- Arterial hypertension
- Myocardial infarction or ACS
- Heart defects
- Toxic lesions of the myocardium of various etiologies, including iatrogenic origin
(chemotherapy, radiation damage to the myocardium, and more)
- Chronic and paroxysmal atrial fibrillation
- Acute cerebrovascular accident
The main causes of heart failure
- increased body weight;
- burdened heredity;
- abuse of alcohol and cigarettes.
In many cases, cardiovascular failure is diagnosed in people with a hereditary predisposition to cardiac diseases. But if we are talking about an adult who has symptoms for the first time, then the main causes of inefficient heart function are:
- heart defects;
- CHD (coronary heart disease);
- high blood pressure, hypertension.
Hypertension is extremely common in people who are over 50 years old. Short-term symptoms and attempts at self-medication lead the pathology to a neglected form, in which the risk of developing heart failure increases significantly. Also, risk factors leading to the disease include: arrhythmia, diabetes mellitus, inflammation of the heart muscle, impaired thyroid function. Related reasons:
- poisoning with toxic substances (alcohol, drugs);
- hormonal changes;
- insomnia, metabolic disorder, prolonged self-medication.
The clinical picture develops in acute and chronic CCH. A person who is diagnosed with this should be familiar with the signs of cardiovascular failure, and if acute heart failure occurs, timely access to medical personnel can save the patient’s life.
- Surgical treatment of heart failure
- Acute and chronic form
- PDT Inhibitors
- Principles of drug therapy for heart failure
- Vasodilators and nitrates
- Treatment of heart failure with folk remedies
- Cardiac glycosides
- Pulmonary edema treatment
Surgical treatment of heart failure
In the acute form, treatment of heart failure at home is unacceptable. Emergency medical assistance is needed. Therapy should be aimed at improving the functioning of the myocardium, increasing its contractility, to improve blood circulation and eliminate life-threatening symptoms as soon as possible: a strong increase in blood pressure, pulmonary edema, and even cardiogenic shock.
Patients with AHF are hospitalized in a specialized department, where they are provided with monitoring of blood pressure, heart rate and respiration, body temperature, an electrocardiogram is performed. With rare exceptions, all drugs are administered intravenously, as they should begin to act as soon as possible.
Tactics of treatment of AHF:
- An important task is to provide internal organs with oxygen to prevent the development of complications, so oxygen therapy is prescribed to the patient. In the respiratory mixture that is served to patients, the oxygen content is slightly increased compared to how much it is contained in ordinary air. This is necessary for better saturation of blood.
- If a strong decrease in blood pressure is not observed, drugs that dilate blood vessels (vasodilators) are prescribed.
- If AHF is accompanied by a decrease in cardiac output, it is necessary to inject fluid intravenously in order to ensure the filling of blood vessels and maintain blood pressure at the proper level.
- Excess fluid is excreted from the body by the use of diuretics.
- It is necessary to eliminate the cause that led to this condition.
- The pain syndrome is removed. With severe pain, the administration of narcotic analgesics is justified.
- If necessary, cardiac catheterization can be performed.
- Medicines are prescribed to prevent repeated attacks.
Morphine – it is usually prescribed in the early stages of severe ASF. It relieves pain, has a calming effect, and also reduces heart rate and dilates blood vessels.
Too large doses of morphine are not used, since it can cause a strong decrease in blood pressure, vomiting, and also depress breathing. Most often, complications from its use develop in the elderly.
- Vasodilators (Nitroglycerin, Nitroprusside, Nizerite) – these drugs for the treatment of acute heart failure are used to reduce blood stasis, while not increasing myocardial oxygen demand. They are used under the tongue or intravenously, while controlling blood pressure.
- ACE inhibitors – drugs of this group are usually not prescribed at the early stages of treatment, since their effect at this stage does not exceed the possible risks. They are more effective after stabilization of the patient’s condition for further treatment.
