Stagnation in the pulmonary circulation x-ray signs. Pain in the right hypochondrium. Symptoms and treatment of venous blood stasis

This condition with a progressive course leads to the development of acute heart failure. Depending on the factors that provoked the disease, treatment can be conservative or surgical.

Mechanism, causes and signs of stagnation development

Pathological processes are due to the low ability of the left half of the heart to pump blood from the right half and the vessels of the lungs. Right-sided cardiac strength is preserved.

The condition can develop due to a number of factors:

• decrease in tone and pumping power of the left atrium and ventricle in various diseases;
• anatomical changes in the myocardium due to hereditary predisposition or with dystrophic, cicatricial, adhesive processes;
• atherosclerosis or thrombosis coronary vessels, pulmonary veins.

Various diseases can cause stagnation:

• angina pectoris, ischemia, heart attack;
• cardiomyopathy, cardiosclerosis;

• hypertension;
• stenosis of the valves of the left half of the heart;
• myocarditis, rheumatism.

At first clinical picture the disease is insidious. This is due to the fact that vascular system lung has many spare capillaries that are capable of long time compensate congestion in heart. But the weakening of the muscle tone of the left ventricle over time leads to an increase in blood volume in the vessels of the pulmonary circulation, the lungs are "flooded" with blood, that is, it partially goes into the alveoli, causing them to swell and stick together. The speed of blood circulation in the venous bed of the lungs slows down, and the function of gas exchange is disturbed.

Depending on the compensatory capabilities of capillaries in the pulmonary circulation, the disease can be acute, subacute and chronic.

At acute process there is a rapid development of pulmonary edema and cardiac asthma.

Vivid clinical signs of pulmonary edema

Shortness of breath is a feeling of shortness of breath, the inability to deep breath and increasing respiratory movements. Shortness of breath is an early sign of the disease, observed before the onset of symptoms of heart failure. On early stages development of the disease, it is possible to identify respiratory dysfunction only after physical exertion, and in the later stages of the disease, it is observed even at rest. The main symptom of pulmonary pathology is the appearance of shortness of breath in the supine position and at night.

But there are other signs:

• Cough. It is explained by edema of the lung tissues (vessels of the bronchi and alveoli) and irritation of the recurrent nerve, the cough is often dry, sometimes with scanty sputum.

• Wheezing in the lungs and crepitus. The first sign is heard as small and medium bubbling, the second - as a series of characteristic clicks.
• Extension chest. It is visually wider than in healthy people.
• Dullness of percussion sound. On the affected side, he is deaf and dumb.
• Deterioration of the general condition. Patients experience dizziness, weakness, fainting.

Clinical symptoms of cardiac asthma are:

1. suffocation, which manifests itself paroxysmal, it is very difficult to inhale until breathing stops;
2. cyanosis of the face and extremities, develops rapidly, the patient turns blue before his eyes;
3. general weakness, confusion.

Cardiac symptoms may be observed: tachycardia and bradycardia, arrhythmic contractions, an increase or a critical decrease in blood pressure.

Possible complications, treatment tactics

The consequences of stagnation of blood in the pulmonary circulation include:

• sclerosis, thickening, necrosis lung tissue, as a result, violation normal functions breathing;
• the development of dystrophic changes in the right ventricle, which experiences increased pressure and eventually overstretches, its tissues become thinner;

• changes in the vessels of the heart due to high blood pressure in a small circle of blood circulation.

The standard method of research is x-ray. The pictures show the expansion of the boundaries of the heart and blood vessels. On ultrasound ( ultrasound examination) are clearly visible increased blood volumes in the left ventricle. In the lungs, the roots of the bronchi are dilated, multiple focal opacities are observed.

Treatment of the disease is based on the reduction physical activity, the use of cardiac glycosides, agents that improve tissue metabolism, drugs that reduce pressure and reduce swelling. For improvement respiratory function apply Eufillin, adrenomimetics (stimulants).

Surgical interventions are indicated for progressive narrowing of the atrioventricular orifice in the left ventricle and valvular stenosis.

How fortunate that I came across this article, much became clear. Not long ago, my grandmother was literally returned from the other world. In the clinic, she was treated for bronchitis (she coughed for a month), nothing helped, she had a cough before asthma attacks, shortness of breath was such that she could not walk around the apartment. Until we called an ambulance ourselves and immediately put her in intensive care, she lay there for a week. Doctors said that it was her heart that was sick and not her lungs. Now, thanks to the information in this article, I will follow my granny so as not to repeat such a horror.

