Chronic heart failure: symptoms and treatment
Chronic heart failure is a formidable pathology of the heart, associated with the occurrence of problems with the nutrition of the body due to insufficient blood supply during exercise or at rest. This syndrome has a complex of typical symptoms, so its diagnosis is usually not difficult. In this case, the main mechanism of this violation is the inability of the body to pump blood due to damage to the heart muscle. As a result of inadequate blood circulation, not only the heart, but also other organs and systems of the body, lacking oxygen and nutrients, suffers.
The syndrome of CHF develops against the background of other pathologies of SSS. In particular, it can develop because of:
- heart valve damage;
- myocardial damage
- pericardial disease;
- violations of the working rhythm of the heart.
By the pathologies associated with myocardial damage include coronary heart disease (myocardial infarction, or without it), myocardial dystrophy, a persistent increase in blood pressure, cardiomyopathies, endocrine disorders, including disorders of the thyroid gland and adrenal disease, infiltrative diseases (amyloidosis, sarcoidosis ), As well as HIV infection.
The following diseases are related to heart rhythm disturbances:
- atrial fibrillation
- heart block.
Also, the cause, due to which this syndrome develops, are congenital and acquired heart valve defects. As for the pericardial diseases that cause this syndrome, they can be referred to:
- dry and effeminate pericarditis
- constructive pericarditis.
There are also predisposing factors that may lead to the development of this syndrome, these are:
- alcohol abuse
- kidney failure
- Aging of the organism
- Diseases of the bronchopulmonary system (bronchial asthma, chronic obstructive pulmonary disease)
In medical practice, there is a certain classification of CHF. In particular, the syndrome is classified according to functional classes (FC), and there may be 4 species (I, II, III and IV).
In chronic heart failure FC I, the person feels good during exercise, and symptoms of the disease when it does not appear — unless noted a slight shortness of breath. In this case, the recovery period in a person with this pathology increases in comparison with healthy people.
In this pathology, like CHF FC II symptoms syndrome are absent at rest, but with a load of people experiencing shortness of breath, his heartbeat quickens and marked fatigue.
With CHF III functional class, the symptoms of the pathology are manifested even with a slight load, while in rest they are absent. People with this type of pathology require a noticeable restriction of physical activity.
Well, the last type is CHF IV FC. With this type of disease a person can not perform any physical work without the manifestation of symptoms. That is, the symptomatology inherent in the disease manifests itself in both physical exertion and at rest.
There is also a classification of the disease in stages — they are allocated 4:
- 1 initial;
- 3 is the end.
At the first stage there are almost no symptomatic manifestations, therefore minor functional disorders are detected exclusively on the ultrasound of the heart. At stage 2A there are pronounced symptoms of blood flow disturbance in the large and small circle of blood circulation. Stage 2B is characterized by pronounced changes in the two circles of the circulation, as well as the appearance of disturbances in the work of the heart and blood vessels. In the final stage 3 marked irreversible changes of structure of target organs (kidney, heart, lung, and so on. D.).
The following classification of this ailment is a classification for the area of blood stagnation. There are the following types of disease, such as CHF syndrome:
- Right ventricle;
- left ventricle;
When right ventricular heart failure circulatory violation occurs predominantly in the vessels of the lungs, that is, in the pulmonary circulation. When the left ventricle — the large circle in the vessels (all organs except the lungs), and for biventricular — blood stagnation in the two circulation
And the last classification of this pathology is based on the phases of cardiac dysfunction. Depending on what violations occur during the work of the heart, there is systolic chronic heart failure, diastolic and mixed.
If we talk about the symptoms of chronic heart failure, then they depend on the severity of the pathology and the bodies involved in the process. There are several basic signs of this pathology, which include:
- violation of the depth and frequency of breathing (development of dyspnea)
- increased fatigue due to physical exertion (and even at rest)
- heart palpitations
- swellings developing first on the lower limbs, and then swelling spreads up the body, and reach the hips, loin, anterior abdominal wall
- the appearance of a dry cough (with the development of the process, the cough becomes wet, with the release of mucous sputum).
Another expressed symptom with CHF syndrome is the patient’s forced position — orthopnea. Thus the person can lay only in position with the raised head, otherwise at it strengthening of a cough and a dyspnea is noted.
Depending on which stage of the disease a person has, his complaints also differ. In initial patients, they usually complain of increased fatigue and sleep disturbances. With physical activity, they noted acceleration of the heartbeat and the appearance of dyspnea. Sometimes swelling of the feet and legs is noted after active physical exertion (after a long day of work, after playing sports, etc.).
