The appearance of edema increases the load on
The cause of heart failure isdeterioration of the ability of the heart to contract or relax. The deterioration may be caused myocardial damage, and also an imbalance systems responsible for contraction and expansion of blood vessels. Violation of motor activity of the heart leads to a decrease in the supply of oxygen to tissues and organs. There is also a fluid retention in the body.
Heart failure is accompanied bythe development of a number of symptoms: dyspnea, decreased efficiency, edema and others. All these signs can be observed in other diseases, so the diagnosis of "heart failure" can not be made only on the basis of symptoms.
There are acute and chronic heart failure. Acute heart failure appears as a result of damage to the myocardium, especially acutemyocardial infarction. It is accompanied by a rapid appearance of stagnation in the lungs, down to their edema. In this article we will consider the symptoms and treatment of the most common form - chronic heart failure.
Manifestations of circulatory failure depend on its severity. Traditionally, three stages are distinguished.
In the initial stage of the disease there isfatigue, shortness of breath, excessive heart rate increase during exercise. Even a few sit-ups cause quickening of breathing a half or two times. Restoration of the initial pulse rate occurs no earlier than 10 minutes rest after a load. With intense physical exertion, slight asthma may appear.
Local symptoms are poorly expressed. Sometimes there may be a short-term acrocyanosis (blue skin of hands, feet). After considerable loads, drinking large amounts of water or salt in the evenings, small swelling of the shins or the swelling of the skin in the area of the ankles appear.
Dimensions of the liver are not enlarged. Sometimes there is a periodic nocturia - frequent urination at night.
After limiting the load and correcting the use of salt and liquid, these phenomena quickly disappear.
In the second stage of the disease, local symptoms of heart failure appear. First, there are signs of lesion of one of the ventricles of the heart.
When right ventricular failure occursstagnation of blood in a large circle of blood circulation. Patients are worried about shortness of breath during physical exertion, for example, when climbing stairs, fast walking. There is a rapid heartbeat, a feeling of heaviness in the right hypochondrium. Quite often there is nocturia and thirst.
For this stage, the edema of the shins is characterized, which does not completely pass by morning. Acrocyanosis is defined: cyanosis of the shins, feet, brushes, lips. The liver is enlarged, its surface is smooth and painful.
With left ventricular failure predominatesymptoms of stagnation in a small circle of circulation. Patient's state of health is worse than in case of right ventricular failure. Dyspnoea with exercise is stronger, occurs with ordinary walking. At a considerable load, and also at night there is a choking, a dry cough and even a little hemoptysis.
Externally, the pallor of the skin, acrocyanosis,In some cases - a kind of cyanotic blush (for example, with mitral heart defects). In the lungs, dry or small bubbling rales can be heard. There is no swelling on the legs, the size of the liver is normal.
Limiting the load, correcting the intake of water and table salt, proper treatment can lead to the disappearance of all these symptoms.
Gradually, a stagnant cardiacinsufficiency, both pathways of circulation are involved in the pathological process. There is a stagnation of fluid in the internal organs, which is manifested by a violation of their function. There are changes in the analysis of urine. The liver becomes denser and becomes painless. Changes in the biochemical blood test, indicating a violation of liver function.
Patients are concerned about shortness of breath with minimalphysical activity, a frequent pulse, a sense of heaviness in the right hypochondrium. Reduces the excretion of urine, there are swelling of the feet, shins. At night, cough may occur, sleep is disturbed.
Upon examination, acrocyanosis, edema,enlargement of the liver. In many patients, abdominal enlargement (ascites), accumulation of fluid in the pleural cavity (hydrothorax) is revealed. In the lungs you can hear dry and wet rattles. The patient can not lie, accepts the forced position of the half-sider (orthopnea).
Treatment often does not lead to normalization of well-being.
This stage is called the final stage, ordystrophic. It is accompanied by severe impairment of the function of internal organs. Due to lack of oxygen and nutrients, multi-organ failure (renal, hepatic, respiratory) develops.
