs when lying down). When a person gets up, the condition normalizes.
In very severe cases, patients with insufficiency develop such a form of malaise as paroxysmal nocturnal dyspnea. This condition is also called cardiac asthma.
There is a dry cough, which is combined with the release of light foamy sputum, fear, agitation. Other symptoms appear:
- cold, clammy sweat;
- severe severe weakness;
- ash blue skin.
Causes of Heart Disease
If the heart cannot cope with stress, shortness of breath occurs. In the vessels of the lungs, the blood flow slows down and the pressure in the arteries increases, as a result of which a spasm of arterioles occurs. Naturally, gas exchange is disturbed.
Organs and tissues begin to experience oxygen starvation. There are signals to the brain, and the respiratory system is activated, making breaths deep and frequent.
You can describe in more detail the development pattern of dyspnea in heart disease:
- If the left areas of the heart are affected, then the volume of cardiac output decreases and blood stasis forms in the lung area.
- Stagnant manifestations disrupt the gas exchange of the respiratory tract, which causes a failure in their ventilation.
- To normalize breathing, the body increases the depth and frequency of breaths. This is how shortness of breath develops.
Almost all cardiovascular pathologies are accompanied by shortness of breath of various types:
- In older people, lack of air is manifested in ischemia and arterial hypertension.
And since there is a correlation between hypertension and overweight, in full patients with constantly high blood pressure, shortness of breath is present not only during exertion, but also at rest, and even at night.
The sleep of such people is disturbing and apnea is often interrupted.
- Myocardial infarction and its asthmatic variant have all the signs of left ventricular failure. Husky breathing is observed with shortness of breath and even suffocation.
- All chronic heart lesions are accompanied by nocturnal dyspnea.
- Cardiac asthma causes a lot of suffering.
- Pulmonary edema, which can be fatal, is very dangerous.
- Thromboembolism, which causes respiratory failure, in general, cannot exist without shortness of breath and suffocation.
How to determine that shortness of breath is cardiac? Such shortness of breath has specific symptoms that you need to know:
- Inhalation is very difficult.
- It arises and amplifies under any loads.
- Appearance in a lying position. The horizontal position makes the heart work in an enhanced mode. If you sit down, breathing returns to normal.
This pathology can go into a severe phase – pulmonary edema. Great weakness appears, breathing becomes heavy, lips turn blue and panic begins. At the same time, known methods of getting rid of shortness of breath do not help.
Cough with heart failure indicates that there has been blood stasis in the small circle of blood circulation.
This provokes a swelling of the mucosa, in rare cases, the fluid flows from the vessels into the lumen of the respiratory tract, pulmonary alveoli.
This leads to irritation of the nerve endings, which are sensitive. This is how a cough develops. Sputum may be clear or pinkish.
In the process of diagnosis, it is important that cardiac dyspnea is not confused with pulmonary.
And in fact, and in another case, it manifests itself at night, but if it has a pulmonary origin, its occurrence is associated with the accumulation of sputum. After its departure, the state normalizes.
If diseases of the two systems are combined, one should distinguish shortness of heart type from pulmonary. To do this, you need to carry out some diagnostic measures.
If it is not possible to accurately determine the origin of shortness of breath, an examination of the function of external respiration is carried out. To exclude or confirm the diagnosis, measurement of the ejection fraction at rest and under load is performed.
For this, isotopic ventriculography and echocardiography are used. If reduced indicators are detected, then there is left ventricular failure.
If you observe the patient, you can identify a simulation and psychogenic shortness of breath.
The main thing is to turn to a doctor in time for help, without taking independent measures. It is necessary to observe the available symptoms: the time of day at which the cough occurs most often, provoking circumstances.
During treatment, it is important to maintain a healthy and calm lifestyle.
Since there are many causes of shortness of breath, the treatment is usually complex. It is based on the use of drugs, dieting, maintaining not only a healthy, but also a calm lifestyle.
However, it is still important to know what to do with the attack itself, what measures to take. You need to immediately call an ambulance. Then it is recommended to follow this algorithm:
- open a window;
- it is convenient to seat a person so that his legs are lowered down;
- limit activity;
- take off bulky, warm clothes that hamper movement;
- reassure a person, if necessary, give sedative tablets, preferably motherwort or valerian;
- if there is a cough or other symptoms requiring sputum production, an expectorant may be given.
If possible, you can give an oxygen mask. This is all you need to do if an attack occurs. The remaining measures should be taken by the ambulance team. To finally stabilize the patient, the doctor injects special drugs into the vein. They often give Lasix a drink if a person hasn’t drunk digitalis.
In the process of treatment, peace is very important. This does not mean that a person should constantly lie. He needs to move. The main condition is that the work performed should not lead to excessive fatigue. Outdoor walks are very important. It is recommended to sleep in the correct position so that the head is above body level.
It is necessary to reduce the amount of salt consumed
You will also have to take some measures regarding food. It is necessary to use as little salt as possible. Food should be low in calories, as extra pounds can worsen well-being, severe attacks, in which there is shortness of breath, coughing and other symptoms will occur more often.
