Heart weakness symptoms treatment. Treatment of pulmonary edema in heart failure. Stages of care for a patient with acute heart failure

Chronic heart failure (CHF) is a condition in which the volume of blood ejected by the heart for each heartbeat decreases, that is, the pumping function of the heart decreases, as a result of which organs and tissues experience a lack of oxygen. About 15 million Russians suffer from this disease.

Depending on how quickly heart failure develops, it is divided into acute and chronic. Acute heart failure can be associated with trauma, toxins, heart disease, and can quickly be fatal if left untreated.

Chronic heart failure develops over a long period of time and is manifested by a complex of characteristic symptoms (shortness of breath, fatigue and decreased physical activity, edema, etc.), which are associated with inadequate perfusion of organs and tissues at rest or during exercise and often with fluid retention in the body

About the causes of this life-threatening condition, symptoms and treatments, including folk remedies we'll talk about in this article.

Classification

According to the classification according to V. Kh. Vasilenko, N. D. Strazhesko, G. F. Lang, three stages are distinguished in the development of chronic heart failure:

• I st. (HI) initial or latent insufficiency, which manifests itself in the form of shortness of breath and palpitations only with significant physical activity, which has not previously called it. At rest, hemodynamics and organ functions are not disturbed, working capacity is somewhat reduced.
• II stage - expressed, prolonged circulatory failure, hemodynamic disturbance (stagnation in the pulmonary circulation) with little physical exertion, sometimes at rest. In this stage, there are 2 periods: period A and period B.
• H IIA stage - shortness of breath and palpitations with moderate exertion. Slight cyanosis. As a rule, circulatory insufficiency is predominantly in the pulmonary circulation: periodic dry cough, sometimes hemoptysis, manifestations of congestion in the lungs (crepitus and inaudible moist rales in the lower sections), palpitations, interruptions in the heart area. At this stage, there are initial manifestations of stagnation in the systemic circulation (small swelling in the feet and lower legs, a slight increase in the liver). By morning, these phenomena are reduced. Employability is drastically reduced.
• H IIB stage - shortness of breath at rest. All objective symptoms of heart failure increase dramatically: pronounced cyanosis, congestive changes in the lungs, prolonged aching pain, interruptions in the heart, palpitations; there are signs of circulatory insufficiency in the systemic circulation, permanent edema lower extremities and trunk, enlarged dense liver (cardiac cirrhosis), hydrothorax, ascites, severe oliguria. The patients are disabled.
• Stage III (H III) - final, degenerative stage of insufficiency In addition to hemodynamic disturbances, morphologically irreversible changes in organs develop (diffuse pneumosclerosis, cirrhosis of the liver, congestive kidney, etc.). Metabolism is disturbed, exhaustion of patients develops. Treatment is ineffective.

Depending on the phases of cardiac dysfunction are isolated:

1. Systolic heart failure (associated with a violation of systole - the period of contraction of the ventricles of the heart);
2. Diastolic heart failure (associated with a violation of diastole - a period of relaxation of the ventricles of the heart);
3. Mixed heart failure (associated with a violation of both systole and diastole).

Depending on the zones of preferential stagnation of blood secrete:

1. Right ventricular heart failure (with stagnation of blood in the pulmonary circulation, that is, in the vessels of the lungs);
2. Left ventricular heart failure (with stagnation of blood in the systemic circulation, that is, in the vessels of all organs except the lungs);
3. Biventricular (biventricular) heart failure (with stagnation of blood in both circles of blood circulation).

Depending on the physical examination results are determined by classes on the Killip scale:

• I (no signs of heart failure);
• II (mild heart failure, few wheezing);
• III (more severe heart failure, more wheezing);
• IV (cardiogenic shock, systolic blood pressure below 90 mmHg).

Mortality in people with chronic heart failure is 4-8 times higher than in their peers. Without proper and timely treatment in the stage of decompensation, the survival rate for a year is 50%, which is comparable to some cancers.

Causes of chronic heart failure

Why does CHF develop, and what is it? The cause of chronic heart failure is usually damage to the heart or a violation of its ability to pump the right amount of blood through the vessels.

The main causes of the disease called:

• ischemic heart disease;
• heart defects.

There are also other precipitating factors disease development:

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

According to statistics, in men, the most common cause of the disease is ischemic disease hearts. In women, this disease is caused mainly by arterial hypertension.

The mechanism of development of CHF

1. The throughput (pumping) capacity of the heart decreases - the first symptoms of the disease appear: intolerance to physical exertion, shortness of breath.
   Compensatory mechanisms are activated, aimed at maintaining the normal functioning of the heart: strengthening the heart muscle, increasing the level of adrenaline, increasing blood volume due to fluid retention.
2. Malnutrition of the heart: muscle cells became much larger, and the number of blood vessels increased slightly.
3. Compensatory mechanisms are exhausted. The work of the heart deteriorates significantly - with each push it pushes out insufficient blood.

signs

The following symptoms can be distinguished as the main signs of the disease:

1. Frequent shortness of breath - a condition when there is an impression of lack of air, so it becomes rapid and not very deep;
2. Fatigue, which is characterized by the speed of loss of strength during the performance of a particular process;
3. Ascending number of heart beats in a minute;
4. Peripheral edema, which indicate a poor removal of fluid from the body, begin to appear from the heels, and then move higher and higher to the lower back, where they stop;
5. Cough - from the very beginning of the clothes it is dry with this disease, and then sputum begins to stand out.

Chronic heart failure usually develops slowly, many people consider it a manifestation of the aging of their body. In such cases, patients often delay contacting a cardiologist until the last moment. Of course, this complicates and lengthens the treatment process.

Symptoms of chronic heart failure

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

• fast fatiguability;
• shortness of breath, ;
• peripheral edema;
• heartbeat.

Complaints of rapid fatigue are presented by the majority of patients. The presence of this symptom is due to the following factors:

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

Shortness of breath in heart failure increases gradually - at first it occurs during physical exertion, then it appears with minor movements and even at rest. With decompensation of cardiac activity, the so-called cardiac asthma develops - episodes of suffocation that occur at night.

Paroxysmal (spontaneous, paroxysmal) nocturnal dyspnea can manifest itself as:

• short attacks of paroxysmal nocturnal dyspnea, passing on their own;
• typical attacks of cardiac asthma;
• acute pulmonary edema.

Cardiac asthma and pulmonary edema are essentially acute heart failure that developed against the background of chronic heart failure. Cardiac asthma usually occurs in the second half of the night, but in some cases it is provoked by physical effort or emotional excitement during the day.

1. In mild cases the attack lasts for several minutes and is characterized by a feeling of lack of air. The patient sits down, hard breathing is heard in the lungs. Sometimes this condition is accompanied by a cough with a small amount of sputum. Attacks can be rare - after a few days or weeks, but can also be repeated several times during the night.
2. In more severe cases, a severe prolonged attack of cardiac asthma develops. The patient wakes up, sits down, tilts the body forward, rests his hands on his hips or the edge of the bed. Breathing becomes rapid, deep, usually with difficulty inhaling and exhaling. Wheezing in the lungs may be absent. In some cases, bronchospasm may be associated, which increases ventilation disorders and the work of breathing.

The episodes can be so unpleasant that the patient may be afraid to go to bed, even after the symptoms have disappeared.

Diagnosis of CHF

In diagnosis, you need to start with an analysis of complaints, identifying symptoms. Patients complain of shortness of breath, fatigue, palpitations.

The doctor asks the patient:

1. How does he sleep?
2. Has the number of pillows changed in the last week?
3. Whether the person began to sleep sitting, and not lying down.

The second stage of diagnosis is physical examination, including:

1. skin examination;
2. Assessment of the severity of fat and muscle mass;
3. Checking for edema;
4. Palpation of the pulse;
5. Palpation of the liver;
6. auscultation of the lungs;
7. Auscultation of the heart (I tone, systolic murmur at the 1st auscultation point, analysis of the II tone, "gallop rhythm");
8. Weighing (a decrease in body weight by 1% in 30 days indicates the onset of cachexia).

