Chronic heart failure - Causes, Symptoms and Treatment .MF .
Symptoms Diagnosis Treatment
Complications and prognosis
Health and well-being of the human body is completely dependent on the heart's ability to perform its functions.The heart, being a muscle "pump" receives oxygen-rich blood from the lungs (pulmonary circulation) and pumps it into the aorta and the arteries of other organs (the systemic circulation).Cardiac cycle consists of phases of systole (contraction) and diastole (relaxation) of the atria and ventricles, ie during diastole of the ventricles is their relaxation, allowing blood from the atria without resistance thrown into the ventricles, and in the phase of ventricular systole the blood is pushed into the large vessels -the aorta and the pulmonary artery.
If cardiac tissues develop any pathological processes, such as necrosis (death), inflammation, trauma, disruption of the structure of the connective tissue (dysplasia), the cells undergo a number of changes that lead to their dysfunction, which affects the contr
These changes characterize a disease, such as chronic heart failure (CHF).It is a pathological condition that occurs in the outcome of almost all cardiac and some extracardiac diseases (hyperthyroidism, alcoholism, etc.), characterized by myocardial contractile dysfunction and thus blood congestion in small and large circulation with damage to other organs and body systems.
Distinguish right and left ventricular failure , but within the framework of this disease is not an anatomical division, and one stage of the process.In addition, the nature of pathological changes, and according to the criteria of ultrasound diagnosis is accepted to allocate diastolic and systolic left ventricular dysfunction types .When type diastolic left ventricle is not able to fully relax and take the proper amount of blood, which causes an overload of the left atrium volume and congestion in the lungs.The fraction of ejection of blood into the aorta retained.Systolic type characterized by dilation (the expansion cavity) of the left ventricle that leads to disruption of its contractility, and cardiac output to decrease, that is, the internal organs receive minimal amount of blood.
The figure shows a dilated cardiomyopathy, which is characterized by violation of contraction of the left ventricle.
This division makes sense from the point of view of medical tactics, since diastolic myocardial dysfunction can not relax, and when the systolic, on the contrary, can not be reduced properly, which leads to the selection of certain cardiac drugs.Net diastolic (restrictive) heart failure occurs in 20 - 30% of all cases of CHF.
Causes of chronic heart failure
To wear the heart muscle can cause the following diseases:
- ischemic heart disease and myocardial infarction,
- myocarditis (viral, bacterial, rheumatic inflammation),
- arterial hypertension (hypertensive heart),
- cardiomyopathy (hypertrophic, restrictive and dilated),
- myocardiodystrophy (violation of metabolic processes in muscle cells),
- rhythm and conduction disturbances (often permanent form of atrial fibrillation),
- congenital and acquired heart defects,
- bacterial endocarditis,
- exudative and adhesive pericardial effusion (accumulation of fluid in the cavity of the heart shirts, gluing sheets of pericardium, leading to myocardial relaxation of the restriction),
- diseases of respiratory system (chronic obstructive pulmonary disease, bronchial asthma) lead to the formation of pulmonary heart withdevelopment of predominantly right ventricular failure,
- chronic alcohol intoxication,
- the general aging of the body.
Symptoms of chronic heart failure
main manifestations of myocardial dysfunction are fatigue, shortness of breath, poholadanie and cyanosis okaraska nail feet (akrotsianoz), swelling of legs and feet, fluid accumulation in the abdomen (ascites), chest (hydrothorax)in the pericardial cavity (hydropericardium), "heart" with episodes of asthma pulmonary edema, anasarca (total body swelling).
degree of symptoms depends on the stage of flow failure.In this regard, cardiologists Vasilenko and Strazhesko has developed a classification called their names.It comprises the following steps:
- Stage I - stage initial manifestations of chronic heart failure.The patient concerned chilliness and cold extremities, slight swelling of legs and feet, resulting in the late afternoon and going in the morning, fatigue and general weakness due to reduced blood flow in the skin and skeletal muscle.When physical activity (walking on foot for long distances, climbing stairs) there are shortness of breath, attacks of dry cough, palpitations, causing discomfort.Shortness of breath and fatigue - the most common symptoms that occur at this stage.From the moment of occurrence of the underlying disease to severe clinical disease may take from several months to many years.
