Chronic heart failure

Chronic heart failure (CHF) is a condition in which the amount of heart-ejected blood is reduced for each cardiac contraction, that is, the pumping function of the heart falls, causing organs and tissues to lack oxygen. About 15 million Russians suffer from this disease.

Depending on how rapidly heart failure develops, it is divided into acute and chronic. Acute congestive heart failure can be associated with injuries, toxins, heart disease and without treatment can quickly lead to death.

Chronic heart failure develops for a long time and manifests itself as a complex of characteristic symptoms (dyspnea, fatigue, and a decrease in physical activity, edema, etc.) that are associated with inadequate perfusion of organs and tissues at rest or under stress and often with fluid retention in the body

The reasons for this life-threatening condition, symptoms and methods of treatment, including folk remedies, we'll talk about in this article.

Classification

According to the classification of B. X. Vasilenko, N. D. Strazhesko, G. F. Lang in the development of chronic heart failure distinguish three stages:

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I Art. (HI) initial, or latent insufficiency, which manifests itself in the form of dyspnoea and palpitation only with considerable physical exertion that did not previously cause it. In rest hemodynamics and functions of organs are not violated, work capacity is somewhat lowered.
II stage - expressed, prolonged circulatory failure, hemodynamic disorders (stagnation in a small circle of circulation) with little physical exertion, sometimes at rest. In this stage, two periods are distinguished: period A and period B.
H IIA stage - shortness of breath and palpitations with moderate exercise. An uneven cyanosis. As a rule, the circulatory insufficiency is mainly in the small circle of the circulation: a periodic dry cough, sometimes hemoptysis, manifestations of stagnation in the lungs (crepitation and silent damp rales in the lower parts), palpitations, irregularities in the heart. In this stage, initial manifestations of stagnation are also observed in a large circle of circulation (small edema on the feet and lower leg, a slight increase in the liver). By the morning these phenomena are decreasing. Sharply reduced work capacity.
H IIB stage - dyspnea at rest. All objective symptomatology of heart failure is sharply increased: pronounced cyanosis, stagnant changes in the lungs, prolonged aching pain, irregularity in the heart, palpitation; signs of circulatory insufficiency along the large circle of blood circulation, constant edema of the lower extremities and trunk, enlarged dense liver (cardiac cirrhosis of the liver), hydrothorax, ascites, heavy oliguria. Patients are disabled.
III stage (H III) - the final, dystrophic stage of insufficiencyIn addition to hemodynamic disorders, morphologically irreversible changes in the organs develop (diffuse pneumosclerosis, liver cirrhosis, congestive kidney, etc.). The metabolism is broken, the depletion of patients develops. Treatment is ineffective.

Depending on thethe phases of cardiac dysfunction are isolated:

Systolic heart failure (associated with a violation of systole - the period of contraction of the ventricles of the heart);
Diastolic heart failure (associated with diastolic dysfunction - the period of relaxation of the ventricles of the heart);
Mixed heart failure (associated with impairment and systole, and diastole).

Depending on thezones of predominant blood stasis are isolated:

Right ventricular heart failure (with stagnation of blood in a small circle of blood circulation, that is, in the vessels of the lungs);
Left ventricular heart failure (with stagnation of blood in a large circle of blood circulation, that is, in the vessels of all organs except the lungs);
Biventricular (two-ventricular) heart failure (with stagnation of blood in both circulation circles).

Depending on thethe results of a physical study are determined by classes on the Killip scale:

I (no signs of HF);
II (mildly expressed CH, little wheezing);
III (more pronounced CH, more wheezing);
IV (cardiogenic shock, systolic blood pressure below 90 mm Hg. c).

Mortality in people with chronic heart failure is 4-8 times higher than that of their peers. Without correct and timely treatment in the stage of decompensation, the survival rate throughout the 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 a heart damage or a violation of its ability to pump the right amount of blood through the blood vessels.

The main causes of the diseasecalled:

ischemic heart disease;
arterial hypertension;
heart diseases.

There are alsoother provoking factorsdevelopment of the disease:

diabetes;
Cardiomyopathy - myocardial disease;
arrhythmia - violation of the heart rhythm;
myocarditis - inflammation of the heart muscle (myocardium);
cardiosclerosis - heart damage, which is characterized by proliferation of connective tissue;
smoking and alcohol abuse.

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

The mechanism of development of CHF

The throughput (pumping) ability of the heart decreases - the first symptoms of the disease appear: intolerance to physical exertion, dyspnea.
Compensatory mechanisms are connected to maintain the normal functioning of the heart: strengthening heart muscle, increased adrenaline, increased blood volume due to fluid retention.
Dysfunction of the heart: muscle cells became much larger, and the number of blood vessels increased slightly.
Compensatory mechanisms are depleted. The work of the heart worsens significantly - with each push it pushes out enough blood.