The manifestations of hepatic insufficiency areedema. The function of the endocrine glands that regulate the insertion-electrolyte balance is violated. At the same time, an unbearable thirst develops. Due to digestive disorders, there is cachexia (exhaustion), which can be masked by pronounced swelling.
Treatment of circulatory failure shouldto eliminate its symptoms, slow progression, improve the quality and life expectancy of patients. It is very important to protect the target organs, especially the heart.
Physical activity is limited in order to reduce the burden on the weakened cardiac muscle. However, rational physical rehabilitation is an important method of treatment.
For patients with severe heart failure, respiratory gymnastics can be recommended, including inflating balloons 3 to 4 timesin a day. Within a month of breathing exercises, the state of health and tolerance of exercise is improving. After stabilization of the state, you can increase the load, including in the form of walking at a normal pace, and then with acceleration. Physical exercise should be part of the lifestyle of a patient with heart failure.
It is advisable to use a vaccine against influenza and hepatitis B.
Travel is allowed, but you must avoidhighlands, hot and humid climate. The duration of the flight must not exceed 2.5 hours. During the flight you need to get up, do light gymnastics every half hour.
When sexual contacts are advised to avoidexcessive emotional stress. In some cases, it is recommended to take nitrates under the tongue before intercourse. The use of such drugs as "Viagra" is allowed, except for the combination with long-acting nitrates.
Moderately limited liquid. The daily amount of fluid taken should not exceed 2 liters. It is necessary to take into account not only the free liquid(drinks), but also the water contained in the products. At the same time, the water content in porridges, salads, other side dishes and bread is conventionally taken as 100% (that is, 50 grams of bread is 50 ml of water). It is important to monitor the amount of urine released, it should not be less than the volume of the fluid taken.
Sharply confined salt, food is not salted when cooking. The total amount of salt should not exceed 3 g in the first stage and 1.5 g in the following stages.
Alcohol is strictly prohibited only when alcoholiccardiomyopathy. In other cases, the restriction of the use of alcoholic beverages is of the nature of the usual recommendations. A large volume of liquid (for example, beer) should be discarded.
The diet should be nutritious, with enough vitamins and protein.
Daily weight control is very important. The gain of weight more than 2 kg for 1 - 3 days speaks about a water retention in an organism and demands immediate measures.
Medication for heart failureis based on the postulates of evidence-based medicine. All officially recommended drugs have gone a long way in proving their need, effectiveness and safety.
The main drugs used to treat this disease include:
- inhibitors of angiotensin-converting enzyme for all patients;
- antagonists of aldosterone receptors;
- diuretics for all patients with fluid retention in the body;
- cardiac glycosides with atrial fibrillation;
- antagonists of angiotensin II receptors (sartans).
In addition, funds are assigned whose properties have been sufficiently studied, but require additional research:
- statins for all patients with ischemic heart disease;
- indirect anticoagulants in most patients with atrial fibrillation.
To auxiliary preparations carry the medicines appointed only in separate cases:
- peripheral vasodilators (nitrates): only with concomitant anginal pain;
- blockers of slow calcium channels (amlodipine): with persistent angina and hypertension;
- antiarrhythmics: with severe heart rhythm disturbances;
- aspirin: after a previous myocardial infarction;
- non-glycoside inotropic stimulants: with low cardiac output and hypotension.
- non-steroidal anti-inflammatory drugs, including aspirin in a large dose;
- tricyclic antidepressants;
- antiarrhythmic drugs I class;
- blockers of slow calcium channels (verapamil, nifedipine, diltiazem).
Surgical treatment of heart failure
These methods can be used only in combination with non-drug and drug therapy.
In some cases, the indications tostaging a pacemaker, including a cardioverter-defibrillator. Some effect can be achieved after heart transplantation, but this method is gradually abandoned. The most promising is the use of mechanical artificial ventricles of the heart.
OTR, transfer "Studio Health" on the topic "Chronic heart failure"
Heart failure. Medical animation.