Congestive heart failure - Causes, Symptoms and Treatment .MF .
Heart failure - state, due to the fact that the heart can not cope with their functions pump, ensure the normal circulation.In heart failure, the heart is unable to efficiently pump blood, and therefore there is a violation of circulation of oxygen and nutrients in the body, leading to stagnation of the blood.It manifested as a result ishemicheskoi heart disease, heart disease, hypertension, lung disease, myocarditis, rheumatic fever.
Heart failure - the inability of the heart to fully perform its pumping (contractile) function, as well as provide the body with the necessary amount of oxygen in the blood.Heart failure is not an independent disease.As a rule, it is - a complication or a result of a variety of diseases and conditions.In the US, heart failure affects about 1% of the population (2.5 million people).The incidence of heart failure increases with age.The same US it affects 10% of the population older than 75 years.
Causes of heart failure
In most cases, heart failure - this is the natu
development of heart failure
Dates of the onset overt cardiac failure unique to each patient and his cardiovascular disease.Depending on which suffers the ventricle as a result of disease, distinguish right and left ventricular heart failure.In cases
right heart failure excess volume of fluid retained in the vessels of the systemic circulation, causing edema occur , at first - in the feet and ankles.In addition to these basic features for right heart failure is characterized by fatigue , due to low blood oxygen saturation as well as feeling of fullness and pulsation in neck.
Left ventricular heart failure characterized by fluid retention in the pulmonary circulation, so that the amount of oxygen entering the blood is reduced.As a result, there dyspnea, aggravated by exertion and weakness and fatigue .
sequence of occurrence and severity of heart failure symptoms are individual for each patient.In cases involving the right ventricle lesion, heart failure symptoms appear faster than in cases of left ventricular failure.This is due to the fact that the left ventricle of the heart is the most powerful department.It usually takes a lot of time before the left ventricle "surrender" their position.But if it does occur, the heart failure develops with catastrophic speed.
Symptoms of heart failure.
Heart failure may manifest different symptoms depending on which parts of the heart more than impressed.There may be shortness of breath, arrhythmia, dizziness, blackout, fainting, swelling of the neck veins, pale skin, swelling of the feet and leg pain, hepatomegaly, ascites (free fluid in the abdomen).The patient can not tolerate even a small exercise.In the later stages of the complaints arise not only under load, but also at rest, completely lost the ability to work.Due to insufficient blood supply to the affected in varying degrees, all the organs and body systems.
Symptoms of heart failure depends on which side of the heart, right, left or both, operate inefficiently.If does not work the right side of the heart, blood fills the peripheral veins, and as a result of leaks in the leg tissue and abdomen, including the liver.This causes swelling and enlargement of the liver.If struck the left side, the blood fills the vessels of the pulmonary circulation and the heart, and in part goes into the lungs.Shortness of breath, cough, rapid heart rate, bluish or pale skin color characteristic for this case of heart failure.Symptoms may be of varying severity, death is possible.
Complaints of patients with heart failure
Swelling are one of the first symptoms of right heart failure.Initially, patients concerned about slight swelling, usually affecting the feet and lower legs.Swelling uniformly affect both feet.Swelling occur in the late afternoon and go in the morning.With the development of edema disease are thick and full in the morning is no longer held.Patients report that they have regular shoes do not fit, they often feel comfortable only in house slippers.Redistributions of edema in the direction of the head increases in diameter hip and thigh.
then fluid accumulates in the abdomen (ascites).With the development of hydrops patient usually sits as in a prone position marked a sharp shortage of air.Develops hepatomegaly - increase in size of the liver due to overflow its venous network of the liquid part of blood.Patients with liver increased in size often noted discomfort (discomfort, heaviness) and pain in the right upper quadrant.When blood accumulates hepatomegaly pigment bilirubin, which can stain sclera ( "proteins" eyes) to yellowish color.Sometimes such yellowness frightens the patient, as the reason for seeking medical attention.
Fatigue is a feature characteristic both for right and for left ventricular failure.Initially, patients note a lack of strength in the performance of the previously well-tolerated exercise.Over time, the duration of periods of physical activity decreases, and pauses for rest - increases.
Dyspnea is the main and often the first symptom of a chronic left ventricular failure.During dyspnea patients breathe more often than usual, as if trying to fill their lungs with the maximum volume of oxygen.Initially, patients notice shortness of breath only when performing intense exercise (running, fast, climbing stairs, etc.).Then, as the progression of heart failure patients can celebrate breathlessness in normal conversation, and sometimes - and in a state of complete rest.Paradoxical as it sounds, the patients themselves are not always aware of the presence of dyspnea at - its notice people around them.
Paroxysmal cough , occurring mostly after the heavy load, the patients are often perceived as a manifestation of chronic lung disease, such as bronchitis.Therefore, the physician survey, patients, especially smokers, do not always complain of cough, considering that it is not related to heart disease.Rapid heartbeat (sinus tachycardia) is perceived by patients as a feeling of "fluttering" in the chest that occurs when a motor activity, and disappears after a certain time for its completion.Often, patients become accustomed to rapid heartbeat, without fixing his attention on him.
diagnosis of heart failure
Heart failure is a consequence various diseases and conditions like cardiovascular and other.To establish the presence of heart failure, it is sometimes quite normal physical examination, while to clarify its causes may require the use of a number of diagnostic methods.