Symptoms

As the main signs of the disease can be identified such symptoms:

Frequent shortness of breath- a state where there is the impression of lack of air, so it becomes rapid and not very deep;
Increased fatigue, which is characterized by the rapidity of loss of power in the performance of a process;
Ascendingnumber of heart beatsin a minute;
Peripheral edema, which indicate a poor withdrawal of fluid from the body, begin to appear from the heels, and then go higher and lower to the waist, where they stop;
Cough- from the very beginning of clothes he 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 until the last moment pull with an appeal to a cardiologist. Of course, this complicates and lengthens the treatment process.

Symptoms of Chronic Heart Failure

The initial stages of chronic heart failure can develop in left- and right ventricular, left- and right-atrial types. With a long course of the disease, there are violations of function, all parts of the heart. In the clinical picture, we can identify the main symptoms of chronic heart failure:

fast fatiguability;
shortness of breath, cardiac asthma;
peripheral edema;
palpitation.

Complaints about fatigue are made by most patients. The presence of this symptom is caused by the following factors:

small cardiac output;
insufficient peripheral blood flow;
the state of tissue hypoxia;
development of muscle weakness.

Dyspnea with heart failure increases gradually - first occurs with physical exertion, subsequently appears with minor movements and even at rest. When cardiac decompensation develops, so-called cardiac asthma - episodes of suffocation that occur at night.

Paroxysmal (spontaneous, paroxysmal) nighttime dyspnoea can manifest itself as:

short attacks of paroxysmal nocturnal dyspnea, which pass independently;
typical attacks of cardiac asthma;
acute edema of the lungs.

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

In light casesthe attack lasts for several minutes and is characterized by a feeling of lack of air. The patient sits down, the lungs listen to hard breathing. Sometimes this condition is accompanied by a cough with the separation of a small amount of phlegm. Seizures may be rare - in a few days or weeks, but may repeat several times during the night.
In heaviercases develop a severe long-term attack of cardiac asthma. The patient wakes up, sits down, tilts the body forward, rests his hands on the hips or the edge of the bed. Breathing becomes rapid, deep, usually with difficulty in inhaling and exhaling. Chrohes in the lungs may be absent. In a number of cases, bronchospasm may be associated, enhancing ventilation disorders and breathing.

Episodes can be so unpleasant that the patient may be afraid to go to bed, even after the symptomatology has disappeared.

Diagnosis of CHF

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

The doctor clarifies the patient:

How he sleeps;
Did the number of pillows change over the past week?
Whether the person began to sleep sitting, instead of lying down.

The second stage of diagnosis isphysical examination, including:

Examination of the skin;
Assessment of the severity of fat and muscle mass;
Check for the presence of edema;
Palpation of pulse;
Palpation of the liver;
Auscultation of the lungs;
Auscultation of the heart (I tone, systolic murmur at the 1st point of auscultation, analysis of the second tone, "gallop rhythm");
Weigh-in (a decrease in body weight by 1% in 30 days indicates the onset of cachexia).

Objectives of diagnosis:

Early detection of the presence of heart failure.
Clarification of the severity of the pathological process.
Determination of the etiology of heart failure.
Assessment of the risk of complications and sudden progression of pathology.
Estimation of the forecast.
Assessment of the likelihood of complications of the disease.
Monitoring the course of the disease and timely response to changes in the patient's condition.

Diagnostic tasks:

Objective confirmation of the presence or absence of pathological changes in the myocardium.
Identification of signs of heart failure: dyspnea, rapid fatigue, rapid heart rate, peripheral edema, wet wheezing in the lungs.
Identification of pathology leading to the development of chronic heart failure.
Determination of the stage and functional class of heart failure by NYHA (New York Heart Association).
Identification of the primary mechanism of development of heart failure.
Identification of provoking causes and factors aggravating the course of the disease.
Identification of concomitant diseases, evaluation of their connection with heart failure and its treatment.
Collecting enough objective data for the necessary treatment.
Detection of the presence or absence of indications for the use of surgical methods of treatment.

Diagnosis of heart failure should be carried out usingadditional survey methods:

EKG usually shows signs of hypertrophy and myocardial ischemia. Often this study can identify concomitant arrhythmia or conduction disorders.
A sample with physical activity is carried out to determine tolerance to it, as well as changes characteristic of coronary heart disease (ST segment deviation from the ECG from the isoline).
Daily Holter monitoring allows you to clarify the state of the heart muscle in the typical behavior of the patient, as well as during sleep.
A characteristic feature of CHF is a reduction in the ejection fraction, which can be easily seen with ultrasound. If you additionally carry out dopplerography, the heart defects will become obvious, and with the proper skill you can even reveal their degree.
Coronary angiography and ventriculography are performed to clarify the state of the coronary bed, and also in terms of preoperative preparation with open interventions on the heart.