Signs of heart failure in children and adults

Circulatory failure is the most common complication of pathology of cardio-vascular system. Since there are two circles of blood circulation in the human body, stagnation of blood can occur in each of them separately, or in both at once. In addition, this process can proceed chronically, for a long time, or be the result of emergency. Depending on this, the symptoms of heart failure will also differ.

Manifestations of stagnation of blood in the pulmonary circulation

With impaired work of the heart and congestion a large number blood in the pulmonary circulation, its liquid part exits into the alveoli. In addition, due to plethora, the alveolar wall itself can swell and thicken, which adversely affects the process of gas exchange.

At acute development symptoms of pulmonary edema and cardiac asthma come first. With a long-term process, irreversible changes in the structure can occur lung tissue and its vessels, congestive sclerosis and brown compaction develop.

Dyspnea

Shortness of breath is the most common symptom cardiovascular insufficiency in the pulmonary circulation.

In this case, there is a feeling of lack of air, a change in the frequency and depth of breathing. Patients complain that they cannot breathe full chest, that is, there is an obstacle of an inspiratory nature.

This sign can appear at the earliest stages of the development of the pathological process, but only with intense physical exertion. As the condition worsens, shortness of breath appears at rest and becomes the most painful symptom of chronic heart failure (CHF). In this case, it is characteristic that it appears in a horizontal position, including at night. This is one of hallmarks from pulmonary disease.

Orthopnea

Orthopnea is a forced sitting position, when a person suffering from heart disease even sleeps with the head end elevated. This symptom is objective a sign of CHF, which can be detected during a routine examination of the patient, since he tends to sit down in any situation. If you ask him to lie down, then after a few minutes he will begin to suffocate.

This phenomenon can be explained by the fact that vertical position most of the blood accumulates in the veins lower extremities under the influence of gravity. And since the total volume of circulating fluid remains unchanged, the amount of blood in the pulmonary circulation is significantly reduced. In a horizontal position, the fluid returns to the lungs, due to which plethora occurs, and the manifestations intensify.

Cough

Congestive heart failure is often accompanied by a patient's cough. It is usually dry or with discharge a small amount mucous sputum. There are two reasons for the development of this symptom:

• swelling of the bronchial mucosa due to plethora;
• irritation of the recurrent nerve with enlarged cavities of the left parts of the heart.

Due to the fact that through damaged vessels can enter the alveolar cavity blood cells, sometimes sputum acquires a rusty color. In this case, it is necessary to exclude other diseases that could lead to such changes (tuberculosis, thromboembolism pulmonary artery, decaying cavity).

cardiac asthma

An attack of cardiac asthma manifests itself in the form of a quickly onset of suffocation up to a complete cessation of breathing. This symptom must be distinguished from bronchial asthma, since the approaches to treatment in this case will be diametrically opposed. Appearance patients may be similar: they often breathe superficially. But in the first case, inhalation is difficult, while in the second - exhalation. Only a doctor can distinguish between these two conditions, so a person with such symptoms is shown urgent hospitalization in a hospital.

In response to an increase in the concentration of carbon dioxide in the blood and a decrease in the amount of oxygen, the respiratory center, which is located in medulla oblongata. This leads to more frequent and shallow breathing, and often there is a fear of death, which only aggravates the situation. In the absence of timely intervention, the pressure in the pulmonary circle will continue to increase, which will lead to the development of pulmonary edema.

Pulmonary edema

This pathology is the final stage of increasing hypertension in the pulmonary circulation. Pulmonary edema often occurs with acute heart failure or decompensation chronic process. The symptoms listed above are accompanied by coughing up pink frothy sputum.

IN severe cases due to an increase in oxygen deficiency, the patient loses consciousness, his breathing becomes shallow and ineffective. In this case, it is necessary to immediately intubate the trachea and start artificial ventilation lung mixture enriched with oxygen.

Manifestations of stagnation of blood in the systemic circulation

Symptoms associated with stagnation of blood in the systemic circulation appear with primary or secondary right ventricular failure. This results in fullness. internal organs which eventually undergo irreversible changes. In addition, the liquid part of the blood accumulates in the interstitial spaces, leading to the appearance of latent and overt edema.