- Inotropic drugs (Norepinephrine, Dopamine, Dobutamine) – are used in order to improve myocardial contractility. However, their purpose leads to the fact that the heart needs more oxygen.
- Diuretic drugs (Furosemide, Torasemide) are used in cases when excess fluid accumulates in the body during AHF. Their use allows you to remove excess fluid, reduce blood pressure and the load on the myocardium. It should be remembered that along with the liquid, potassium and magnesium are eliminated from the body, therefore, it is necessary to control these indicators in the blood, and also, if necessary, ensure their additional supply. The use of small doses of diuretic drugs in conjunction with other groups of drugs is more effective than the appointment of simply large doses of diuretics. Most patients tolerate the purpose of these drugs, but sometimes complications can develop, so it is necessary to monitor the patient’s condition and monitor the body’s response to the appointment of a drug.
- Cardiac glycosides – they are prescribed for certain indications, since they are able to increase cardiac output, thereby freeing the heart chambers of a large amount of blood.
- Beta-blockers (Propranolol, Metoprolol, Esmolol) – are rarely used, since a violation of myocardial contractility is a contraindication for their use. Nevertheless, in certain cases, their purpose may be justified.
In some cases, surgical methods are used to treat acute heart failure. The decision is made by a cardiologist, depending on which disease caused a sharp deterioration in the contractility of the heart. Usually, surgery is used in cases where drug treatment of circulatory failure does not bring results.
Surgical methods include:
- Myocardial revascularization
- Correction of some defects both in the heart and in the valves
- Temporary maintenance of blood circulation by mechanical means
- In especially severe cases, a heart transplant can be prescribed.
In some cases, when drug therapy does not have the desired effect, the patient’s health deteriorates and a life threat occurs, surgical treatment may be prescribed. It is aimed at the underlying disease that caused heart failure.
Methods of surgical treatment:
- Aorto-coronary and mammary-coronary artery bypass grafting – is used in cases where the movement of blood through the coronary vessels is difficult due to the narrowing of their lumen. Because of this, the myocardium does not receive enough oxygen for its work. Bypass surgery creates workarounds along which blood can go around a pathological focus;
- Correction of the valvular apparatus of the heart;
- Heart transplantation from a donor;
- The use of artificial ventricles of the heart to create an auxiliary circulatory apparatus. This method has a rather high cost and is dangerous with complications: the attachment of a bacterial infection, the formation of blood clots.
Cardiac glycosides and beta blockers are selected after a long examination. Medication gives good results, so experts prefer to choose them, refusing other methods. When comparing, there is no difference in effectiveness, so there is no point in resorting to surgery or other categorical measures. What drugs are prescribed more often than others?
Cardiac glycosides are diverse, so their choice depends on many parameters. With hypertension, you can use some tablets, and with hypotension, others, and which ones are more effective, can only be found with regular examination on an individual basis.
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Nitroglycerin – a tool in the form of small red balls, taken by patients during an attack for decades. It is well known to people whose heart has ever hurt. Now manufacturers have introduced nitrosorbitol, which has become a good alternative to an obsolete drug, but no one disputes its effectiveness. Ambulance paramedics use it to instantly relieve spasm from the heart muscle in order to restore the patient to normal health.
Captopril is a common drug used as a beta inhibitor. Used in the course of treatment, helping patients to relieve regular pain. It is weaker than digoxin, and therefore does not require constant supervision. Because of what, his admission is carried out individually with home treatment.
Enalapril is another beta inhibitor often taken by patients to lower blood pressure. It is prescribed at the initial stages of the development of weakening of the heart muscle, when you can get rid of the disease in simple ways. To take it does not require regular examination. The person who took it easily relieves pain, and also reduces the risk of increased symptoms.
Furosemide is an additional remedy used for left ventricular failure. It relieves hydrothorax, removing pulmonary edema. This reduces the risk of death, which often ends in seizures. Digoxin, taken on time, eliminates such consequences, but if they have already appeared, there is no other option to find it. Only a diuretic drug will quickly remove excess fluid from the patient’s body.