Diagnostic goals:

1. Early detection of the presence of heart failure.
2. Clarification of the severity of the pathological process.
3. Determining the etiology of heart failure.
4. Assessment of the risk of complications and rapid progression of pathology.
5. Forecast evaluation.
6. Assessment of the likelihood of complications of the disease.
7. Monitoring the course of the disease and timely response to changes in the patient's condition.

Diagnostic tasks:

1. Objective confirmation of the presence or absence of pathological changes in the myocardium.
2. Identification of signs of heart failure: shortness of breath, fatigue, palpitations, peripheral edema, moist rales in the lungs.
3. Identification of the pathology that led to the development of chronic heart failure.
4. Determination of the stage and functional class of heart failure according to NYHA (New York Heart Association).
5. Identification of the predominant mechanism for the development of heart failure.
6. Identification of provoking causes and factors that aggravate the course of the disease.
7. Identification of concomitant diseases, assessment of their relationship with heart failure and its treatment.
8. Collecting enough objective data to prescribe the necessary treatment.
9. Identification of the presence or absence of indications for the use of surgical methods of treatment.

Diagnosis of heart failure should be made using additional methods surveys:

1. The ECG usually shows signs of myocardial hypertrophy and ischemia. Quite often this research allows to reveal the accompanying arrhythmia or disturbance of conductivity.
2. An exercise test is performed to determine tolerance to it, as well as changes characteristic of coronary heart disease (ST segment deviation on the ECG from the isoline).
3. 24-hour Holter monitoring allows you to clarify the state of the heart muscle with typical patient behavior, as well as during sleep.
4. A characteristic sign of CHF is a decrease in ejection fraction, which can be easily seen with ultrasound. If you additionally conduct Dopplerography, then heart defects will become obvious, and with proper skill, you can even identify their degree.
5. Coronary angiography and ventriculography are performed to clarify the state of the coronary bed, as well as in terms of preoperative preparation for open interventions on the heart.

When diagnosing, the doctor asks the patient about complaints and tries to identify signs typical of CHF. Among the evidence for the diagnosis, the discovery of a history of heart disease in a person is important. At this stage, it is best to use an ECG or determine the natriuretic peptide. If no deviations from the norm are found, the person does not have CHF. If manifestations of myocardial damage are detected, the patient should be referred for echocardiography in order to clarify the nature of cardiac lesions, diastolic disorders, etc.

At the subsequent stages of diagnosis, doctors identify the causes of chronic heart failure, specify the severity, reversibility of changes in order to determine adequate treatment. Additional studies may be ordered.

Complications

Patients with chronic heart failure may develop dangerous conditions such as

• frequent and protracted;
• pathological myocardial hypertrophy;
• numerous thromboembolism due to thrombosis;
• general depletion of the body;
• violation of the heart rhythm and conduction of the heart;
• dysfunction of the liver and kidneys;
• sudden death from cardiac arrest;
• thromboembolic complications (, thromboembolism of the pulmonary arteries).

Prevention of the development of complications is the use of prescribed medications, the timely determination of indications for surgical treatment, the appointment of anticoagulants according to indications, antibiotic therapy for lesions of the bronchopulmonary system.

Treatment of chronic heart failure

First of all, patients are advised to follow an appropriate diet and limit physical activity. You should completely abandon fast carbohydrates, hydrogenated fats, in particular, animal origin, and carefully monitor salt intake. You should also stop smoking and drinking alcohol immediately.

All methods of therapeutic treatment of chronic heart failure consist of a set of measures that are aimed at creating necessary conditions in everyday life, contributing to a rapid decrease in the load on the S.S.S., as well as the use of drugs designed to help the myocardium work and influence the disturbed processes of water-salt metabolism. The appointment of the volume of therapeutic measures is associated with the stage of development of the disease itself.

Treatment of chronic heart failure is long-term. It includes:

1. Medical therapy aimed at combating the symptoms of the underlying disease and eliminating the causes that contribute to its development.
2. rational mode, including the restriction of labor activity according to the forms of the stages of the disease. This does not mean that the patient must always be in bed. He can move around the room, classes are recommended physical therapy.
3. Diet therapy. It is necessary to monitor the calorie content of food. It should correspond to the prescribed regimen of the patient. For overweight people, the calorie content of food is reduced by 30%. And patients with exhaustion, on the contrary, are prescribed enhanced nutrition. If necessary, unloading days are held.
4. Cardiotonic therapy.
5. Treatment with diuretics aimed at restoring the water-salt and acid-base balance.

Patients with the first stage are fully able-bodied, with the second stage there is a limited ability to work or it is completely lost. But in the third stage, patients with chronic heart failure need permanent care.

Medical treatment

Drug treatment of chronic heart failure is aimed at improving the functions of contraction and ridding the body of excess fluid. Depending on the stage and severity of symptoms in heart failure, the following groups of drugs are prescribed:

1. Vasodilators and ACE inhibitors- angiotensin-converting enzyme (, ramipril) - lower vascular tone, dilate veins and arteries, thereby reducing vascular resistance during heart contractions and contributing to an increase in cardiac output;
2. Cardiac glycosides (digoxin, strophanthin, etc.)- increase myocardial contractility, increase its pumping function and diuresis, contribute to satisfactory exercise tolerance;
3. Nitrates (nitroglycerin, nitrong, sustak, etc.)- improve blood supply to the ventricles, increase cardiac output, dilate the coronary arteries;
4. Diuretics (, spironolactone)- reduce the retention of excess fluid in the body;
5. Β-blockers ()- reduce heart rate, improve blood supply to the heart, increase cardiac output;
6. Drugs that improve myocardial metabolism(vitamins of group B, ascorbic acid, riboxin, potassium preparations);
7. Anticoagulants ( , )- prevent thrombosis in the vessels.

Monotherapy in the treatment of CHF is rarely used, and only ACE inhibitors can be used in this capacity in the initial stages of CHF.

Triple therapy (ACE inhibitor + diuretic + glycoside) - was the standard in the treatment of CHF in the 80s, and now remains an effective regimen in the treatment of CHF, however, for patients with sinus rhythm, it is recommended to replace the glycoside with a beta-blocker. The gold standard from the early 90s to the present is a combination of four drugs - ACE inhibitor + diuretic + glycoside + beta-blocker.

Prevention and prognosis

To prevent heart failure, proper nutrition sufficient physical activity, avoidance of bad habits. All diseases of the heart vascular system should be promptly identified and treated.

The prognosis in the absence of CHF treatment is unfavorable, since most heart diseases lead to wear and tear and the development of severe complications. When conducting medical and / or cardiac surgical treatment, the prognosis is favorable, because there is a slowdown in the progression of insufficiency or a radical cure for the underlying disease.

Today, almost everyone experiences chronic fatigue syndrome, which is expressed in rapid fatigue. Many are familiar with palpitations or dizziness that occur for no apparent reason; shortness of breath that appears when walking fast or while climbing stairs on foot to the desired floor; swelling in the legs at the end of the working day. But few people realize that all these are symptoms of heart failure. Moreover, in one manifestation or another, they accompany almost all pathological conditions of the heart and diseases of the vascular system. Therefore, it is necessary to determine what heart failure is and how it differs from other heart diseases.

What is heart failure?

With many heart diseases caused by pathologies of its development and other causes, there is a violation of blood circulation. In most cases, there is a decrease in blood flow to the aorta. This leads to what happens in various organs, which violates their functionality. Heart failure leads to an increase in circulating blood, but the speed of blood movement slows down. This process can occur suddenly (acute course) or be chronic.

Video: heart failure - medical animation

Acute heart failure

All activity of the heart is carried out by the heart muscle (myocardium). Its work is affected by the state of the atria and ventricles. When one of them stops working normally, myocardial overstrain occurs. It can be caused by various diseases or abnormalities outside the heart that affect the heart. It can happen suddenly. This process is called acute heart failure.