- Stage II A - stagnation of blood in one of the circles of circulation.Characterized by impaired blood flow in the small (light) or in the organs of the systemic circulation (liver, kidney, skeletal muscle, brain, etc.).Venous congestion in the lungs of clinically occurrence of attacks "heart" of asthma or pulmonary edema episodes."Heart" Asthma develops most often during the night, because due to the horizontal position of the person in which the blood stagnates in even more light.The patient is in a fit of choking feeling disturbed, obsessive dry cough, inability to take a deep breath, anxiety, palpitations;relief may come in half-sitting position, or with the head of the bed elevated.For pulmonary edema is characterized by noisy, bubbling breath, cough with frothy sputum pink color (due to the small capillary ruptures).Venous congestion in the organs of the systemic circulation manifest severity and pain in the right upper quadrant, the increase in abdominal circumference, yellowness of the skin and sclera (due to stagnation in the liver and increase it in violation of the functions), increase of edema (including from - for salt delayin the body, since the disrupted kidney), headaches, insomnia, mild mental disorders and intelligence (due to violation of the blood supply to the brain).
- Phase II In - venous stasis and hemodynamic instability in both the systemic circulation, manifested symptoms characteristic of dysfunction of the above bodies.
- Stage III - severe heart failure, irreversible degenerative changes in all organs and tissues.The patient is worried about the constant shortness of breath at rest, most of the time he spends in bed in a reclining position.Develops cardiac cirrhosis.Swelling take the character of anasarca, heart and lungs are compressed fluid in the chest and abdominal cavities, blood pressure is reduced.There is a complete depletion of cardiac muscle, liver, kidney, brain, and death occurs.
Besides clinical, there are functional classification of heart failure , developed by New -Yorkskoy Heart Association, and designed to assess the patient's physical reserves.
- So, when I functional class (FC) patient experiences certain difficulties only at very considerable physical exertion, and the initial stage of a change of heart may be suspected on the results of ultrasound of the heart and not on the basis of symptoms.
- II FC manifested mild limitation of physical activity, ie the complaint concerned a patient during normal loads.
- III FC characterized by marked limitation of physical activity - small load can trigger the onset of symptoms;the patient feels comfortable only at rest.
- For IV FC characterized by the presence of complaints at the lowest consumer activity and at rest, the patient is not able to look after themselves.
diagnosis of chronic heart failure
diagnosis is established on the basis of the relevant complaints, survey and examination of the patient.Auscultation of the chest auscultated weakened heart tones, irregular heart rhythm in violation of rhythm and conduction, abnormal tones and noise in heart defects, dry or moist rales in the lungs during stagnation of blood in them.
main method of diagnosis of the disease is echocardiography (ultrasound of the heart).The method allows to detect abnormalities, cause of failure, to assess the overall myocardial contractility and distinguish between diastolic and systolic myocardial dysfunction, as in the first type of ejection fraction is normal or increased (50%), while the second - is reduced (less than 40%).
Besides ultrasound of the heart, are appointed by the laboratory (common blood and urine tests, biochemical, immunological and hormonal blood tests) and instrumental methods of diagnosis.Of the latter, the following:
- ECG - detects myocardial ischemia, myocardial infarction symptoms, arrhythmias, atrial or ventricular hypertrophy, blockade, and other features.If necessary, it can be assigned to daily monitoring of ECG and blood pressure, ECG stress (treadmill test, bicycle ergometry - to determine the functional class of angina and congestive heart failure)
- radiography of the chest cavity - can show the expansion of the shadow of the heart due to hypertrophyinfarction or ventricular dilatation, changes in the lower regions of the lungs or all pulmonary fields (signs of venous congestion or pulmonary edema, respectively).
On radiographs of the chest can be seen an increase in all chambers of the heart, called cardiomegaly.