To treat shortness of breath, you can use folk remedies. Birch leaves help well. Need to take two tsp. crushed raw materials and pour it with one glass of boiling water. The composition is insisted for half an hour, after which 0,5 tsp is added. soda. You can drink it during the day, but every day you should prepare a fresh broth.
A good folk remedy is a tincture of seeds of bitter wormwood and olive oil, which can be replaced with vegetable. The used proportion is 1 to 4. Insist 12 hours.
They drink the medicine in the morning, while dripping it on sugar and gradually dissolving. There are many other popular recipes that help treat heart dyspnea.
But it is important to remember that their use should be discussed with the doctor.
Heart dyspnea is an important and dangerous symptom that requires medical attention. Timely treatment will help to avoid complications. A healthy lifestyle will also contribute to therapy and minimize the risk of seizures.
Dyspnea in heart failure is usually inspiratory (difficulty breathing), and with it the frequency of respiratory movements increases to 30 or more times per minute (normal – about 15).
About why there is shortness of breath and how to treat this condition and will be discussed in our article.
Shortness of breath in heart failure is provoked by the accumulation and stagnation of fluid in the tissues of the lungs, which is caused by the inability of the heart to pump the necessary amount of blood. The blood flow through the vessels of the lungs slows down and the liquid part of the blood “sweats” into the alveoli. Liquid-overloaded lungs hardly provide gas exchange.
At the initial stages of heart failure, the patient begins to experience shortness of breath after exercise, and with the progression of the disease, difficulty in breathing becomes noticeable and at rest. Four classes of heart failure are distinguished depending on the degree of load on the heart and lungs:
- I – shortness of breath appears after significant physical exertion;
- II – breathing quickens after moderate motor load;
- III – shortness of breath develops even with normal and light load;
- IV – difficulty breathing can be felt during sleep or in a state of complete rest.
The rapid decompensation of heart failure and exacerbation of cardiac dyspnea can lead to:
- renal failure and kidney disease;
- pulmonary embolism;
- pulmonary vasculitis;
- lack of adequate treatment.
With proper treatment and following all the doctor’s recommendations, shortness of breath and symptoms of heart failure may become less pronounced, and the progression of the disease can slow down significantly.
Shortness of breath with heart failure is accompanied by a number of characteristic signs that distinguish it from other types of shortness of breath:
- difficulty breathing;
- shortness of breath intensifies and appears after exercise;
- in a horizontal position, shortness of breath becomes more intense, and after trying to sit down or take a reclining position, it weakens;
- shortness of breath is combined with wheezing in the lungs, periodic cardialgia, swelling of the lower extremities and cooling of the feet and hands, cyanosis of the tip of the nose, ears, toes and fingers, palpitations and arrhythmias.
Also, shortness of breath in heart failure can be accompanied by a feeling of weakness, increased fatigue, dizziness, fainting, attacks of heart cough and pulmonary edema.
The patient must consult a general practitioner or cardiologist if:
- There is a feeling of lack of air, which cannot be compensated by rapid breathing.
- Against the background of shortness of breath, there is cardialgia, hoarse breathing, cough with sputum and swelling of the extremities.
To determine the cause of cardiac dyspnea, he is prescribed such studies:
For the treatment of dyspnea in heart failure, the patient is recommended not only taking medications, but also following a diet, a healthy lifestyle, developing the right response to stressful situations, and sufficient motor activity.
With very severe shortness of breath, the patient is recommended:
- Stop smoking and drinking alcohol.
- More often to be in the fresh air.
- Avoid actions that provoke shortness of breath.
- Perform daily activities slowly, taking rest breaks.
- Avoid climbing stairs and lifting weights.
- Wear clothing that does not constrain breathing.
- Putting the medicine in an accessible place, because excitement always exacerbates shortness of breath.
- Adjust your bed: there should be a slope of 35-40 degrees from the head of the head.
- There are small portions.
- Follow a low-calorie diet and limit (in severe cases, exclude) the use of salt. The patient needs to reduce the intake of fats (especially of animal origin) and carbohydrates, and include more foods containing protein, fiber and vitamins in the menu.
- Monitor blood pressure.
Cardiac dyspnea – causes, symptoms, diagnosis and treatment
Respiratory failure is the same symptom for which diagnostic accuracy is important, since it occurs in different diseases and requires completely different therapy. Algorithm for examining a patient:
- medical history, physical examination;
- blood gas analysis – the level of oxygen concentration in the blood;
- chest x-ray;
- spirometry – measurement of the amount of inhaled-exhaled air;
- ECG, echocardiography;
- CT, MSCT.
During testing, the doctor can measure the strength of the breath with a spirometer and the level of oxygen in the blood.