Edema

This symptom is one of the most common in chronic heart failure. Usually they begin to appear in the feet, and then, as the disease progresses, they rise up, up to the anterior abdominal wall. There are several hallmarks of edema in heart failure:

1. Symmetry, in contrast to the unilateral lesion with thrombophlebitis or lymphostasis.
2. Dependence on the position of the body in space, that is, after a night's sleep, the fluid accumulates in the back and buttocks, while during walking it moves to the lower extremities.
3. The face, neck and shoulders are usually unaffected, unlike renal edema.
4. To detect latent edema, the patient's weight is monitored daily.

Complications of long-term edema are trophic changes in the skin associated with a violation of its nutrition, the formation of ulcers, cracks and ruptures, from which fluid flows. Secondary infection can lead to gangrene.

Pain in the right hypochondrium

This symptom is associated with the filling of the liver with blood and its increase in volume. Since the capsule around is not stretchable, there is pressure on it from the inside, which leads to discomfort or pain. In chronic heart failure, a transformation of liver cells occurs with the development of its cirrhosis and impaired function.

In the final stage, the pressure increases portal vein, resulting in accumulation of fluid in abdominal cavity(ascites). On the anterior abdominal wall around the navel, saphenous veins may increase with the formation of a “jellyfish head”.

heartbeat

Most often, this symptom appears with a rapid contraction of the heart muscle, but may also be due to increased susceptibility nervous system. Therefore, this symptom is more characteristic of women and very rarely occurs in men.

Tachycardia is a compensatory mechanism aimed at normalizing hemodynamics. It is associated with the activation of the sympathetic-adrenal system and reflex reactions. The increased work of the heart rather quickly leads to myocardial depletion and an increase in congestion. That is why in the treatment of CHF in recent years, small doses of beta-blockers have been used, which slow down the frequency of contractions.

Fast fatiguability

Fatigue is rarely seen as specific symptom CHF. It is associated with increased blood supply. skeletal muscle and can be observed in other diseases.

Dyspeptic phenomena

This term combines all the signs of disruption of the gastrointestinal tract (nausea, vomiting, increased gas formation and constipation). The function of the gastrointestinal tract is impaired both due to a decrease in oxygen delivery through the vessels, and due to reflex mechanisms that affect peristalsis.

Impaired excretory function of the kidneys

due to spasm renal vessels the amount of primary urine decreases, while its reverse absorption in the tubules also increases. As a result, fluid retention occurs, and signs of heart failure increase. This pathological process leads to decompensation of CHF.

Heart failure is a formidable manifestation of diseases of the cardiovascular system. This pathology is more common in adults than in children, and the manifestations depend on the circulation in which blood stasis occurs. If the fluid accumulates in the lungs, then respiratory failure develops, with the plethora of internal organs, their work is disturbed and the structure changes.

What causes congestive heart failure

The term "Congestive heart failure" means a violation of blood circulation in the systemic and pulmonary circulation, which is accompanied by stagnation and the appearance of symptoms of edema. This symptom is ambiguous, because it is characteristic of stagnation of blood in the lungs, and the systemic circulation, mainly in the portal vein.

Stagnation of blood in the pulmonary circle

Congestive heart failure in the pulmonary circle occurs due to a violation of the outflow of blood from the pulmonary vascular system. Initially, this is provoked by the following conditions:

• Violation of the contractility of the myocardium of the left ventricle;
• Mitral stenosis (stenosis) mitral valve);
• Mitral valve insufficiency (widening of the miter opening and reflux of blood during left ventricular contraction;
• Myocarditis, myocardial infarction, restrictive heart failure in autoimmune diseases.

The latter category of diseases is somewhat less common than those mentioned above. However, congestive heart failure is provoked by them in almost every case. Here one should take into account such pathologies as myocarditis, infective endocarditis, systemic lupus erythematosus, systemic sclerosis, sclerosing pericardial armor. All of them lead to violation contractile function heart muscle, most often in the region of the left ventricle. This provokes stagnation of blood in the lungs, which is accompanied by edema and the onset respiratory failure.

Stagnation of blood in a large circle

Right ventricular heart failure is associated with dysfunction of the right ventricle. Here the same reasons are important that were indicated above for the left ventricle. Moreover, the pathogenesis of the disease here is completely different:

1. Initially, the work of the right ventricle is disrupted, which is accompanied by a decrease in the ejection of blood from its cavity. It can also be provoked by an increase in pressure in the pulmonary arteries, which the right ventricle cannot overcome after a certain value.
2. This provokes stagnation of blood in the right ventricle, in which pressure rises.
3. The result of this is an increase in venous pressure in the superior and inferior vena cava, which leads to stagnation of blood in them.
4. The third element of pathogenesis is mainly important for the system of the inferior vena cava, since it is more difficult to pump blood from it under the influence of superior pressure against gravity. Therefore, signs of stagnation in the portal vein begin to be noted. It is directly connected to the abdominal vein system, which leads to an increase in pressure in them.
5. The obstruction of blood flow in them causes an increase in the permeability of the fluid that enters the abdominal cavity, causing ascites. Outwardly, it is manifested by an increase in the volume of the abdomen. Distinguish ascites from others similar pathologies it is possible by the nature of the navel: if it is retracted, then this condition will not be associated with ascites, which necessitates contacting a surgical hospital. If the navel is squeezed out, then this is a sign of ascites, although this is also observed on later dates pregnancy.