Etiology of the acute form

It can lead to:

1. coronary insufficiency;
2. Malformations of valves ( , );
3. Chronic and acute processes in the lungs;
4. Raise blood pressure in the systems of small and large blood circulation.

Symptoms

Clinically, acute heart failure manifests itself in different ways. It depends on which ventricle (right (RV) or left (LV)) muscle overstrain occurred.

• In acute LV insufficiency (it is also called), attacks mainly overtake at night. A person wakes up from the fact that he has nothing to breathe. He is forced to take a sitting position (orthopnea). Sometimes this does not help and the sick person has to get up and walk around the room. He has rapid (tachypnea) breathing, like a hunted animal. His face takes on a gray color with cyanosis, pronounced acrocyanosis is noted. The skin becomes hydrated and cool. Gradually, the patient's breathing changes from rapid to bubbling, which can be heard even at a great distance. Occurs with pink frothy sputum. BP is low. Cardiac asthma requires immediate medical attention.
• In acute right ventricular failure, blood stasis occurs in the vena cava (lower and upper), as well as in the veins of the large circle. There is swelling of the veins of the neck, stagnation of blood in the liver (it becomes painful). There is shortness of breath and cyanosis. The attack is sometimes accompanied by bubbling breathing of Cheyne-Stokes.

Acute heart failure can lead to pulmonary edema (alveolar or interstitial), cause. Sudden weakness of the heart muscle leads to instant death.

Pathogenesis

Cardiac asthma (the so-called interstitial edema) occurs with infiltration of serous contents into the perivascular and peribronchial chambers. As a result, metabolic processes in the lungs are disturbed. With the further development of the process, liquid penetrates into the lumen of the alveoli from the bed of the blood vessel. Interstitial edema of the lung becomes alveolar. This is a severe form of heart failure.

Alveolar edema can develop independently of cardiac asthma. It can be caused by AK (aortic valve), LV, and diffuse prolapse. Conducting clinical trials makes it possible to describe the picture of what is happening.

1. At the time of acute insufficiency, in the blood circulation system in a small circle, there is a rapid increase in static pressure to significant values ​​​​(above 30 mm Hg), which causes the flow of blood plasma into the alveoli of the lungs from the capillaries. At the same time, the permeability of the capillary walls increases, and the oncotic pressure of the plasma decreases. In addition, the formation of lymph in the tissues of the lung increases and its movement in them is disturbed. Most often, this is facilitated by an increased concentration of prostaglandin and mediators, caused by an increase in the activity of the sympathetic-adrenergic locator system.
2. A sharp decrease in the antroventricular opening contributes to the delay in blood flow in the small circle and accumulation in the left atrial chamber. It is not able to pass the blood flow in the left ventricle in full. As a result, the pumping function of the pancreas increases, creating an additional portion of blood in the small circle and increasing venous pressure in it. This causes pulmonary edema.

Diagnostics

Diagnosis at a doctor's appointment shows the following:

• During percussion (tapping to determine the configuration of the heart, its position and size) in the lungs (its lower sections), a dull, box-like sound is heard, indicating blood stagnation. Swelling of the mucous membranes of the bronchi is detected by auscultation. This is indicated by dry rales and noisy breathing in the lungs.
• In connection with the developing emphysema of the lung, it is rather difficult to determine the boundaries of the heart, although they are enlarged. The heart rhythm is disturbed. It develops (an alternation of the pulse, a gallop rhythm may occur). Auscultated, characteristic of pathologies of valvular mechanisms, bifurcation and amplification of the II tone above the main artery of the lung.
• BP varies over a wide range. Increased and central pressure in the veins.

The symptoms of cardiac and bronchial asthma are similar. For accurate diagnosis of heart failure requires a comprehensive examination, including methods of functional diagnostics.

• On x-rays, horizontal shadows are visible on the lower sections of the lungs (Kerley lines), indicating swelling of the septa between its lobules. The compression of the gap between the lobes is differentiated, the pattern of the lung is strengthened, the structure of its roots is vague. Main bronchi without visible lumen.
• When carrying out, LV overload is detected.

Treatment of acute heart failure requires emergency medical therapy. It is aimed at reducing myocardial overstrain and increasing its contractile function, which will relieve swelling and chronic fatigue syndrome, reduce shortness of breath and other clinical manifestations. An important role is played by the observance of a sparing regimen. The patient needs to ensure peace for several days, eliminating overvoltage. He should get enough sleep at night (night sleep for at least 8 hours), rest during the day (reclining up to two hours). It is mandatory to switch to a dietary diet with restriction of liquid and salt. You can use the Carrel diet. IN severe cases the patient requires hospitalization for treatment in a hospital.

Medical therapy

Video: how to treat heart failure?

Acute coronary insufficiency

With a complete cessation of blood flow in the coronary vessels, the myocardium receives less nutrients and lacks oxygen. coronary insufficiency develops. It can have acute (sudden onset) and chronic course. Acute coronary insufficiency can be caused by strong excitement (joy, stress or negative emotions). Often it is caused by increased physical activity.

The most common cause of this pathology is vasospasm, caused by the fact that in the myocardium due to violations of hemodynamics and metabolic processes, products with partial oxidation begin to accumulate, which lead to irritation of the receptors of the heart muscle. The mechanism of development of coronary insufficiency is as follows:

• The heart is surrounded on all sides by blood vessels. They resemble a crown (crown). Hence their name - coronary (coronary). They fully meet the needs of the heart muscle in nutrients and oxygen, creating favorable conditions for its work.
• When a person is engaged in physical work or just moves, there is an increase in cardiac activity. At the same time, myocardial demand for oxygen and nutrients increases.
• Normally, the coronary arteries dilate, increasing blood flow and providing the heart with everything it needs in full.
• During a spasm, the bed of the coronary vessels remains the same size. The amount of blood entering the heart also remains the same level, and it begins to experience oxygen starvation (hypoxia). This is acute insufficiency of the coronary vessels.

Signs of heart failure caused by coronary spasm are manifested by the appearance of (angina pectoris). A sharp pain compresses the heart, not allowing to move. It can give to the neck, shoulder blade or arm on the left side. The attack most often occurs suddenly during motor activity. But sometimes it can come and in a state of rest. At the same time, a person instinctively tries to take the most comfortable position to relieve pain. The attack usually lasts no more than 20 minutes (sometimes it lasts only one or two minutes). If an angina attack lasts longer, there is a possibility that coronary insufficiency has passed into one of the forms of myocardial infarction: transient (focal dystrophy), small-focal infarction, or myocardial necrosis.

In some cases, acute coronary insufficiency is considered a type of clinical manifestation, which can occur without severe symptoms. They can be repeated repeatedly, and the person does not even realize that he has a severe pathology. Accordingly, the necessary treatment is not carried out. And this leads to the fact that the condition of the coronary vessels gradually worsens, and in certain moment the next attack takes a severe form of acute coronary insufficiency. If at the same time the patient is not provided with medical care, myocardial infarction can develop in a matter of hours and sudden death occurs.

one of the main causes of coronary insufficiency

Treatment of acute coronary insufficiency is to stop angina attacks. For this are used:

1. Nitroglycerine. You can take it often, as it is a fast-acting but short-acting drug. ( For myocardial infarction Nitroglycerin does not have the desired effect).
2. Intravenous administration contributes to the rapid removal of an attack Eufillina (Sintofillina, Diafillina).
3. A similar effect is No-shpa and hydrochloric Papaverine(subcutaneous or intravenous injections).
4. Seizures can also be controlled by intramuscular injection. Heparin.