In the second stage, the clinical manifestations intensify. Tachycardia and dyspnea are observed in all types of physical activity, swelling on the feet and legs is observed, the amount of urine released decreases. On ultrasound, you can see an increase in the chambers of the heart, with a visual examination — unexplained cyanosis of the lips, tip of the nose and fingertips. Also there is a cough with phlegm — at auscultation at patients are defined by small bubbles wet rales. Edema in the second stage is more pronounced, and affects not only the feet and lower legs, but also the thighs of patients.
Stage 2A final is characterized by an even greater severity of the above symptoms — cyanosis is significantly increased, the patient becomes more and more difficult to breathe, a person can fall asleep only when sitting. In addition, edema develops with the development of ascites and hydrothorax, and other internal organs suffer, which leads to the appearance of such symptoms as:
- loss of appetite
- a sharp decrease in body weight (cardiac cachexia);
- nausea and vomiting
- increased heart rate;
- poor pulse filling and others.
Without timely and adequate treatment against a background of increasing symptoms, there is a high percentage of deaths of patients.
Chronic heart failure among all pathologies of SSS is the most common cause of hospitalization, disability and mortality of patients. Therefore, an important role in reducing these indicators is played by timely diagnosis of the disease, which is based on conducting instrumental surveys that allow obtaining objective data for the establishment or confirmation of a diagnosis.
The main criteria for diagnosis are the definition of serious changes in the heart and myocardial dysfunction.
Diagnosis of CHF is also carried out by conducting clinical studies (gas and electrolyte blood composition, protein index, creatinine, carbohydrates, urea, etc.). Electrocardiography makes it possible to identify ischemia and hypertrophy of the myocardium, as well as any arrhythmic changes.
X-ray examination is used in the diagnosis of this pathology with the purpose of detecting stagnant phenomena in the lungs, and ventriculography allows assessing the contractility of the ventricles. Echocardiography makes it possible to establish the cause of the development of this syndrome in humans, as well as MRI.
If we talk about the treatment of chronic heart failure, its main goal is to slow the progression of pathology and alleviate the symptoms of the disease.
The main method is the medical treatment of chronic heart failure, which is prescribed for a long period with the regulation of the necessary dosage depending on the patient’s health condition.
The drugs that treat this syndrome include:
- Diuretics that reduce the swelling associated with this pathology and relieve organs in which congestion is noted
- ACE inhibitors that lower blood pressure in the blood vessels and protect those organs that suffer the most from heart disorders (kidney, liver, heart, brain)
- beta-blockers that lower heart rate and overall vascular resistance, allowing blood to flow freely through the circulatory system
- anticoagulants, blood thinning, and antiaggregants — drugs that prevent the formation of blood clots
- cardiac glycosides, which increase myocardial contractility and reduce heart rate
- Nitrates that exert a relaxing effect on the veins and reduce blood flow to the heart
- Calcium channel antagonists that also act on the vessels and relax them, which reduces the strength of the heartbeat and decreases blood pressure in the vessels.
Very often doctors combine different drugs to obtain the optimal effect of therapy. The combination depends on the stage of the disease and the nature of its course, and is selected individually for each individual patient.
Importance in the treatment of such pathologies as CHF syndrome is the normalization of the regime of physical activity and compliance with a certain diet. In particular, the norms of physical activity for a patient with different functional categories of CHF will be different, but the diet is the same for everyone and involves the exclusion of such products as:
- strong tea
- strong coffee.
It is recommended to eat food in small portions 5-6 times a day (no later than 19 hours). In addition, the food should be high in calories, but easy to digest and contain a minimum amount of salt. At any stage of the pathology, it is allowed to take 1 liter of pure water, while decreasing the amount of salt supplied. Limiting salt, rather than changing the amount of fluid, helps reduce swelling, which is the main symptom of CHF.
In some cases, when the symptoms of the disease are expressed or medication is not effective, surgical intervention is shown, which consists in surgical correction of the initial pathology that caused CHF. Such operations include coronary artery bypass grafting, surgical correction of valves, heart transplantation and others.
This syndrome is an extremely serious pathology that leads to multiple complications. Among the most common are:
- cardiac arrest
- development of thrombosis and thromboembolism
- development of liver failure
- complete exhaustion of the body.
There is a primary and secondary prevention of such a pathological condition as chronic heart failure. Primary can prevent the development of cardiac pathologies, which subsequently lead to CHF, and secondary — it makes it possible to prevent the progression of already existing chronic failure.
The primary preventive measures are:
- Quitting smoking
- refusing to take alcohol;
- Normalized physical. Activity
- proper nutrition, etc.
Secondary prevention consists in the treatment of existing SSS pathologies and in strict adherence to all the doctor’s recommendations regarding the treatment of chronic heart failure.