Stagnation in the system of the inferior vena cava

Since initially the pressure rises in all the veins of the body, there will also be signs of edema in the lower extremities. In the early stages, congestive heart failure can be recognized by the presence of marks from socks, shoes, belts. These are reddish depressions on the legs and trunk, which are eliminated after sleep. Later stages proceed with the phenomena of edema. They are recognized by an increase in the circumference of the legs and hips.

With a pathology such as heart failure, the prognosis for blood stasis can significantly worsen. A decrease in the rate of its circulation leads to the formation of blood clots, which can enter the lungs, causing thromboembolism. This is a formidable complication of the course of the disease, which can freely lead to death due to respiratory failure or due to cardiac arrest.

Signs of congestive heart failure in a large circle

Most often, it is worth considering local changes that are noted on the lower extremities. This is pastosity of the legs, the presence of a venous pattern on them, as well as foci of small hemorrhages. It is noteworthy that drugs for heart failure do not always help to eliminate these signs, although edema can be effectively relieved with diuretic therapy.

An increase in the size of the legs and thighs often reaches critical indicators. Up to 10 liters of water can accumulate in the patient's legs, and about the same amount can fit in the abdominal cavity. With a pathology such as heart failure, the consequences of this type most often characterize the third degree of severity. Therefore, constant pharmacological support with standard drugs is needed here.

Signs severe edema lower limbs are:

• An increase in the volume of the lower leg or thigh by 1-2 thirds;
• Paleness of the skin;
• Cold skin to the touch;
• The appearance of the consequences of circulatory disorders: trophic ulcers and skin dystrophy;
• The appearance of spots of depigmentation and hyperpigmentation, atrophy of the nail plates.

In the abdominal cavity, changes will relate to local hemodynamic disorders, as well as typical complications. Therefore, with a disease such as heart failure, symptoms and treatment should be a consequence of each other, that is, timely pharmacological therapy with diuretics, as well as auxiliary cardiological agents, should be carried out. For this reason, congestive heart failure in the elderly is the object of close attention of doctors and relatives of the patient.

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And in Omsk, on the old Moskovka, half-ka No. 10 is treated with ACC and lazolvan, because the patient had a cough in the first place, and during auscultation, the heart works according to age. 3 days after calling the local therapist, the diagnosis of the pathologist- congestive heart failure.

/ Circulatory failure1

Circulatory failure (cordially- vascular insufficiency) is a pathophysiological syndrome in which the cardiovascular system, even under conditions of its stress, cannot provide the hemodynamic needs of the body, this leads to functional and structural restructuring (remodeling) of organs and systems.

Depending on which link of the cardiovascular system mainly suffers, there are:

heart failure (HF) - myocardial dysfunction plays a leading role;

vascular insufficiency vascular bed(hypotension).

Each of the forms of NK according to the speed of development of symptoms is divided into:

acute - develops minutes, hours a day (for example, with myocardial infarction);

chronic - develops gradually (months-years).

Acute vascular insufficiency presented in three forms:

chronic - vegetative-vascular dystonia.

Acute heart failure is:

sudden violation of the pumping function of the heart, leading to the impossibility of providing adequate blood circulation, despite the inclusion of compensatory mechanisms;

develops in myocardial infarction acute insufficiency mitral and aortic valves rupture of the walls of the left ventricle.

Acute heart failure has three clinical forms:

Chronic HF (CHF)- This clinical syndrome, characterized by the presence of shortness of breath, palpitations during exercise, and then at rest, fatigue, peripheral edema and objective (physical, instrumental) signs of dysfunction of the heart at rest; complicates the course of many heart diseases.

Depending on the nature of the dysfunction of the heart, CHF is divided into forms:

Systolic - due to a decrease in myocardial contractility (systolic myocardial dysfunction);

Diastolic - violation of diastolic relaxation of the myocardium (diastolic dysfunction);

Mixed - more common, more often diastolic dysfunction precedes systolic in time.