Chronic heart failure

With the weakening of the myocardium caused, chronic heart failure (CHF) gradually develops. This is a pathological condition in which the cardiovascular system cannot supply the organs with the volume of blood necessary for their natural functionality. The onset of CHF development proceeds secretly. It can only be detected by testing:

• A two-stage MASTER test, during which the patient must go up and down the stairs with two steps, the height of each is 22.6 cm, with a mandatory ECG before testing, immediately after it and after a 6-minute rest;
• On a treadmill (recommended annually for people over 45 years of age, in order to identify cardiac disorders);

Pathogenesis

The initial stage of CHF is characterized by a violation of the correspondence between cardiac output per minute and the circulating blood volume in a large circle. But they are still within the normal range. Hemodynamic disorders are not observed. With the further development of the disease, all indicators characterizing the processes of central hemodynamics have already changed. They are decreasing. The distribution of blood in the kidneys is disturbed. The body begins to retain excess water.

complications on the kidneys - a characteristic manifestation of the congestive course of CHF

Both left ventricular and right ventricular heart failure may be present. But sometimes it is quite difficult to differentiate types. In the large and small circle, blood stagnation is observed. In some cases, there is stagnation of only venous blood, which overflows all organs. This significantly changes its microcirculation. The rate of blood flow slows down, the partial pressure decreases sharply, and the diffusion rate of oxygen in the cell tissue decreases. The decrease in lung volume causes shortness of breath. Aldosterone accumulates in the blood due to disturbances in the functioning of the excretory tracts of the liver and kidneys.

With further progression of insufficiency of the cardiovascular system, the synthesis of hormone-containing proteins decreases. Corticosteroids accumulate in the blood, which contributes to adrenal atrophy. The disease leads to severe hemodynamic disturbances, decreased functionality of the lungs, liver and kidneys, and their gradual dystrophy. Water-salt metabolic processes are disturbed.

Etiology

The development of CHF is facilitated by various factors that affect the tension of the myocardium:

• Pressure overload of the heart muscle. This is facilitated by aortic insufficiency (AN), which may be of organic origin due to chest trauma, aneurysm and atherosclerosis of the aorta, septic. In rare cases, it develops due to the expansion of the mouth of the aorta. In AN, blood flow moves in the opposite direction (to the left ventricle). This contributes to an increase in the size of its cavity. The peculiarity of this pathology is a long asymptomatic course. As a result, LV weakness gradually develops, causing left ventricular type heart failure. It is accompanied by the following symptoms:
  1. Shortness of breath during physical activity during the day and at night;
  2. Dizziness associated with standing up abruptly or turning the torso;
  3. and pain in the region of the heart with increased physical activity;
  4. The large arteries in the neck constantly pulsate (this is called the "dance of the carotid");
  5. The pupils either constrict or dilate;
  6. The capillary pulse is clearly visible when pressing on the nail;
  7. There is a symptom of Musset (slight shaking of the head caused by pulsation of the aortic arch).
• Increased volume of residual blood in the atria. Leads to this factor. MV pathology can be caused by functional disorders of the valvular apparatus associated with the closure of the atrioventricular orifice, as well as pathologies of organic origin, such as chord sprain or leaflet prolapse, rheumatic disease, or atherosclerosis. Too much expansion often leads to MK insufficiency. circular muscles and the fibrous ring of the atrioventricular orifice, LV expansion, provoked by myocardial infarction, cardiosclerosis, etc. Hemodynamic disorders in this pathology are caused by blood flow in the opposite direction (reflux) at the time of systole (from the ventricle back to the atrium). This is due to the fact that the valve leaflets sag inside the atrial chamber and do not close tightly. When more than 25 ml of blood enters the atrial chamber during reflux, its volume increases, which causes its tonogenic expansion. Subsequently, hypertrophy of the left atrial heart muscle occurs. The amount of blood that exceeds that required will begin to flow into the LV, as a result of which its walls will hypertrophy. Gradually develops CHF.
• Circulatory failure may develop due to primary pathology of the heart muscle in the event of a macrofocal infarction, diffuse cardiosclerosis, cardiopathy and myocarditis.

It should be noted that most often the cause of circulatory failure is a combination of several factors. A significant role in this is played by a biochemical factor, which is expressed in a violation of the transport of ions (potassium-sodium and calcium) and adrenergic regulation of the function of myocardial contraction.

Congestive form of CHF

With circulatory disorders in the right atrium and ventricle, congestive heart failure of the right ventricular type develops. Its main symptoms are heaviness in the hypochondrium on the right side, reduced diuresis and constant thirst, swelling in the legs, enlarged liver. Further progression of heart failure contributes to the involvement of almost all internal organs. This causes a sharp weight loss of the patient, the occurrence of ascites and impaired external respiration.

CHF therapy

Treatment of chronic heart failure is long-term. It includes:

1. Drug therapy aimed at combating the symptoms of the underlying disease and eliminating the causes that contribute to its development.
2. A rational regime, including the restriction of labor activity according to the forms and stages of the disease. This does not mean that the patient must always be in bed. He can move around the room, physical therapy is recommended.
3. Diet therapy. It is necessary to monitor the calorie content of food. It should correspond to the prescribed regimen of the patient. For overweight people, the calorie content of food is reduced by 30%. And patients with exhaustion, on the contrary, are prescribed enhanced nutrition. If necessary, unloading days are held.
4. Cardiotonic therapy.
5. Treatment aimed at restoring the water-salt and acid-base balance.

At the initial stage, treatment is carried out with vasodilators and alpha-blockers, which improve hemodynamic parameters. But the main medications for the treatment of chronic heart failure are. They increase the ability of the myocardium to contract, reduce the heart rate and excitability of the heart muscle. Normalize the patency of impulses. Glycosides increase cardiac output, thereby reducing diastolic pressure in the ventricles. At the same time, the need of the heart muscle for oxygen does not increase. There is an economical, but powerful work of the heart. The group of glycosides includes the following drugs: Corglicon, Digitoxin, Celanide, Digoxin, Strofantin.

Their treatment is carried out according to a special scheme:

• The first three days - in a shock dosage to reduce and relieve swelling.
• Further treatment is carried out with a gradual decrease in dosage. This is necessary so as not to cause intoxication of the body (glycosides tend to accumulate in it) and not lead to increased diuresis (they have a diuretic effect). With a decrease in dosage, the frequency of heart contractions is constantly monitored, the degree of diuresis and shortness of breath is assessed.
• After the optimal dosage is established, at which all indicators are stable, maintenance therapy is carried out, which can last for a long time.

Diuretics remove excess fluid from the body and are eliminated in heart failure. They are divided into four groups:

1. Ethacrynic acid And Furasemide- forced action;
2. Cyclometazide, Hydrochlorothiazide, Clopamid- moderate action;
3. Dyteq (Triamterene), Spiranolactone, Amiloride, Veroshpiron- potassium-sparing diuretics intended for long-term use.

They are appointed depending on the degree of imbalance of water-salt metabolism. In the initial stage, drugs of forced action are recommended for periodic administration. With long-term, regular use, it is necessary to alternate moderate-acting drugs with potassium-sparing ones. The maximum effect is achieved with the right combination and dosage of diuretics.

For the treatment of congestive heart failure, which causes all types of metabolic disorders, drugs that correct metabolic processes are used. These include:

• Isoptin, Fitoptin, Riboxin and others - ;
• Methandrostenolol, Retabolil- Anabolic steroids that promote the formation of proteins and accumulate energy inside myocardial cells.

In the treatment of severe forms, plasmapheresis gives a good effect. With congestive heart failure, all types of massage are contraindicated.

For all types of heart failure, it is recommended to take: Caviton, Stugeron, Agapurin or Trental. Treatment should be accompanied by the mandatory appointment of multivitamin complexes: Pangeksavit, Geksavit etc.

Treatment allowed folk methods. It should Supplement the main drug therapy, but do not replace it. Sedative preparations are useful, normalizing sleep, eliminating cardiac excitement.

Strengthening the heart muscle is promoted by an infusion of flowers and berries blood red hawthorn, fruits wild rose. Have diuretic properties fennel, cumin, celery, parsley. Eating them fresh will help reduce the intake of diuretics. Well remove excess fluid from the body infusion birch buds, bearberry ( bear's ear ) And lingonberry leaves.

Medicinal plants in combination with bromhexine and ambroxol effectively eliminate cough in heart failure. Soothes cough infusion hyssop. And inhalations with extracts eucalyptus contribute to the purification of the bronchi and lungs in congestive heart failure.