When diagnosed, the doctor asks the patient about the complaints and tries to identify the signs typical for CHF. Among the evidence of diagnosis, it is important to find a person with a history of heart disease. At this stage, it is best to use the ECG or determine the natriuretic peptide. If no abnormality is found, there is no CHF in humans. If a manifestation of damage to the myocardium is found, the patient should be referred to echocardiography to determine the nature of heart lesions, diastolic disorders, etc.

At the subsequent stages of diagnosing the physician identify the causes of chronic heart failure, clarify the severity, reversibility of changes to determine the appropriate treatment. It is possible to assign additional studies.

Complications

Patients with chronic heart failure may develop such dangerous conditions as

frequent and protracted pneumonia;
pathological hypertrophy of the myocardium;
numerous thromboembolism due to thrombosis;
general exhaustion of the body;
violation of heart rhythm and conduction of the heart;
impaired liver and kidney function;
sudden death from cardiac arrest;
thromboembolic complications (heart attack, stroke, thromboembolism of pulmonary arteries).

Prevention of complications is the use of prescribed medications, timely detection of indications for operative treatment, the appointment of anticoagulants according to indications, antibiotic therapy in the defeat of the bronchopulmonary system.

Treatment of chronic heart failure

First of all, patients are advised to follow the appropriate diet and limit physical activity. It is necessary to completely abandon fast carbohydrates, hydrogenated fats, in particular, animal origin, and also carefully monitor the consumption of salt. It is also necessary to immediately quit smoking and drink alcohol.

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

Treatment of chronic heart failure is prolonged. It includes:

Medication Therapy, aimed at combating the symptoms of the underlying disease and eliminating the causes that contribute to its development.
Rational mode, including the limitation of labor activity according to the forms of the stages of the disease. This does not mean that the patient should always be in bed. He can move around the room, it is recommended to practice physical therapy.
Dietotherapy. It is necessary to monitor the calorie content of food. It must correspond to the prescribed regimen of the patient. Total caloric intake decreases by 30%. And patients with exhaustion, on the contrary, are given enhanced nutrition. If necessary, unloading days are carried out.
Cardiotonic therapy.
Treatment with diuretics, aimed at restoring the water-salt and acid-base balance.

Patients who have the first stage are fully able to work, at the second stage there is a limited capacity or completely lost. But in the third stage, patients with chronic heart failure need constant care.

Medication

The drug treatment of chronic heart failure is aimed at increasing the functions of contracting and eliminating the body from excess fluid. Depending on the stage and severity of symptoms in heart failure, the following groups of drugs are prescribed:

Vasodilators and ACE inhibitors- angiotensin-converting enzyme (enalapril, captopril, lisinopril, perindopril, ramipril) - lower the tone of the vessels, dilate veins and arteries, thereby reducing vascular resistance during cardiac contractions and contributing to an increase in cardiac output;
Cardiac glycosides (digoxin, strophanthin, etc.)- increase the contractility of the myocardium, increase its pump function and diuresis, promote a satisfactory tolerance of physical exertion;
Nitrates (nitroglycerin, nitron, sustac, etc.)- improve blood filling of the ventricles, increase cardiac output, expand the coronary arteries;
Diuretics (furosemide, spironolactone)- reduce the delay of excess fluid in the body;
Β-adrenoblockers (carvedilol)- reduce the heart rate, improve blood filling of the heart, increase cardiac output;
Drugs that improve myocardial metabolism(B vitamins, ascorbic acid, riboxin, potassium preparations);
Anticoagulants (aspirin, warfarin)- prevent thrombosis in the vessels.

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

Triple therapy (ACEI + diuretic + glycoside) - was the standard in the treatment of CHF in the 80's, and now remains effective scheme in the treatment of CHF, but for patients with sinus rhythm, the replacement of glycoside by a beta-blocker is recommended. Gold standard since the early 90s to the present - a combination of four drugs - ACEI + diuretic + glycoside + beta-blocker.

Prophylaxis and prognosis

To prevent heart failure, you need proper nutrition, sufficient physical activity, rejection of bad habits. All diseases of the cardiovascular system should be timely identified and treated.

The prognosis in the absence of CHF treatment is unfavorable, since most heart diseases lead to its wear and development and severe complications. When carrying out medical and / or cardiosurgical treatment, the prognosis is favorable, because slowing the progression of failure or a radical cure for the underlying disease.