- coronary may be indicated in patients with coronary heart disease to assess the patency of coronary arteries and determine the need for cardiac surgery treatment
- liver ultrasound, renal reveals structural changes in organs due to the stagnation of the blood and chronic hypoxia (hepatomegaly - enlarged liver,cardiac cirrhosis, renal scarring secondary)
- thyroid ultrasound assigned to identify diseases that can cause heart disease (nodular goiter, Graves' disease)
list of necessary diagnostic methods determined by the attending physician individually in the clinical examination.
Treatment of chronic heart failure
The objectives of the treatment of this disease are a decrease in the symptoms of the primary disease, slowing the progression of disease and improve the quality of life of patients. Medication assigned long-term and continuous, with correction when necessary medications, their dosages and combinations.Of the drugs in the failure shows the following main groups:
- ACE inhibitors.Exerts antihypertensive and organ-effect, ie not only lower blood pressure, but also protect the organs - target - heart, blood vessels, kidneys, and brain.These include prestarium, zokardis, Hart et al
-. receptor antagonists angiotenzinogenu II - have similar properties.They include drugs such as lorista, mikardis, vazotenz etc.
-. diuretics (diuretics) .Appointed to reduce the volume of circulating blood and consequently, "downloading" organs in which blood stagnation occurs.Includes quick preparations - Lasix (furosemide), diuver (torasemide) appointed mainly in patients with severe hydropic syndrome in the case of acute heart failure, such as pulmonary edema.Also, this group includes thiazide (hydrochlorothiazide, indapamide) and potassium-sparing diuretics (veroshpiron).
- beta - blockers .Lower heart rate, thereby reducing myocardial oxygen demand, which is important for the treatment of coronary artery disease, reduce the total resistance of blood vessels, making blood more easily pushed out of the heart into the vessels.They include drugs such as Bisogamma, rekardium, betalok.
- anticoagulants and antiplatelet agents .Effects on blood clotting by inhibiting the formation of blood clots.The former include clopidogrel (Plavix), warfarin, to the second - aspirin preparations -. Atsekardol, Aspirin Cardio, cardiomagnil etc. Appointment of anticoagulants require a regular (preferably, monthly) monitoring the state of the blood system (INR, aPTT, prothrombin time), soit increases the risk of bleeding.
- nitrates - nitroglycerin preparations, have a relaxing effect on the veins, reducing blood flow to the heart, which contributes to more effective cardiac output and coronary blood vessels expand, increasing blood flow to the myocardium.Short-acting drugs (nitroglycerin, Nitromintum, nitrosprey) used for the relief of angina attacks, the preparations of medium and long-acting (monocinque, pektrol, izoket) appointed angina III and IV angina, nitrates intravenously effective in the treatment of pulmonary edema, but in combination with drugsthat increase vascular tone (to prevent a sharp drop in blood pressure and collapse).A side effect is a persistent headache in the first few days of taking the drugs due to the expansion of the cerebral vessels.
- lipid-lowering drugs have an effect on the exchange of cholesterol and lipids, forming it, contributing to a decrease in the level of "bad" cholesterol in the blood.These include statins - Atoris, lovakor, Simla and many others).
- cardiac glycosides are used to enhance myocardial contractility and heart rate deceleration.Appointed mainly when the patient has a permanent form of atrial fibrillation, and / or the presence of left ventricular systolic dysfunction, when reduced contractility (ejection fraction less than 40%).If you have a normal ejection fraction and diastolic dysfunction appointment is not justified.For drugs in this group include digoxin (novodigal).
- antagonists, calcium channel affect the muscle cells of the heart and blood vessels, relaxing them, resulting in reduced blood pressure, dilate the coronary arteries, and the strength of heart contractions.In connection with the recent appointment of the effect of drugs in this group is not justified in the presence of left ventricular systolic dysfunction, as myocardial contractility, and so suffer.This group includes nifedipine, verapamil and diltiazem (trade names - diltsem, amlodipine, Corinfar etc.).
addition monotherapies, can be assigned a combination of different active ingredients in a single tablet, which greatly simplifies the dosage regimen of drugs and improves compliance - patient adherence to treatment.This group includes Prestancia (amlodipine + perindopril) and Abi noliprel A fort (perindopril + indapamide) and others.
Surgical treatment is surgical correction of the original disease, if possible.
therapists Sazykina OJ