During the period of therapy and subsequent rehabilitation, it is recommended to constantly engage in physiotherapy exercises. The doctor selects the load individually. It is useful after each class to take a cold shower or pour over cold water, followed by rubbing the body to a slight reddening. This helps to harden the body and strengthen the heart muscle.

CHF classification

Classification of heart failure is carried out according to the degree of exercise tolerance. There are two types of classification. One of them was proposed by a group of cardiologists N.D. Strazhesko, V.Kh. Vasilenko and G.F. Lang, who divided the development of CHF into three main stages. Each of them includes characteristic manifestations during exercise (group A) and at rest (group B).

1. The initial stage (CHF I) - proceeds secretly, without pronounced symptoms, both at rest and during normal physical activity. Slight shortness of breath and palpitations occur only when performing unusual, harder work or increasing the load during the training process for athletes before important competitions.
2. Expressed stage (CHF II):
   • Group II CHF (A) - is manifested by the occurrence of shortness of breath when performing even the usual work with a moderate load. Accompanied by palpitations, cough with bloody sputum, swelling in the legs and feet. Blood circulation is broken in a small circle. Partial disability.
   • CHF group II (B) - characterized by shortness of breath at rest, to the main signs of CHF II (A), constant swelling of the legs (sometimes some parts of the body swell), cirrhosis of the liver, cardiac, ascites are added. Complete decline in performance.
3. The final stage (CHF III). It is accompanied by serious hemodynamic disturbances, development of congestive kidney, liver cirrhosis, diffuse pneumosclerosis. Metabolic processes are completely broken. The body is exhausted. The skin takes on a light tan color. Medical therapy is ineffective. Only surgery can save the patient.

The second option provides for the classification of CHF according to the Killip scale (the degree of exercise intolerance) into 4 functional classes.

• I f.c. Asymptomatic CHF, mild. There are no restrictions on sports and work activities.
• II f.c. During physical activity, the heart rate increases and there is a slight shortness of breath. Rapid fatigue is noted. Physical activity is limited.
• III f.c. Shortness of breath and palpitations occur not only under the influence of physical activity, but also when moving around the room. Significant limitation of physical activity.
• IV f.c. Symptoms of CHF occur even at rest, intensifying with the slightest physical activity. Absolute intolerance to physical activity.

Video: a lecture on the diagnosis and treatment of heart failure for physicians

Circulatory failure in childhood

In children, circulatory failure can manifest itself in both acute and chronic forms. In newborns, heart failure is associated with complex and combined. In infants, early and late myocarditis leads to heart failure. Sometimes the cause of its development is acquired heart defects associated with the pathology of valvular mechanisms.

Heart defects (congenital and acquired) can cause CHF in a child of any age. In children of primary school age (and older), CHF is often caused by the formation of rheumatic carditis or rheumatic pancarditis. There are also extracardiac causes of heart failure: for example, severe kidney disease, hyaline membrane disease in newborns, and a number of others.

Treatment is similar to drug therapy for chronic and acute heart failure in adults. But unlike adults, small patients are assigned strict bed rest, when they perform all the necessary movements with the help of their parents. Relaxation of the regimen (it is allowed to read in bed, draw, and do homework) with CHF II (B). You can start independent hygiene procedures, walk around the room (light mode) when CHF passes to stage II (A). Mandatory intake of magnesium preparations (Magnerot) is recommended.

First aid for heart failure

Many people are in no hurry to provide themselves with the necessary medical assistance in case of heart failure. Someone simply does not know what to do in such cases, others simply neglect treatment. Still others are afraid that frequent use of potent drugs can cause addiction to them. Meanwhile, if symptoms of acute coronary insufficiency occur, if treatment is not started on time, death can occur very quickly.

First aid for acute attacks of heart failure is to take a comfortable position and take a fast-acting drug (Nitroglycerin with Validol under the tongue).

You can take these drugs more than once. They do not accumulate in the body and are not addictive, but you should always remember that Nitroglycerin is capable significantly (and quickly) lower blood pressure, and, besides this, some patients simply do not tolerate it.

People who have been diagnosed with mild heart failure (I f.k. or CHF stage I) are shown sanatorium-and-spa treatment. It has a preventive value and is aimed at improving the functionality of the cardiovascular system. Thanks to a systematic, properly selected alternation of periods of physical activity and rest, the heart muscle is strengthened, which prevents the further development of heart failure. But when choosing a sanatorium, it must be taken into account that patients with cardiovascular diseases are contraindicated:

• A sharp change in climatic conditions,
• Moving long distances
• Too high and low temperatures,
• High solar radiation.

Resort and sanatorium treatment is strictly prohibited for patients with severe clinical manifestations of heart failure.

Heart failure is a serious disease, accompanied by a violation of the ability of the heart muscle to provide adequate blood circulation. This leads to hypoxia and deterioration of tissue trophism. Symptoms of heart failure may even have a greater impact on a patient's quality of life than symptoms of other chronic diseases, such as diabetes or arthritis.

The first signs of heart failure is the topic of the article. With heart failure, you may experience:

Increased fatigue - especially in severe form;

Shortness of breath - at first appears only during physical exertion, but in the later stages it can also occur at rest;

■ cough with white or pink frothy sputum associated with fluid retention and congestion in the lungs;

Edema - accumulation of excess fluid in the tissues; localized on the legs in walking patients and in the lumbosacral region and on the thighs - in bedridden patients;

Weight loss - the disease is often accompanied by a decrease in appetite, nausea and vomiting;

Abdominal pain - may occur due to congestion in the liver.

Heart failure occurs when the heart is damaged or overloaded, for example, against the background of one of the following diseases:

Ischemic heart disease - often associated with damage to the myocardium of the left ventricle of the heart;

Chronic pathology of the heart muscle - for example, due to viral infections or alcoholism;

Hypertension - leads to a decrease in the elasticity of the arterial wall, which makes it difficult for the heart to work;

Acute or chronic myocarditis (inflammation of the heart muscle) - may be a complication of viral and bacterial infections;

■ heart defects - changes in the heart valves of a congenital, degenerative nature or due to damage;

Narrowing of the aorta is a congenital pathology;

Inconsistency of the minute output of the heart with the needs of the body - when the body works with an increased load to saturate the tissues with oxygen;

Impaired venous flow—for example, chronic thickening of the pericardium restricts blood flow to the heart, causing it to work harder to maintain circulation.

Functions of the heart

The heart is a muscular pump that pumps blood to all organs, saturating them with oxygen and nutrients. The heart makes about 100,000 beats per day, pumping 25-30 liters of blood per minute. The heart is divided into left and right halves, each consisting of an atrium and a ventricle. Oxygen-poor blood from the vena cava enters the right atrium. From here it is pumped through the right ventricle into the vessels of the lungs. The left atrium receives oxygenated blood from the pulmonary circulation, ejecting it into the left ventricle, from where it is pumped into the systemic circulation. Heart valves prevent backflow of blood. The heart muscle has its own blood supply provided by the coronary arteries. The two-layer membrane that covers the heart is called the pericardium. The diagnosis of heart failure is made on the basis of clinical data, however, additional research allows us to clarify its causes and choose the optimal treatment. Symptoms such as shortness of breath and swelling allow suspecting heart failure.

In the process of diagnosis, the following studies are carried out:

Blood tests - a complete blood count, biochemical studies to evaluate the function of the liver, kidneys and thyroid gland; determination of the level of cardiac enzymes (with myocardial infarction it is increased);

X-ray of the chest - to detect an increase in the size of the heart, the presence of fluid in the lungs, hardening of the walls of the arteries;

Electrocardiogram (ECG) - patients with heart failure usually have abnormal ECG changes;

Echocardiography is a key study to assess the function of the left ventricle, heart valves and pericardium; color dopplerography - used to study the condition of the heart valves and intracardiac blood flow;

■ cardiac catheterization - allows you to measure the pressure in the heart chambers and the main vessels;

Stress tests - allow you to evaluate the reaction of the heart to physical activity.