Digoxin is a powerful drug that remains one of the main ones in the course of treatment for the chronic form of the disease. Its reception is possible only after examination and examination to clarify the absence of harmful effects on the patient’s body. Such tablets can not be used once and hope for a sharp decrease in pain, so they are only prescribed by cardiologists.
Vitamins for heart failure are mandatory, but they are selected exclusively in the quality of additional funds. Specialists pay special attention to a careful calculation of the dosage of the full course of drug treatment. If effectiveness is insufficient, categorical measures will follow.
Acute and chronic form
With cardiovascular failure, treatment is aimed at eliminating the cause of the disease. In acute and chronic forms of the disease, different treatments are carried out. In acute heart failure, drugs are used that can improve the functioning of the heart muscle and normalize blood circulation. After stopping the attack, the underlying disease is treated. In order to stop the attack, use the following groups of medicines for cardiovascular failure:
- Phosphodiesterase Inhibitors (PDT);
- Sympathomimetic agents (pressor);
- Vasodilators and nitrates;
These substances are used to improve cardiac contractility, they act on adrenergic receptors. Drug treatment should be carried out in the intensive care unit or intensive care unit, always under the supervision of an electrocardiogram.
Dopamine is the most effective treatment for heart failure, and also fights hypotensive conditions. It helps to improve cardiac output, constricts large vessels, thereby normalizing the flow of blood through the veins. In small doses (2-10 μg / kg of weight intravenously, drip) improves the functioning of the heart receptors for one minute, and a large dose leads to an increase in blood pressure.
Dobutamine – this drug reduces vascular resistance in the periphery, but does not affect pressure, therefore, intravenous drip is used to treat CCH, in which there is no pronounced increase in pressure.
Milrinon – this drug is also used to relieve symptoms of cardiovascular failure. Its effect is to increase the tone of the myocardium. In addition, it acts on the pulmonary vessels, relieving their spasm. The drug is used for administration with a dropper, first a shock dose of 50 μg / kg of a person’s weight is used, then the dose is reduced to 0,35-0,75 μg / kg in one minute.
Amrinon is a derivative of Milrinone, has similar pharmacological actions, also inhibits the effect of the phosphodiesterase enzyme, acts on the pulmonary and cardiac vessels.
Principles of drug therapy for heart failure
- It is necessary to detect the underlying disease, which led to a gradual deterioration in myocardial contractility and the development of heart failure. Proper treatment of the underlying disease will significantly improve the prognosis for the patient;
- If possible, it is necessary to eliminate those factors that may contribute to the onset of an attack of acute heart failure;
- Treatment of heart failure itself: a decrease in blood stasis and an increase in cardiac output. The elimination of these two factors will improve blood circulation to the internal organs and eliminate the symptoms of oxygen deficiency.
For the treatment of heart failure, certain groups of drugs are used. You can take them at home, with an uncomplicated course, it is not necessary to go to hospital, but you should still consult a doctor. He will conduct the necessary diagnostics, select the right drugs and tell you how to treat heart failure at home.
All drugs for the treatment of heart failure are divided into three groups:
- Fixed assets – the effectiveness of these drugs is proven and recommended in all countries of the world.
- Additional funds – they are prescribed according to indications.
- Auxiliary means – their effectiveness is not % proven in chronic heart failure, but depending on a specific situation, the appointment of this group may be justified.
Let’s consider each group in more detail.
- ACE inhibitors (Captopril, Enalapril) – these drugs should be prescribed to all patients with heart failure, regardless of stage, severity, etiology, form and other indicators. They slow down the course of the disease, protect internal organs, reduce blood pressure. When using them, undesirable effects such as a dry cough, a strong decrease in blood pressure, and deterioration of the kidneys can occur. To avoid this, it is necessary to start treatment with small dosages, gradually increasing to the required numbers, not to take ACE inhibitors and vasodilators at the same time, and also not to take large doses of diuretics before the appointment.