Electrocardiography (ECG) helps doctors identify signs of hypertrophy and failure of blood supply (ischemia) infarction, as well as a variety of arrhythmias.As a rule, these ECG signs may occur in various diseases, ie,They are not specific to cardiac failure.
ECG based on established and widely used so-called stress tests , consisting in the fact that the patient must be overcome gradually increasing load levels.For these purposes, use special equipment to dispense the load: a special modification of a bike (bicycle ergometry) or "treadmill" (treadmill).These tests provide information about the reserve capacity of the pumping function of the heart.
basic and accessible for today method for diagnosing diseases that occur with heart failure, a cardiac ultrasound - echocardiography (echocardiography).With this method one can not only determine the cause of heart failure, but also to assess contractile function of the heart ventricles.Currently, only one echocardiography enough to make a diagnosis of congenital or acquired heart disease, suggest the presence of coronary artery disease, hypertension and many other diseases.This method can also be used to evaluate the results of treatment.
X-ray examination of the chest for heart failure identifies congestion in the pulmonary circulation and an increase in the size of heart chambers (cardiomegaly).Some heart diseases, such as valvular heart disease have a characteristic radiological "picture".This method is also, like echocardiography can be useful for monitoring treatment.
Radioisotope methods for studying the heart, in particular, radioisotope ventriculography, with high accuracy in patients with heart failure to evaluate the contractile function of the heart ventricles, including blood volume enclosing them.These methods are based on the introduction and subsequent distribution of radioisotope in the body preparations.
One of the latest advances in medical science, in particular, the so-called nuclear diagnosis is method of positron emission tomography (PET).It is very expensive and is less common study.PET allows you to use special radioactive "tag" to identify areas of viable myocardium in patients with heart failure to be able to adjust the treatment.
Treatment of heart failure
In acute heart failure patient is hospitalized.Observe mode with limited physical activities (physiotherapy chosen doctor);need a diet rich in proteins, vitamins, potassium, restriction of salt (for large edema - salt-free diet).Appointed by cardiac glycosides, diuretics, vasodilators, calcium antagonists, potassium supplements.
Unlike past years, is now the achievements of modern pharmacology have allowed not only to renew, but also improve the quality of life of patients with heart failure.However, prior to the start of drug treatment of heart failure all possible factors need to be addressed, provoking its appearance (fevers, anemia, stress, excessive consumption of salt, alcohol abuse, as well as the administration of drugs that promote fluid retention in the body, and others.).
The main focus of the treatment is done as a on eliminating the causes of heart failure itself , and the correction its manifestations.
Among general activities for the treatment of heart failure should be noted rest .This does not mean that the patient must lie down all the time. Exercise permissible and desirable, but it should not cause significant fatigue and discomfort.If the load is considerably limited tolerance, the patient should be as large as possible to sit, rather than lie.In the absence of severe shortness of breath and swelling recommend walks in the fresh air.Keep in mind that the performance of physical exercise in patients with heart failure should be devoid of any elements of the competition.
Sleep heart failure patients more comfortable with a raised head of the bed or on a high pillow.Patients with leg edema also recommend sleeping with a slightly raised foot end of the bed and planted his feet thin cushion that reduces the severity of edema.
Diet should be low in salt, cooked food should not be dosalivat.It is very important to reduce overweight, since it creates a significant additional burden on the diseased heart.Although far advanced heart failure, weight can be reduced by itself.For weight control and early detection of fluid retention in the body should be performed daily weigh-in at the same time.
At present, for the treatment of heart failure following apply drugs , promoting:
• increase myocardial contractility;
• reduce vascular tone;
• reduction of fluid retention in the body;
• elimination of sinus tachycardia;
• Prevention of thrombosis in the heart cavities.
Among medicinal agents that increase myocardial contractility , it may be noted already used for several centuries, the so-called cardiac glycosides (digoxin and others.).Cardiac glycosides increase cardiac pump function and urine output (diuresis), as well as contribute to a better exercise tolerance.Among the main adverse effects observed when they overdose, nausea note, the appearance of arrhythmias, changes in color perception.If in past years, cardiac glycosides administered to all patients with heart failure, it is now their time is prescribed primarily to patients with heart failure in combination with the so-called atrial fibrillation.
Medicinal means lowering the tone vessels carry so-called vasodilators (from the Latin words and vas dilatatio - «expansion vessel").There are vasodilators with a primary effect on the arteries, veins and drugs in mixed (arterial + venous).Vasodilators expanding arteries help to reduce the resistance created by the arteries during the cardiac contraction, resulting in increased cardiac output.Vasodilators, extending veins, increases venous capacity.This means that the volume of the enclosing blood veins increases, whereby the pressure in the ventricles of the heart decreases and increases in cardiac output.The combination of the impact of arterial and venous vasodilators reduces the severity of myocardial hypertrophy and dilatation of the heart cavities degree.By vasodilator mixed type include so-called angiotensin-converting enzyme (ACE).I will mention some of them: captopril, enalapril, perindopril, lisinopril, ramipril.Currently, it is the ACE inhibitors are the main drugs used to treat chronic heart failure.As a result of the action of ACE inhibitors exercise tolerance increases significantly improves blood circulation in the heart and cardiac output, increased urination.The most frequently reported side effect associated with the use of ACE inhibitors is a dry irritating cough ( "like a brush in my throat tickle").This cough is not indicative of any new disease, but can disturb the patient.The cough may pass after a short discontinuation of the drug.