Patients with decompensated heart failure usually require hospitalization. If possible, the diseases underlying the development of heart failure, such as anemia, are treated. Providing rest to the patient reduces the load on the heart, but bedtime should be limited to avoid the formation of blood clots in the vessels of the lower extremities. All medical manipulations are best done in a sitting position, and not lying down. Meals should be in small portions, with salt restriction. Alcohol and smoking are excluded. For the treatment of heart failure, the following drugs are used: diuretics - increase the amount of urine output, lower blood pressure, reduce the severity of edema and shortness of breath; beta-blockers - normalize the work of the heart, slowing down the heart rate, but at the beginning of their use, a doctor's supervision is necessary; angiotensin-converting enzyme inhibitors (ACE inhibitors) - can prevent the progression of the disease, as well as reduce mortality from chronic heart failure and myocardial infarction. The initial selection of the dose should be under the supervision of a physician.

Angiotensin II receptor antagonists - similar in their action to ACE inhibitors, but have fewer side effects;

Digoxin - often causes nausea, in addition, there are often difficulties with dose selection. It is mainly used to normalize the heart rhythm during arrhythmias.

Many patients require combination therapy with multiple drugs. Heart failure can develop at any age, but occurs mainly in the elderly. Chronic heart failure affects 0.4 to 2% of the adult population. With age, the risk of developing heart failure gradually increases. Among all patients attending medical institutions Russia, 38.6% have signs of chronic heart failure. Despite advances in treatment options, the prognosis for patients with heart failure often remains poor. Survival rates among them are worse than for some common types of cancer. About 50% of patients with severe heart failure die within two years of diagnosis.

What are the signs of heart failure?

Risk factors and absolute risk of development

Cardiovascular pathologies are so common that most people directly encounter them or close relatives get sick.

Therefore, it is important to know the likelihood of developing this disease and the factors conducive to these negative consequences in order to prevent undesirable consequences.

The most common causes of heart failure are arterial hypertension and cardiac ischemia. The combination of them together can be observed in 75% of patients with heart failure.

Myocarditis, heart defects and cardiomyopathy are less likely to provoke heart disease.

Factors contributing to the worsening of heart failure or its progression include the following:

• exacerbation or worsening of heart disease;
• accession to existing ailments of other cardiovascular diseases (myocardial infarction, infectious endocarditis, arterial hypertension, heart rhythm and conduction disturbances);
• accession of diseases of other organs and systems, such as infections of the respiratory organs, thrombosis of the pulmonary artery, thromboembolism, anemia and diseases of the endocrine system;
• physical stress, poor nutrition, intoxication, beriberi, stress;
• the use of drugs with an inotropic negative effect on the body (diltiazem, verapamil, disopyramide).

Pay attention to the useful article - drugs for the treatment of heart failure. What resources should be trusted?

Five signs of heart failure.

Cardiologists warn: this dangerous disease in Russia has become much younger. What symptoms should alert?

In Russia, more than 9 million people suffer from this disease. Moreover, unlike the United States and Europe, where the diagnosis of CHF (chronic heart failure) is made mainly to people from 70 to 89 years old, in our country the age of such hearts is increasingly not even up to 60.

We can say that now we have entered the era of heart failure, many Russians have been developing this dangerous disease since the age of 50.

Heart failure is a common and potentially life-threatening condition in which the heart becomes less able to pump blood through the vessels. Because of this, the organs receive less nutrients and oxygen, it becomes increasingly difficult for the body to perform daily physical activity. Most often, due to impaired blood supply, the kidneys, liver, muscles and central nervous system suffer.

According to doctors, one of the main prerequisites for the development of CHF is hypertension. About 40% of the population in our country suffers from it, and often the pressure begins to regularly jump above the norm (130 to 80 mm Hg) already after 35 years. The second main cause of heart failure is coronary heart disease. Also, the impetus for the occurrence of CHF is often heart attacks and strokes.

The main danger is the deterioration of the course of the disease and the patient's condition after each exacerbation (decompensation). A person seems to be on an escalator that takes him down, and after each aggravation, the escalator becomes steeper and moves faster and faster. Alas, the result of this movement - death. Up to 30% of patients with decompensated heart failure die within a year after discharge from the hospital.

BE INFORMED: 5 DANGEROUS SYMPTOMS

Therefore, cardiologists urge not to let the disease take its course and explain what the main symptoms should be. These are the five signs:

heartbeat,

weakness, fatigue,

the appearance of edema, primarily in the abdomen and ankles.

Of course, this is a reason to see a doctor and undergo the necessary examinations, but if you or someone close to you feels pain behind the sternum and feels shortness of breath, then you should immediately call ambulance. Doctors call these two symptoms "incompatible with life" and urge in no case to hope that "it will pass by itself." In addition, if a person has not taken any heart medications before, it is dangerous to swallow pills at home as an emergency. There are cases when nitroglycerin, which is usually recommended to be put under the tongue for heart attacks, led to clinical death in a patient. Therefore, it is important that doctors are nearby.

This is the final stage of any cardiac pathology. As with strokes, it is best to prevent heart failure from developing. Five-year survival in the presence of heart failure is comparable to some cancers.

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 rarely is heart failure one of the first manifestations of a heart disease, such as dilated cardiomyopathy.

Causes of heart failure

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, for example, of 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 appearance or aggravation of manifestations of heart failure is facilitated by:

• feverish conditions;
• anemia;
• increased thyroid function (hyperthyroidism);
• alcohol abuse, etc.

Acute heart failure

Acute heart failure that develops at lightning speed (from several minutes to several hours). Its manifestations are pulmonary edema, cardiac asthma and cardiogenic shock. Acute cardiovascular failure occurs with myocardial infarction, rupture of the wall of the left ventricle, acute insufficiency of the mitral and aortic valves.

Chronic heart failure

Chronic heart failure (unlike acute heart failure) develops slowly and develops over weeks, months, or even years. The following diseases can cause chronic heart failure:

• heart disease;
• hypertonic disease;
• chronic respiratory failure;
• persistent anemia.

Heart failure symptoms

Heart failure is always associated with impaired pumping function of the heart. In the human circulatory system, there are two circles of blood circulation: large and small.

In a small circle, the blood is enriched with oxygen in the lungs, in a large circle - the nutrition of all organs and tissues. With heart failure, blood can stagnate both in each of these circles individually, and in the entire circulatory system.

The main clinical symptoms of heart failure are:

• shortness of breath (lack of air);
• swelling;
• weakness;
• dry cough;
• pain in the right hypochondrium.

Shortness of breath in heart failure

Shortness of breath is one of the first signs of stagnation of blood in the pulmonary circulation. Initially, shortness of breath manifests itself only during exertion, and then at rest, especially at night.

It should be remembered that shortness of breath can also occur with pathology respiratory system. The main distinguishing feature of cardiac dyspnea is its strengthening in the supine position.

This is due to the fact that in a horizontal position, the outflow of blood from the lungs is impeded and the liquid fraction of blood leaks into the lung tissue. The extreme manifestation of circulatory failure in the small circle is pulmonary edema, requiring immediate hospitalization in the intensive care unit.

Edema in heart failure

Edema is a sign of circulatory insufficiency in the systemic circulation. Initially, swelling appears on the legs, on the back of the feet and ankles. With the progression of heart failure, edema grows, rising to the thigh and even the abdomen.

An extreme manifestation of circulatory failure in a large circle is anasarca (accumulation of fluid under the skin of most of the body surface). As the symptoms of heart failure appear, ulcers and age spots may form on the legs, which are a manifestation of malnutrition of the skin in these areas.

Do not forget that with chronic venous insufficiency, edema of the lower extremities will also be observed. The doctor should understand the cause of edema after receiving the results of the examination.

Weakness in heart failure

Weakness is a non-specific symptom of heart failure associated with impaired blood supply to the muscles.

Dry cough in heart failure

Dry cough in heart failure occurs due to swelling of the lung tissue due to stagnation of blood in the pulmonary circulation. This cough should be distinguished from the cough that occurs with a cold, or as a side effect of certain drugs used in the treatment of cardiac patients. Cough in heart failure is aggravated in a horizontal position.