- Angiotensin receptor antagonists – they are most often prescribed if the patient has intolerance to ACE inhibitors or side effects have developed on them.
- Beta-blockers (Carvedilol, Bisoprolol, Metoprolol) – they are usually prescribed in addition to AFP inhibitors. They reduce the heart rate, have an antiarrhythmic effect. They start taking them also with minimal doses, gradually increasing. At the same time, it is desirable to increase the dose of diuretic drugs, as due to a decrease in heart rate, symptoms of heart failure may worsen.
- Aldosterone receptor antagonists – these drugs have a small diuretic effect, retain sodium in the body. They are usually prescribed for severe symptoms of heart failure, as well as after myocardial infarction.
- Diuretics (diuretics) – are used when fluid accumulates in the body. Usually, the weakest of effective drugs is prescribed to avoid the development of addiction in the patient.
- Cardiac glycosides (digoxin) are herbal preparations made from digitalis plants. In large doses, they are poisonous, but indispensable in the treatment of heart failure caused by atrial fibrillation.
- Statins – they are used if chronic heart failure appears on the background of coronary heart disease. Drugs of this group inhibit the production of fats in the liver, which are deposited on the walls of blood vessels and cause a narrowing or complete obstruction of their lumen, making it difficult for blood to flow through these vessels;
- Indirect anticoagulants – used for the risk of blood clots, which can clog the vessel. These drugs disrupt the formation in the liver of factors that contribute to blood coagulation.
- Nitrates – are prescribed mainly for angina pectoris to improve the nutrition of the heart itself and relieve pain, since they have a vasodilating effect and improve blood flow;
- Calcium antagonists – are also used for angina pectoris, high blood pressure, heart valve insufficiency;
- If there is a violation of the heart rhythm, then antiarrhythmic drugs can be used;
- Disaggregants – these drugs are prescribed mainly to patients after myocardial infarction, to prevent its repetition. They worsen the adhesion of platelets to each other, thereby diluting the blood and preventing the formation of blood clots.
The use of a diuretic for the treatment of cardiovascular failure is very effective, but should be used taking into account the electrolyte balance. In medical practice, a thiazide group of drugs has been widely used. The peak of action occurs after four hours, an increase in the amount of urine lasts up to 12 hours.
Chlorothiazide is a thiazide diuretic, it is prescribed every 6 hours in a dosage of up to 500 mg. Various analogues of this agent are also used, they are not distinguished by the presence of advantages with the exception of Oxodoline, it can be used once in 24 hours.
Metozalon – has the same effect as all diuretic groups of thiazides.
Furosemide – the drug also speeds up the formation and withdrawal of urine, is well absorbed when taken orally in the form of tablets, and is used for iv administration.
All diuretics have side effects in the form of a lack of potassium, since a large amount of it is disposed of together with urine. To avoid hypokalemia, patients are additionally prescribed potassium preparations or adjust therapy in favor of potassium-sparing diuretics.
Triamteren, Amiloride – do not have pronounced diuretic actions, but belong to potassium-sparing diuretics, so they are prescribed in combination with other diuretics.
Vasodilators and nitrates
They are prescribed together with diuretics for pulmonary edema, substances increase the clearance of veins and arteries, lower blood pressure, and stimulate myocardial tone.
Nitroglycerin, Nitrosorbide – affect the venous vessels, reduce pressure in the ventricles of the heart. Means are administered intravenously. Nitroglycerin is used one tablet under the tongue every 10 minutes, to improve the effect it can be used in the form of a cream or patch on the heart area.
Apressin, Minoxidil – act on arterial vessels, used in the form of tablets, the duration of action is several hours.
Nitroprusside – is administered dropwise 0,1-5 μg / kg of weight per minute, after administration it begins to act quickly, and just as quickly ceases its action within a few minutes after stopping the dropper.