Differences in heart dyspnea from other dyspnea options
|Cardiac dyspnea||Pulmonary dyspnea|
|Occurs under normal loads.||Dyspnea has a different degree of severity: there is no day at all, and after a day – an attack of suffocation|
|Does not disappear after 10-15 minutes of rest||Cervical veins swell during exhalation|
|Difficult to inhale-exhale||Difficulty breathing on exhalation|
|Strengthens in a prone position||Shortness of breath does not change depending on the position of the human body|
|Accompanied by dry coughing||Wet, productive cough|
|Tachycardia, acrocyanosis||Dry wheezing is heard whistling in the distance|
|Swelling of the ankles||No swelling of the legs|
|Retrosternal discomfort||Spilled chest pain without attachment to the sternum|
|Cold limbs||Warm arms, legs|
|Garlic||350 gr||Grind the garlic to a state of slurry (using a crush or meat grinder). Mix the resulting mass with lemon juice, pour into a glass jar and insist in a warm place for a day.||Dilute a teaspoon of the composition in half a tablespoon of water. Take before bedtime.||2 week|
|Garlic||10 heads||Peeled peeled garlic and peeled lemon through a meat grinder. Mix the resulting mass with honey. Pour into a glass jar, cover and insist for a week.||4 teaspoons of the composition are consumed daily. At the same time, it must not be swallowed, but absorbed.||2 month|
|Dried Elderberry||In equal amounts||Mix herbs together. 4 teaspoons of raw materials pour a glass of cold water and leave for 2 hours. Put the composition on the fire and boil for 15 minutes.||The resulting amount of broth needs to be drunk in 1 day, divided into 3 doses.|
What will help if there is shortness of breath in heart failure? Treatment. Alternative treatment, of course, can alleviate the condition and even have a therapeutic effect in the initial stages. However, it cannot replace qualified medical care.
An attack of cardiac dyspnea is dangerous with complications that occur without timely medical attention. Dyspnea can cause:
- an attack of cardiac asthma (congestion in the pulmonary circulation);
- Pulmonary embolism (pulmonary embolism);
- coronary cardiac arrest: asthmatic myocardial infarction;
- imbalance in the influx and outflow of blood, lymph in the pulmonary circle of blood flow with sweating plasma in the alveoli, the development of pulmonary edema;
- pneumosclerosis, emphysema.
All complications require emergency medical attention.
|Glycosides||It has a cardiotonic effect, expand the stroke volume of the heart, and also eliminate tachycardia.|
|ACE Inhibitors||Provide the expansion of arteries, as well as the activation of vascular functions.|
|Diuretics||Elimination of puffiness, reduction of pressure on blood vessels and heart.|
|Beta-blockers||Elimination of oxygen starvation and arrhythmias.|
|If-channel inhibitors of the sinus node||Elimination of tachycardia.|
|Aldosterone Receptor Antagonists||The fight against arterial hypertension, congestive processes in the vessels, as well as the removal of excess fluid from the body.|
|Vasodilators||Reducing the load on the heart by reducing the tone of blood vessels.|
|Antiarrhythmic drugs||Normalization of heart rate.|
|Anticoagulants||The prevention of blood clots, as well as the facilitation of blood transport through the vessels.|
|Statins||Decreased blood cholesterol levels prevent the formation of plaques in blood vessels.|
|Vitamin Complexes||Total strengthening effect.|
Any pills for shortness of breath in heart failure should be taken as directed and under the supervision of a physician. Independent and uncontrolled use of drugs can lead to deterioration or disruption in the functioning of other body systems.
In most cases, medication, as well as alternative methods, help patients to eliminate the unpleasant symptoms associated with heart failure. However, if they are useless, surgery is possible. It may include the following actions:
- elimination of defects of heart valves;
- installation of an electronic stimulator;
- defibrillator installation;
- ventricular transplantation of artificial origin;
- vestment of the heart in a protective mesh frame;
- heart transplant.
A serious problem is shortness of breath in heart failure. What to do in case of exacerbation has been described above. In addition, there are a number of recommendations, the implementation of which will help maintain normal health:
- complete cessation of smoking and drinking;
- daily walks in the fresh air;
- minimize the actions that provoke shortness of breath (for example, intense physical exertion, weight lifting, etc.);
- wear loose clothing that does not cause discomfort;
- always have medications with you to feel confident in case of an attack;
- arrange your sleeping place so that the headboard is raised 45 degrees;
- do not eat large amounts of food at one time;
- limit salt and fat intake;
- with a sudden deterioration in the condition, you should immediately call an ambulance;
- sleep at least 8 hours a day;
- conduct continuous monitoring of blood pressure.
Unfortunately, the prognosis for dyspnea that accompanies heart failure is disappointing. In 95% of cases, shortness of breath indicates decompensation of the mechanisms for maintaining normal gas exchange in the body. In other words, pathology can no longer be cured at this stage. Adverse factors during heart failure with dyspnea are:
- Monitoring Blood pressure at least once a year in a specialized clinic or hospital;
- correction of cholesterol;
- lack of extra pounds;
- anti-atherogenic diet;
- regular exercise
- refusal of alcohol, cigarettes, drugs;
- elimination of stressful situations;
- timely treatment of concomitant diseases.
A prerequisite is a healthy 8-9 hour sleep.
Higher medical education. 30 years of working experience in practical medicine.