Depending on the dominance functional disorders in a certain part of the heart, CHF is divided into:

Left ventricular - stagnation in the pulmonary circulation;

Right ventricular - stagnation in the systemic circulation;

Total - stagnation in both circles.

Main reasons development of CHF can be divided into:

damage to the heart muscle (mainly systolic insufficiency; ejection fraction< 40%):

Primary: myocardium, dilated cardiomyopathies;

Secondary: diffuse and post-infarction cardiosclerosis (damage to the heart during diffuse diseases connective tissue, toxic-allergic, endocrine).

hemodynamic overload of the heart muscle:

Pressure (LV systolic overload): valve stenosis (mitral, tricuspid, aortic, pulmonary artery); arterial hypertension (systemic, pulmonary).

By volume (LV diastolic overload): valvular insufficiency; intracardiac shunts (defect interventricular septum etc.);

Pressure and volume overload - combined vices hearts;

violation of the filling of the ventricles (mainly diastolic insufficiency):

Arterial hypertension, hypertrophic and restrictive cardiomyopathy, adhesive pericarditis; significant hydropericardium;

diseases with high cardiac output:

Thyrotoxicosis, anemia, obesity.

From the pathogenetic point of view, CHF is regarded as a complex of hemodynamic and neurohumoral reactions to heart dysfunction.

At the core modern theory pathogenesis of CHF lies the neurohumoral model. It is based on the fact that due to a violation of the pumping function of the heart, the following occurs:

activation of neurohumoral systems (sympathetic-adrenal (SAS), renin-angiotensin-aldosterone (RAAS), production of antidiuretic hormone (ADH), the effect of natriuretic factors decreases;

activation of the SAS leads to peripheral vasoconstriction, an increase in heart rate;

activation of the RAAS leads to peripheral vasoconstriction, restructuring of the vascular bed, myocardial hypertrophy, sodium and water retention;

increased production of ADH (vasopressin) is accompanied by vasoconstriction, water retention.

In the early stages of heart failure, compensatory mechanisms function, aimed at eliminating hypoxia in a vital way. important organs(Frank-Starling effect, Bain-Bridge reflex); with a long course of CHF, they are depleted, heart failure progresses.

Clinical manifestations of CHF

Most early symptoms CHF:

weakness, fatigue due to inadequate oxygenation of skeletal muscles;

palpitations during physical exertion - compensatory activation of cardiac activity;

thirst - due to intracellular dehydration.

The clinical symptoms of CHF depend on the circulation in which hemodynamic disturbances occur.

Left ventricular heart failure- due to dysfunction of the left ventricle in aortic and mitral defects, arterial hypertension, IBS ( coronary insufficiency affects the left ventricle).

Clinical manifestations are due to stagnation in the pulmonary circulation.

the accumulation of under-oxidized metabolites in the blood (lactate) when they interact with sodium bicarbonates, promotes the release of CO 2, which leads to irritation of the respiratory center;

increase in hydrostatic pressure in the pulmonary capillaries with an increase in their permeability, extravasation of effusion into the lumen of the alveoli;

accumulation of fluid in pleural cavity(hydrothorax).

Features of shortness of breath in heart failure:

aggravated by physical exertion, after eating;

intensifies when moving to horizontal position(night shortness of breath);

paroxysmal intensifies - attacks of cardiac asthma.

unproductive or with scanty discharge of mucous sputum; the reason is the impregnation of the walls of the bronchi with transudate.

hemoptysis (streaks of blood in the sputum due to rupture of crowded pulmonary capillaries - more often with mitral stenosis).

Forced orthotopic position - sitting with lowered legs - venous return decreases, preload on the heart decreases;

Respiratory examination:

Signs of congestive bronchitis: hard breathing, dry, then wet, muffled wheezing;

When impregnating the walls of the alveoli with transudate, the weakening of vesicular respiration, crepitus. These phenomena are more pronounced in the posterior basal parts of the lungs (subscapular, axillary areas);

Hydrothorax syndrome, more often on the right.

Spilled, enhanced apex beat with compensatory increased heart rate, its lateral displacement with left ventricular hypertrophy;

Shift of the left border of relative dullness of the heart to the left;

Change in the configuration of the heart - mitral, aortic;

Auscultation of the heart - weakening of the first tone at the apex;

The appearance of additional 3 and 4 tones (“gallop rhythm”), the emphasis of the second tone on the pulmonary artery (increased pressure in the pulmonary circulation);

Systolic noise of relative mitral insufficiency, there may be an auscultatory picture of the corresponding defect;

The level of blood pressure - first, DBP decreases (compensatory expansion of the artery and capillaries), then it rises (activation of the SAS, RAAS).

