Chronic heart failure (CHF) is a condition in which the volume of blood emitted by the heart decreases for each heartbeat, that is, the pumping function of the heart drops, resulting in organs and tissues lacking oxygen. About 15 million Russians suffer from this disease.
Depending on how quickly heart failure develops, it is divided into acute and chronic. Acute heart failure can be associated with injuries, toxins, heart disease, and, without treatment, can quickly be fatal.
Chronic heart failure develops over a long period of time and manifests a complex of characteristic symptoms (shortness of breath, fatigue and decreased physical activity, edema, etc.) that are associated with inadequate organ and tissue perfusion at rest or under stress and often with fluid retention in the body.
We will talk about the causes of this life-threatening condition, symptoms and methods of treatment, including folk remedies, in this article.
According to the classification according to V. Kh. Vasilenko, N. D. Strazhesko, and G. F. Lang, there are three stages in the development of chronic heart failure:
- I st. (HI) initial or latent insufficiency, which manifests itself in the form of shortness of breath and palpitations only with considerable physical exertion, which had not previously caused it. At rest, hemodynamics and organ functions are not impaired, the work capacity is somewhat lowered.
- Stage II - severe, prolonged circulatory failure, impaired hemodynamics (stagnation in the pulmonary circulation) with little exertion, sometimes at rest. In this stage, there are 2 periods: period A and period B.
- H IIA stage - shortness of breath and palpitations with moderate exertion. Unsharp cyanosis. As a rule, circulatory failure is mainly in the small circle of blood circulation: periodic dry cough, sometimes hemoptysis, manifestations of congestion in the lungs (crepitus and non-sound moist rales in the lower sections), heartbeat, interruptions in the heart. At this stage, the initial manifestations of stagnation and in the systemic circulation (slight swelling of the feet and lower legs, a slight increase in the liver) are observed. By morning, these phenomena are reduced. Sharply reduced work capacity.
- H IIB stage - shortness of breath at rest. All the objective symptoms of heart failure increase dramatically: pronounced cyanosis, congestive changes in the lungs, prolonged aching pain, interruptions in the heart area, palpitations; signs of circulatory failure along a large circle of blood circulation, persistent edema of the lower limbs and trunk, enlarged dense liver (cardiac cirrhosis of the liver), hydrothorax, ascites, severe oliguria. Patients are disabled.
- Stage III (H III) - the final, dystrophic failure stage In addition to hemodynamic disturbances, morphologically irreversible changes in organs develop (diffuse pneumosclerosis, liver cirrhosis, congestive kidney, etc.). The metabolism is broken, the exhaustion of patients develops. The treatment is ineffective.
Depending on the phase of violation of cardiac activity, there are:
- Systolic heart failure (associated with a violation of systole - the period of reduction of the ventricles of the heart);
- Diastolic heart failure (associated with a violation of diastole - a period of relaxation of the ventricles of the heart);
- Mixed heart failure (associated with a violation of both systole and diastole).
Depending on the zone of primary stagnation of blood, the following are distinguished:
- Right ventricular heart failure (with blood stasis in the pulmonary circulation, that is, in the vessels of the lungs);
- Left ventricular heart failure (with blood stasis in the pulmonary circulation, that is, in the vessels of all organs except the lungs);
- Biventricular (two-ventricular) heart failure (with blood stasis in both circles of blood circulation).
Depending on the results of physical research, the classes are determined according to the Killip scale:
- I (no signs of CH);
- II (mild CH, little wheezing);
- III (more severe CH, more wheezing);
- IV (cardiogenic shock, systolic blood pressure below 90 mm Hg. St).
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 with some oncological diseases.
Causes of Chronic Heart Failure
Why is CHF developing, and what is it? The cause of chronic heart failure is usually damage to the heart or impaired ability to pump the right amount of blood through the vessels.
The main causes of the disease are:
- ischemic heart disease;
- heart defects.
There are other provoking factors for the development of the disease:
- cardiomyopathy - myocardial disease;
- arrhythmia - heart rhythm disorder;
- myocarditis - inflammation of the heart muscle (myocardium);
- cardiosclerosis is a lesion of the heart, which is characterized by the growth of connective tissue;
- smoking and alcohol abuse.
According to statistics, in men, most often the 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) capacity of the heart decreases - the first symptoms of the disease appear: physical intolerance, shortness of breath.
Compensatory mechanisms are aimed at preserving the normal functioning of the heart: strengthening the heart muscle, increasing adrenaline levels, increasing blood volume due to fluid retention.
- Malnutrition of the heart: muscle cells became much larger, and the number of blood vessels increased slightly.