Captopril, Prazosin, Enalapril – these vasodilators affect both venous and arterial vessels, are administered orally, the duration of action is several hours.
Cardiologists, choosing one or another remedy, take into account the mechanisms of action of substances that affect the bloodstream, as well as correlate the effect of the drug and the patient’s condition.
Treatment of heart failure with folk remedies
For the preparation of folk remedies, the following herbs are usually used:
- Shredded blueberry shoots;
- Lily of the valley flowers;
- Digitalis leaves;
- St. John’s wort grass;
- Parsley seeds;
- Dry ginseng root;
- Hawthorn flowers;
- Motherwort grass and many other plants.
It should be remembered that many of these plants are poisonous. Incorrect use, non-compliance with the dosage can result in poisoning. Treatment with folk remedies only the symptoms of heart failure, without proper treatment of the underlying disease, will not bring the expected result and can worsen the patient’s condition.
To get rid of the symptoms of cardiovascular failure, it is necessary to increase the contractility of the heart muscle. For this, in clinical practice, cardiac glycosides are used. They restore myocardial contractility (improve the quality of contractions), while reducing the number of heart beats per minute.
Even if there is edema in the heart failure, drugs of this group are well absorbed, 85% are excreted in the urine, 15% come out with stool.
Digitalis products inhibit the movement of sodium and potassium ions across the cell membrane, thereby contributing to an increase in the number of trace elements in the heart. This makes the processes of excitation and contraction of the heart more rational. These drugs include: Digoxin, Digitoxin, and their commercial analogues, such as Lanoxin.
Side effects of glycosides Despite the fact that symptoms quickly disappear with cardiovascular failure, digitalis preparations have side effects and can also lead to fatal complications. They must be used with caution in the following cases:
- Elderly age;
- Acute heart muscle infarction;
- Renal failure;
- Lack of magnesium in the blood;
- Increased amount of calcium;
- Diseases of the thyroid gland.
An increase in the dosage of glycosides even 2 times in these conditions can lead to serious intoxication. Therefore, in cases of contraindications to the use of cardiac glycosides, cardiotonics of the non-glycoside group are used.
Levosimendan, Simdax – these funds do not apply to digitalis preparations, however, they have a positive effect on the contraction of the ventricles of the heart, increasing their strength. In acute CCH, first, a shock dose of a substance is taken in the amount of 6-10 μg / kg, then the drug is administered slowly, dropwise (0,1 μg / kg per minute).
Pulmonary edema treatment
A condition in which pulmonary edema develops is a life threat to the patient and requires immediate relief. It is caused due to the narrowing of the mitral valve of the heart. The process is developing quickly and acutely, so the following activities are carried out simultaneously:
- Introduction of morphine hydrochloride – 2-5 mg, if necessary, the introduction can be repeated;
- Inhalation O2
- The patient should be in a sitting position with legs down from the bed, this reduces venous outflow;
- Diuretics help to quickly reduce the amount of circulating blood. Furosemide or ethacrylic acid in a dosage of 40-100 mg will quickly restore diuresis;
- If systolic pressure is higher than 100 mmHg. Art. Nitroprusside is administered at 20-30 mcg / min;
- In some cases, aminophylline is administered intravenously (240-480 mg). It increases blood flow in the lungs and also increases heart muscle contractions.
- If all these actions do not bring a positive result, tourniquets are applied to the lower extremities.
Treatment of acute heart failure should be carried out with a strict reduction in physical activity, compliance with emotional rest. An important part of treatment is nutritional correction. From the menu you need to exclude spicy, salty and smoked products. It is useful for heart failure to eat dried fruits, fresh tomatoes, garlic, honey. In detail about what needs to be emphasized, the nutritionist will tell.
In the case of chronic CCH, moderate exercise is indicated. It can be short-distance walking with a little warm-up before that. Morning exercises are also shown. All exercises should be fun – in no case should you exercise until you are very tired or exhausted – because of this, the disease can go into the acute stage.
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