It can develop with the progression of the left ventricular or independently (with mitral stenosis, COPD, pulmonary emphysema, pneumosclerosis, primary pulmonary hypertension)

Clinical manifestations of right ventricular heart failure are caused by congestion in tissues and organs supplied by blood vessels great circle circulation.

Edema - on the legs, in bed patients - in the lumbar region, sacrum; with severe CHF, accumulation of fluid in the cavities.

Causes of edema in CHF:

increase in hydrostatic pressure in the capillary;

sodium and water retention;

a decrease in the oncotic pressure of the blood plasma due to a decrease in the protein-forming function of the liver;

Dull pain, heaviness, bursting in the right hypochondrium (stretching of the fibrous capsule of the liver);

Nausea, vomiting, lack of appetite, flatulence, constipation - congestive gastroenteropathy;

Decrease daily diuresis, nocturia - congestive nephropathy;

Headaches, deterioration mental activity- dysfunction of the central nervous system.

Objective research data:

swelling in the legs, may be diffuse up to anasarca;

icteric staining of the skin and mucous membranes with cardiac fibrosis of the liver.

Respiratory examination:

signs of COPD, emphysema.

Study of the cardiovascular system:

swelling of the neck veins;

positive venous pulse;

the appearance of a cardiac impulse and epigastric pulsation with hypertrophy and dilatation of the right ventricle;

shift of the right border of relative dullness of the heart to the right;

increase in absolute dullness of the heart;

auscultatory weakening of tone 1, the appearance of additional tones, systolic murmur at the point of listening to the tricuspid valve, emphasis of tone 2 on the pulmonary artery (pulmonary hypertension);

tachycardia (Bain-Bridge reflex)

increased blood pressure, mainly diastolic.

Examination of the digestive organs:

an increase in the abdomen - ascites, umbilical hernia;

"medusa head" portal hypertension against the background of cardiac fibrosis of the liver;

bulging in the right hypochondrium with a significant increase in the liver;

hepatomegaly - the edge is rounded, elastic, painful, the surface is smooth;

with the development of fibrosis, the liver is dense, the edge is pointed;

positive symptom Plesha - swelling jugular vein on the right when pressing on the liver;

with ascites - a positive symptom of fluctuation, dullness of percussion sound in the flanks.

According to the severity of hemodynamic changes, CHF is divided into stages (N.D. Strazhesko, V.Kh. Vasilenko, 1935):

Stage I (initial) - latent heart failure, symptoms (shortness of breath, palpitations, fatigue) appear only during physical exertion, there are no objective signs of hemodynamic disorders;

Stage II (expressed) - violation of hemodynamics, organ functions and metabolism are expressed at rest:

IIA - moderate violations hemodynamics, signs of stagnation are revealed only in one (large or small) circle of blood circulation;

IIB - deep violations hemodynamics, signs of stagnation in both circles of blood circulation;

Stage III (final, dystrophic) - severe violations hemodynamics, persistent changes in metabolism and functions of all organs, irreversible changes in the structure of tissues and organs.

Depending on the tolerance of physical activity, functional classes (FC) of heart failure are distinguished. They may change during treatment.

With FC I, there is no restriction of physical activity. Habitual physical activity not accompanied fatigue, shortness of breath or palpitations. Increased load the patient tolerates, but it may be accompanied by shortness of breath and (or) delayed recovery.

In FC II, physical activity is slightly limited. At rest, there are no symptoms, habitual activity is accompanied by fatigue, shortness of breath or palpitations.

Clinic III FC is accompanied by a noticeable limitation of physical activity. At rest, there are no symptoms, physical activity of less intensity than usual is accompanied by the appearance of discomfort.

In FC IV, symptoms of heart failure are present at rest and worsen with minimal physical activity.

Basic goals additional methods research:

exclude other diseases that occur with similar symptoms (anemia, thyrotoxicosis);

identify objective signs of CHF;

to figure out etiological factor CHF;

assess the severity of CHF.

General blood analysis:

exclude anemia, secondary erythrocytosis is possible against the background of hypoxia;

leukocytosis, increase in ESR- with inflammatory lesions of the myocardium, endocarditis, secondary infection (congestive bronchitis, pneumonia);

Urinalysis - manifestations of congestive nephropathy;

high specific gravity of urine;

Study of the level of brain natriuretic hormone: compensatory increase in early and sure sign CH.