- Compensatory mechanisms are exhausted. The work of the heart is much worse - with each push it pushes out not enough blood.
The main symptoms of the disease can be identified such symptoms:
- Frequent shortness of breath - a condition where there is an impression of lack of air, so it becomes rapid and not very deep;
- Increased fatigue, which is characterized by the rapid loss of strength in the commission of a process;
- The increase in the number of heartbeats per minute;
- Peripheral edema, which indicate a poor output of fluid from the body, begins to appear from the heels, and then go higher and higher to the lower back, where they stop;
- Cough - from the very beginning of clothes, it 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 the left and right ventricular, left and right atrial types. With a long course of the disease there are dysfunctions of all parts of the heart. In the clinical picture, the main symptoms of chronic heart failure can be distinguished:
- fast fatiguability;
- shortness of breath, cardiac asthma;
- peripheral edema;
Complaints of fatigue makes the majority of patients. The presence of this symptom is due to the following factors:
- low cardiac output;
- insufficient peripheral blood flow;
- the state of tissue hypoxia;
- the development of muscle weakness.
Dyspnea in heart failure increases gradually - first occurs during physical exertion, subsequently appears with minor movements and even at rest. With decompensation of cardiac activity, so-called cardiac asthma develops - episodes of suffocation that occur at night.
Paroxysmal (spontaneous, paroxysmal) night dyspnea may manifest as:
- short attacks of paroxysmal night dyspnea, self-induced;
- typical heart attacks;
- acute pulmonary edema.
Cardiac asthma and pulmonary edema are essentially acute heart failure that has developed against the 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 arousal during the day.
- In mild cases, the attack lasts a few minutes and is characterized by a feeling of lack of air. The patient sits down, hard breathing is heard in the lungs. Sometimes this condition is accompanied by a cough with a small amount of sputum. Attacks can be rare - in a few days or weeks, but they can be repeated several times during the night.
- In more severe cases, a severe long-term attack of cardiac asthma develops. The patient wakes up, sits down, bends the trunk forward, rests his hands on the hips or the edge of the bed. Breathing becomes rapid, deep, usually with difficulty breathing in and out. Rattling in the lungs may be absent. In some cases, bronchospasm may be added, which increases ventilation problems and respiratory function.
Episodes can be so unpleasant that the patient may be afraid to go to bed, even after the symptoms disappear.
Diagnosis of CHF
In the diagnosis should begin with the analysis of complaints, symptoms of symptoms. Patients complain of shortness of breath, fatigue, palpitations.
The doctor specifies the patient:
- How he sleeps;
- Has the number of pillows changed in the past week?
- Did a person sleep while sitting, not lying down?
The second stage of diagnosis is a physical examination, including:
- Examination of the skin;
- Assessment of severity of fat and muscle mass;
- Checking for edema;
- Palpation of the pulse;
- Palpation of the liver;
- Auscultation of the lungs;
- Auscultation of the heart (tone I, systolic murmur at the 1st auscultation point, analysis of tone II, "canter rhythm");
- Weighing (weight loss of 1% for 30 days indicates the beginning of cachexia).
Purpose of diagnosis:
- Early detection of the presence of heart failure.
- Refinement of the severity of the pathological process.
- Determination of the etiology of heart failure.
- Assessment of the risk of complications and a sharp progression of pathology.
- Evaluation of the forecast.
- Assessment of the likelihood of complications of the disease.
- Control over the course of the disease and timely response to changes in the patient's condition.
- Objective confirmation of the presence or absence of pathological changes in the myocardium.
- Detection of signs of heart failure: dyspnea, fatigue, rapid heartbeat, peripheral edema, moist rales in the lungs.
- Detection of the pathology leading to the development of chronic heart failure.
- Determination of the stage and functional class of heart failure by the NYHA (New York Heart Association).
- Identify the primary mechanism of development of heart failure.
- Identification of provoking causes and factors aggravating the course of the disease.
- Detection of comorbidities, assessment of their connection with heart failure and its treatment.
- Collect enough objective data to prescribe 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 using additional methods of examination:
- On an ECG, signs of hypertrophy and myocardial ischemia are usually present. Often this study allows you to identify a concomitant arrhythmia or conduction disturbance.
- A test with physical activity is carried out to determine the tolerance to it, as well as changes characteristic of coronary heart disease (deviation of the ST segment on the ECG from the isoline).
- Daily Holter monitoring allows you to specify the state of the heart muscle during typical patient behavior, as well as during sleep.