Pain in the right hypochondrium with heart failure

Pain in the right hypochondrium occurs with stagnation of blood in the liver. Since the shell of the liver is not extensible, the blood-filled tissue of the liver presses on it, causing dull, aching pain.

Diagnosis of heart failure

Since heart failure is a secondary syndrome that develops with known diseases, diagnostic measures should be aimed at its early detection, even in the absence of obvious signs.

When taking a clinical history, attention should be paid to fatigue and dyspnea as the most early signs heart failure; the patient has coronary artery disease, hypertension, myocardial infarction and rheumatic attack, cardiomyopathy.

Identification of edema of the legs, ascites, rapid low-amplitude pulse, listening to the III heart sound and displacement of the boundaries of the heart are specific signs of heart failure.

If heart failure is suspected, the electrolyte and gas composition of the blood, acid-base balance, urea, creatinine, cardiospecific enzymes, and indicators of protein-carbohydrate metabolism are determined.

Electrocardiography for specific changes helps to detect hypertrophy and insufficiency of blood supply (ischemia) of the myocardium, as well as arrhythmias. On the basis of electrocardiography, various stress tests are widely used using an exercise bike (bicycle ergometry) and a treadmill (treadmill).

Such tests with a gradually increasing level of load make it possible to judge the reserve capacity of the heart function. With the help of ultrasound echocardiography, it is possible to establish the cause of heart failure, as well as to evaluate the pumping function of the myocardium.

With the help of echocardiography, IHD, congenital or acquired heart defects, arterial hypertension and other diseases are successfully diagnosed. X-ray examination of the chest in heart failure determines congestive processes in the small circle, cardiomegaly.

Radioisotope ventriculography in patients with heart failure allows a high degree of accuracy to assess the contractility of the ventricles and determine their volumetric capacity.

In severe forms of heart failure, ultrasound of the liver, spleen, and pancreas is performed to determine the damage to internal organs.

Heart failure treatment

Unlike past years, at present, the achievements of modern pharmacology have made it possible not only to prolong, but also to improve the quality of life of patients with heart failure.

However, before starting drug treatment heart failure, it is necessary to eliminate all possible factors provoking its occurrence:

Feverish conditions; anemia stress; excessive consumption of table salt; alcohol abuse; taking drugs that contribute to fluid retention in the body.

The main emphasis in the treatment of heart failure is both on the elimination of the causes of the disease and on the correction of its manifestations.

Among the general measures for the treatment of heart failure, rest should be noted. This does not mean that the patient needs to lie down all the time. Physical activity is acceptable and desirable, but it should not cause significant fatigue and discomfort.

If exercise tolerance is significantly limited, then the patient should sit as much as possible, and not lie down. In periods of absence of severe shortness of breath and edema, walks in the fresh air are recommended.

It should be remembered that the performance of physical activity in patients with heart failure should be devoid of any elements of the competition.

It is more convenient for patients with heart failure to sleep with a raised head end of the bed or on a high pillow. Patients with swelling of the legs are also recommended to sleep with a slightly raised foot end of the bed or a thin pillow placed under the legs, which helps to reduce the severity of edema.

The diet should be low in salt; cooked food should not be salted. It is very important to reduce overweight, as it creates a significant additional burden on the diseased heart.

Although with advanced heart failure, weight can decrease 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, for the treatment of heart failure, drugs are used that contribute to:

• increased myocardial contractility;
• decrease in vascular tone;
• reduce fluid retention in the body;
• elimination of sinus tachycardia;
• prevention of thrombus formation in the cavities of the heart.

Among medicines that increase myocardial contractility, one can note the so-called cardiac glycosides (digoxin, etc.) that have been used for several centuries.

Cardiac glycosides increase the pumping function of the heart and urination (diuresis), and also contribute to better exercise tolerance. Among the main side effects observed with 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, at present they are prescribed primarily to patients with heart failure in combination with the so-called atrial fibrillation.

To drugs that lower vascular tone, include the so-called vasodilators (from the Latin words vas and dilatatio - "vasodilation"). There are vasodilators with a predominant effect on the arteries, veins, as well as mixed-action drugs (arteries + veins).

Vasodilators, which dilate the arteries, help reduce the resistance created by the arteries during cardiac contraction, resulting in an increase in cardiac output. Vasodilators, which dilate the veins, increase venous capacity.

This means that the volume of blood placed in the veins increases, as a result of which the pressure in the ventricles of the heart decreases and cardiac output increases. The combination of exposure to 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. 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, exercise tolerance increases significantly, blood filling of the heart and cardiac output improve, and urination increases.

Most frequently noted side effect associated with the use of all ACE inhibitors is a dry, irritating cough (“as if a brush were being tickled in the throat”).

This cough does not indicate any new disease, but may disturb the patient. Cough may disappear after a short-term discontinuation of the drug. But, unfortunately, it is cough that is the most common reason for discontinuation of ACE inhibitors.

As an alternative to ACE inhibitors in the event of a cough, so-called angiotensin II receptor blockers (losartan, valsartan, etc.) are currently used.

To improve ventricular blood supply and increase cardiac output in patients with chronic heart failure in combination with coronary artery disease, nitroglycerin preparations are used, a vasodilator that mainly affects the veins.

In addition, nitroglycerin also dilates the arteries that supply the heart itself - the coronary arteries. To reduce the retention of excess fluid in the body, various diuretic drugs (diuretics) are prescribed, differing in strength and duration of action.

The so-called loop diuretics (furosemide, ethacrynic acid) begin to act very quickly after taking them. Through the use of furosemide, in particular, it is possible to get rid of several liters of fluid in a short time, especially when it is administered intravenously.

Usually the severity of the existing shortness of breath decreases right before our eyes. The main side effect of loop diuretics is a decrease in the concentration of potassium ions in the blood, which can cause weakness, convulsions, and interruptions in the work of the heart.

Therefore, simultaneously with loop diuretics, potassium preparations are prescribed, sometimes in combination with the so-called potassium-sparing diuretics (spironolactone, triamterene, etc.).

Spironolactone is often used alone in the treatment of chronic heart failure. The diuretic drugs of medium strength and duration of action used in the treatment of chronic heart failure include the so-called thiazide diuretics (hydrochlorothiazide, indapamide, etc.).

Thiazide drugs are often combined with loop diuretics to achieve a greater diuretic effect. Since thiazide diuretics, like loop diuretics, reduce the amount of potassium in the body, its correction may be required.

To reduce the heart rate, so-called (beta)-blockers are used. Due to the effect of these drugs on the heart, its blood supply improves, and, consequently, cardiac output increases.

For the treatment of chronic heart failure, an adrenergic blocker carvedilol was created, initially prescribed in minimal doses, ultimately contributing to an increase in the contractile function of the heart.

Unfortunately, side effect Some adrenergic blockers, in particular, the ability to cause bronchial constriction and increase blood glucose, may limit their use in patients with bronchial asthma and diabetes mellitus.

To prevent thrombosis in the chambers of the heart and the development of thromboembolism, so-called anticoagulants are prescribed, which inhibit the activity of the blood coagulation system.

The so-called indirect anticoagulants (warfarin, etc.) are usually prescribed. When using these drugs, regular monitoring of the parameters of the blood coagulation system is necessary.

This is due to the fact that with an overdose of anticoagulants, various internal and external (nasal, uterine, etc.) bleeding can occur. Treatment of an attack of acute left ventricular failure, in particular, pulmonary edema, is carried out in a hospital.

But already the doctors of the "ambulance" can introduce loop diuretics, oxygen inhalation and other urgent measures. In the hospital, the therapy started will be continued.

In particular, continuous intravenous administration of nitroglycerin, as well as drugs that increase cardiac output (dopamine, dobutamine, etc.), can be established.

Surgical treatment of heart failure

If the current arsenal of drugs used to treat chronic heart failure is ineffective, surgical treatment may be recommended.