Examination of the level of thyroid-stimulating hormones to exclude thyrotoxicosis.

Blood chemistry:

creatinine level - increases with congestive kidney damage;

bilirubin, AST, ALT - increased with congestive liver damage;

hypoalbuminemia - due to liver damage;

cholesterol, -lipoproteins - an increase in coronary artery disease (the most common etiological factor in CHF);

hyperfibrinogenemia, positive C - reactive protein- with atherosclerosis (aseptic inflammation), secondary infections, inflammatory lesion myocardium;

potassium, sodium levels:

Hyponatremia - signs of high plasma renin activity - a poor prognostic sign;

Control of potassium during treatment with diuretics.

Instrumental diagnosis of CHF

Allows you to identify possible reasons CHF; diagnosis of valvular defects, septal defects, intracardiac thrombi, zones of hypokinesia and akinesia, heart aneurysm;

Determines the objective criteria for CHF, the severity of the heart remodeling process (stage), the nature of myocardial dysfunction.

Signs of systolic dysfunction of the left ventricle:

Ejection fraction reduction (EF<50%);

Increased end diastolic pressure in the cavity of the left ventricle.

Signs of diastolic dysfunction of the left ventricle:

Decrease in the rate and magnitude of rapid LV accumulation (determined by the Doppler method).

Tachycardia, possibly extrasystole, atrial fibrillation, signs of myocardial infarction, scarring of the myocardium;

Hypertrophy of the left or right ventricles;

Blockade of the legs of the bundle of His.

Chest X-ray:

Signs of stagnation in the pulmonary circulation: decreased transparency of the lung fields; Kerley lines, darkening of the roots, increased lung pattern, thickening of the costal pleura.

Myocardial scintigraphy, radionuclide study -

Allows you to assess the degree of dysfunction of the right or left ventricles.

Magnetic resonance imaging - a more accurate method for determining the volume of cavities, wall thickness, mass of the myocardium of the left ventricle, allows you to assess the blood supply, features of myocardial function.

Exercise tests:

Bicycle ergometry for the diagnosis of coronary artery disease, the determination of exercise tolerance;

6-minute test - for objectification of CHF FC.

Basic principles of CHF treatment

Diet - restriction of liquid and salt.

Dosed physical activity.

Drug therapy for CHF is pathogenetic in nature and is aimed at blocking neurohumoral influences and reducing BCC.

5 groups of drugs are used:

ACE inhibitors blocking the activation of the RAAS;

-blockers - blockade of sympathetic influences;

aldosterone antagonists - blocks the effects of hyperaldosteronism;

diuretics - a decrease in BCC, are used for congestive CHF (stages II - III);

Timely detection and treatment of diseases of the heart and broncho-pulmonary system;

Surgical correction of heart defects - according to indications;

Medical treatment of disorders heart rate, arterial hypertension;

Dispensary observation of patients;

Identification of risk groups for coronary artery disease, hypertension, explanation of preventive measures (physical education, diet).

Regular treatment, observation and rehabilitation of patients with CHF.

Acute left ventricular and left atrial failure

This is a suddenly developed pumping dysfunction of the left ventricle and left atrium, leading to acute stagnation in the pulmonary circulation.

Myocardial infarction is a more common cause: a large amount of damaged myocardium, rupture of the walls of the heart, acute mitral valve insufficiency.

Arterial hypertension - complicated hypertensive crises.

Arrhythmia (paroxysmal supraventricular and ventricular tachycardia, bradycardia, extrasystole, blockade).

Obstacle in the way of blood flow: stenosis of the mouth of the aorta and mitral orifice, hypertrophic cardiomyopathy, intracardiac tumors and blood clots.

Valvular insufficiency of the mitral or aortic valve.

Decompensation of CHF - inadequate treatment, arrhythmia, severe concomitant disease.

More often there is a combined violation of the pumping function of the left ventricle and the left atrium (hemodynamic relationship), isolated left atrial insufficiency occurs with mitral stenosis, left atrial infarction.