- A characteristic feature of CHF is a reduction in the ejection fraction, which can be easily seen with an ultrasound. If you additionally dopplerography, heart defects will become obvious, and with proper skill you can even reveal their degree.
- Coronary angiography and ventriculography are performed to clarify the condition of the coronary bed, as well as in terms of preoperative preparation with open heart interventions.
When diagnosing, the doctor asks the patient about complaints and tries to identify signs typical of CHF. Among the proofs of the diagnosis, the detection of heart disease in a person with a history of heart disease is important. At this stage, it is best to use an ECG or to determine the natriuretic peptide. If no abnormality is found, the person does not have CHF. When manifestations of myocardial damage are detected, the patient should be referred for echocardiography to clarify the nature of cardiac lesions, diastolic disorders, etc.
At the subsequent stages of diagnosis, doctors identify the causes of chronic heart failure, clarify the severity, reversibility of changes in order to determine the appropriate treatment. Perhaps the appointment of additional research.
Patients with chronic heart failure can develop dangerous conditions such as
- frequent and prolonged pneumonia;
- pathological myocardial hypertrophy;
- multiple thromboembolism due to thrombosis;
- total depletion of the body;
- violation of heart rate and conduction of the heart;
- impaired liver and kidney function;
- sudden death from cardiac arrest;
- thromboembolic complications (heart attack, stroke, pulmonary thromboembolism).
Prevention of the development of complications is the use of prescribed drugs, the timely determination of indications for surgical treatment, the appointment of anticoagulants according to the indications, antibiotic therapy in case of a bronchopulmonary system.
Chronic Heart Failure Treatment
First of all, patients are advised to follow an appropriate diet and limit physical exertion. It is necessary to completely abandon the fast carbohydrates, hydrogenated fats, in particular, of animal origin, as well as carefully monitor salt intake. You also need to quit smoking and drinking alcohol immediately.
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 the rapid reduction of the load on the SCS, as well as the use of drugs designed to help the myocardium work and affect impaired water processes. salt exchange. The purpose of the volume of therapeutic measures is associated with the stage of development of the disease itself.
Treatment of chronic heart failure is a long one. It includes:
- Drug therapy aimed at combating the symptoms of the underlying disease and the elimination of the causes contributing to its development.
- Rational mode, which includes limiting employment according to the forms of the disease.This does not mean that the patient should be constantly in bed. He can move around the room, recommended physical therapy exercises.
- Diet therapy. It is necessary to monitor the calorie content of food. It must comply with the prescribed mode of the patient. Fat people caloric content of food is reduced by 30%. A patient with exhaustion, on the contrary, is assigned an enhanced diet. If necessary, hold fasting days.
- Cardiotonic therapy.
- Treatment with diuretics, aimed at restoring water-salt and acid-base balance.
Patients with the first stage are fully able to work, in the second stage there is a limitation in working capacity or it is completely lost. But in the third stage, patients with chronic heart failure need permanent care.
Drug treatment of chronic heart failure is aimed at improving the functions of reducing and ridding the body of 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 vascular tone, expand the veins and arteries, thereby reducing the resistance of the blood vessels during heart contractions and contributing to an increase in cardiac output;
- Cardiac glycosides (digoxin, strophanthin, etc.) - increase myocardial contractility, increase its pumping function and diuresis, promote satisfactory exercise tolerance;
- Nitrates (nitroglycerin, nitrong, sustak, etc.) - improve the blood supply to the ventricles, increase cardiac output, dilate the coronary arteries;
- Diuretics (furosemide, spironolactone) - reduce the retention of excess fluid in the body;
- Β-adrenergic blockers (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 blood clots in the vessels.
Monotherapy in the treatment of CHF is rarely used, and as this can only be used with an ACE inhibitor during the initial stages of CHF.
Triple therapy (ACEI + diuretic + glycoside) was the standard in the treatment of CHF in the 80s, and now remains an effective scheme in the treatment of CHF, however, for patients with sinus rhythm, the replacement of glycoside by a beta-blocker is recommended. The gold standard from the beginning of the 90s to the present is a combination of four drugs - an ACE inhibitor + diuretic + glycoside + beta-blocker.
Prevention and prognosis
To prevent heart failure, you need proper nutrition, adequate physical activity, avoiding bad habits. All diseases of the cardiovascular system should be promptly identified and treated.
The prognosis in the absence of treatment for CHF is unfavorable, since most heart diseases lead to its deterioration and the development of severe complications. When conducting medical and / or cardiac surgery, the prognosis is favorable, because there is a slowdown in the progression of insufficiency or a radical cure for the underlying disease.