The essence of the operation of cardiomyoplasty is that a flap is surgically cut out of the so-called latissimus dorsi muscle of the patient. Then, this flap is wrapped around the heart of the patient himself to improve the contractile function.

Subsequently, electrical stimulation of the transplanted muscle flap is performed simultaneously with contractions of the patient's heart. The effect after the operation of cardiomyoplasty appears on average after 8-12 weeks.

Another alternative is implantation (suturing) into the patient's heart of a circulatory assist device, the so-called artificial left ventricle. Such operations are expensive and rare in Russia.

And, finally, at present, special pacemakers have been created and are being used, which help to improve the blood filling of the ventricles of the heart, primarily by ensuring their synchronous work. Thus, modern medicine does not abandon attempts to intervene in the natural course of heart failure.

Prognosis for heart failure

The five-year survival threshold for patients with heart failure is 50%. The long-term prognosis is variable, it is influenced by the following factors:

• severity of heart failure;
• accompanying background;
• effectiveness of therapy;
• Lifestyle.

Treatment of heart failure in the early stages can fully compensate for the condition of patients; the worst prognosis is observed in stage III heart failure.

Prevention of heart failure

Measures to prevent heart failure is to prevent the development of diseases that cause it (IHD, hypertension, heart defects, etc.), as well as factors contributing to its occurrence.

In order to avoid the progression of already developed heart failure, it is necessary to comply with the optimal regimen of physical activity, taking prescribed drugs, and constant monitoring by a cardiologist.

Questions and answers on the topic "Heart failure"

Question:Hello, tell me if somewhere once a month the heartbeat begins to clear. My heart hurts a lot. Yes, so that already the pressure rises to 140/100. Cardiogram shows that everything is fine. What to do?

Answer: Perhaps paroxysmal tachycardia is a sudden onset and just as suddenly ending attack of rapid heartbeat. For diagnosis, daily ECG monitoring or ECG recording under stress is used. Address to the cardiologist internally.

Question:After prolonged stress (my son had a heart attack, treatment and death), my left arm began to hurt. At first I thought it was just stress. Then shortness of breath appeared and the hand continues to hurt. I take various soothing infusions - there is not much pain in my heart - just weakness and shortness of breath. I am 68 years old, 10 years ago I had an oncological operation to remove my left breast and my heart was exposed to radiation. I'm afraid to take strong medicines. What do you advise? Especially how to treat the hand?

Question:The man is 56 years old, persistent cough in the supine position, it is on the back with sputum production, shortness of breath, increased pulse and heart rate.

Answer: Hello. Your letter suggests that the cause of the cough, shortness of breath, and increased heart rate is heart failure. In heart failure, the occurrence of coughing in the supine position is due to an increase in the return of blood to the heart and stagnation of blood to the vessels of the lungs. The cough is usually dry, painful, accompanied by a feeling of lack of air. Sputum with such a cough is allocated in small quantities and may be frothy, sometimes pink. Similar symptoms (cough, shortness of breath) can also occur during exercise. We repeat that our assumption is based purely on the facts set forth in your letter. It is possible that the patient suffers from some disease of the respiratory system (for example, bronchitis), but we do not have enough information to suggest this. We recommend that you consult with a specialist cardiologist.

Question:Hello. My father had two heart attacks in January, three days apart. He is 56 years old. He spent a month in the hospital. After discharge, he was at home for a month, shortness of breath began at the slightest movement and cough, swelling of the legs appeared, he smoked for about 30 years before a heart attack and now he abruptly quit, now he was again in the hospital with changes in the ECG, according to the attending physician, the heart works only 35%. Please give me advice on how to restore the heart? Can anything help?

Answer: Hello. Obviously, after suffering heart attacks, your father developed heart failure, but you should not despair, because provided that the heart attack does not recur, his heart will soon begin to gradually adapt and heart failure will subside. However, there are no special recipes for restoring heart function. Unfortunately, it is not possible to restore parts of the heart muscle that died during a heart attack. In this case, all hopes should be associated with the adaptation of the heart and supportive treatment. Strictly follow the instructions of the cardiologists involved in the treatment of the patient.

Question:Chills, sweating, but at the same time the child is cold, fatigue, fatigue, drowsiness, pale complexion, can these be signs of heart failure, if there is a heart murmur from birth (the valve does not close completely and one chord has grown in the wrong place).

Answer: Yes, the symptoms you describe could be a sign of heart failure caused by congenital defect hearts.

Question:Hello! Please tell me how best to get rid of fluid in the lungs, legs, stomach, with heart failure of the 3rd degree. What kind of sleep aid should I use? Woman 70 years old.

Answer: Hello. The development of edema in heart failure indicates decompensation of the patient's condition. In such cases, patients must be treated in a hospital, or at home under the supervision of a physician. The condition of your patient is dangerous, since at any time she may develop pulmonary edema. Concerning sleeping pills: most sleeping pills are contraindicated in heart failure, but good cardiac treatment can not only improve general state sick but also to restore her sleep.

Question:Good day! My child, 3 years old, has appeared around the mouth, as it were, small bruises, or it still looks like burst capillaries or a bruise. Although, the rest of the behavior and state has not changed. He is also active, mobile, does not complain about anything. Could these spots be evidence of heart failure?

Answer: In all likelihood, your suspicions of heart failure are false, since this disease is manifested not only by perioral cyanosis, but also by many other symptoms. However, we recommend that the child be shown to a pediatrician (to exclude heart pathology, it is enough just to listen to the child's heart and do an ultrasound of the heart). With heart defects, blueness increases during crying - have you noticed this in your child?

Question:I am 36 years old, not married, no children. For the past 3 years, BP has been rising frequently. Max 240/160, mostly 200/130. There were no injuries or serious illnesses. From birth predisposed to completeness. Now pains in the region of the heart, shortness of breath, swelling, weakness have begun.

Answer: The symptoms you describe indicate an unfavorable course of the disease (possibly, against the background of arterial hypertension, you developed heart failure and angina pectoris). Treatment of such cases of hypertension cannot be done at home! You need to contact the cardiological hospital as soon as possible and undergo a course of treatment. You can start treatment at home only after the stabilization of the disease. Do not waste time in vain - for you it may be a matter of life!

Question:Good afternoon I am 23 years old. At the age of 10-12, I was diagnosed with bradycardia (44 beats per minute), then with ECG, respectively, it was detected every time. Lately I have been working hard, besides that I have been doing sports for 6 years (3-4 times a week) at home - exercise bike and Yoga. Since the age of 2, I have had unpleasant sensations when breathing (I can’t breathe completely, as if not completely, like you’re yawning, but you can’t yawn), sometimes it presses in the sternum, not much, sometimes I wake up from this at night, from the fact that can't breathe. And somehow lately there have been strange sensations in my chest - as if I feel the heart, sometimes it presses a little, but tolerable. Please tell me - are these signs of increasing heart failure?

Answer: No, the symptoms you describe cannot be a sign of heart failure. You should consult at the cardiologist and the neuropathologist. The symptoms you describe can be observed with vegetative-vascular dystonia.

Question:Good afternoon My son is 7 years old. In closed rooms and in rooms with a large crowd of people, he begins to yawn, and very often, almost without stopping. Recently, a dry cough has been added to the yawning. Sometimes the son complains of pain in the left hypochondrium. All these symptoms appeared within last year. Previously observed by a neurologist due to increased intracranial pressure. A year and a half ago, we visited a cardiologist: nothing was revealed. Whether prompt, please, these signs can be signs of heart failure? Which specialist should we contact?

Answer: Considering the fact that earlier the child did not show any signs of heart pathology and that since then he has not suffered serious diseases that could affect the heart muscle (at least you do not mention them), we can say with great certainty that your child does not have heart failure and that the symptoms you describe are related to something else. Perhaps the cause of yawning and coughing is the lack of oxygen in the rooms by a large number of people (children feel oxygen starvation more acutely than adults). We recommend that you contact a general practitioner (therapist), take a blood test (you need to exclude anemia), and do an ultrasound of the internal organs.