The inability of the left ventricle and atrium to pump the blood coming to them leads to an increase in hydrostatic pressure in the pulmonary veins, and then in the arteries;

the balance between hydrostatic and oncotic pressure is disturbed - extravasation of fluid into the lung tissue, not compensated by lymphatic outflow;

development of respiratory failure (violation of ventilation-perfusion relations, alveolar shunting, airway obstruction with foam) → hypoxia → increased alveolar and capillary permeability → increased fluid transudation into the lungs (vicious circle);

hypoxia → stress activation of blood circulation (activation of the SAS) → increase in alveolar-capillary permeability;

vasoconstriction → increase in cardiac output resistance → decrease in cardiac output (vicious circle).

Clinical manifestations of acute left ventricular and left atrial insufficiency - cardiogenic pulmonary edema:

interstitial pulmonary edema (an attack of cardiac asthma) - extravasation of fluid into the interstitial tissue;

alveolar pulmonary edema (transudation into the alveoli).

Interstitial pulmonary edema

Complaints - severe shortness of breath, chest compression, aggravated in the supine position, difficulty in breathing (stridor).

History the patient has myocardial infarction, heart disease, arterial hypertension, CHF.

Objective research data:

anxiety, fear of death;

cyanosis, cold moist skin;

auxiliary muscles are involved in the act of breathing;

retraction of the intercostal spaces and supraclavicular fossae on inspiration;

noisy wheezing;

auscultatory- hard, bronchial breathing, scattered dry whistling rales, sometimes meager fine bubbling rales against the background of weakened breathing.

Study of the cardiovascular system:

accent II tone on the pulmonary artery;

protodiastolic gallop rhythm;

Alveolar pulmonary edema

cough with copious pink frothy sputum.

With an objective examination:

forced orthopedic position;

noisy bubbling breath;

discharge of pink foam from the mouth;

cyanosis, cold sweat;

in severe cases, Cheyne-Stokes respiration.

on auscultation of the lungs: weakened breathing, wet small and medium bubbling rales, first in the lower sections, then over the entire surface, then coarse bubbling rales in the trachea and bronchi.

Study of the cardiovascular system:

changes as in interstitial edema, arterial hypotension is possible.

Chest X-ray:

signs of interstitial pulmonary edema;

Kerley lines - contrasting interlobular septa;

darkening and infiltration of the roots;

blurred lung pattern;

thickening of the tangent pleura.

X-ray signs of alveolar pulmonary edema:

diffuse decrease in the transparency of the lung field;

hypertrophy or overload of the left atrium;

hypertrophy or overload of the left ventricle;

blockade of the left leg of the bundle of His.

Emergency care for cardiogenic pulmonary edema:

giving the patient a sitting position, with legs down, the imposition of venous tourniquets (venous return to the heart decreases);

oxygen therapy - inhalations of 100% humidified oxygen through nasal cannulas;

defoaming with alveolar edema - inhalation of a 30% solution of ethyl alcohol, 2-3 ml of a 10% alcohol solution of antifomsilan;

assisted ventilation;

with the progression of pulmonary edema - mechanical ventilation;

morphine 2-5 mg IV - suppression of excessive activity of the respiratory center;

neuroleptics (droperidol) or tranquilizers (diazepam) to eliminate hypercatecholaminemia; not possible with hypotension;

nitroglycerin - sublingually, then it is possible in / in, sodium nitroprusside in / in - peripheral vasodilation, reduction of pre- and afterload on the heart;

furosemide - for a decrease in BCC, venous vasodilation, a decrease in venous return;

with arterial hypertension - antihypertensive drugs;

with arterial hypotension, the introduction of dobutamine or dopamine;

anticoagulants for the prevention of thrombosis;

the use of cardiac glycosides;

eufillin - an adjuvant, indicated in the presence of bronchospasm and bradycardia, contraindicated in acute coronary syndrome;

Cardiogenic shock (CS) is a critical circulatory disorder with arterial hypotension and signs of an acute deterioration in blood supply and organ function, caused by myocardial dysfunction and accompanied by excessive stress on the mechanisms of homeostasis regulation.

The same as in acute left ventricular failure. Most often, CABG is a complication of myocardial infarction.

Pathogenesis of hemodynamic disorders in CABG:

decrease in cardiac output;

narrowing of the peripheral arteries due to the activation of the SAS;

opening of arteriovenous shunts;

disorder of capillary blood flow due to intravascular coagulation.

Classification of cardiogenic shock

True cardiogenic shock - it is based on the death of 40 or more percent of the mass of the myocardium of the left ventricle. The most common cause is myocardial infarction.

Reflex shock - it is based on pain syndrome, the intensity of which is quite often not related to the volume of myocardial damage. This type of shock can be complicated by impaired vascular tone, which is accompanied by the formation of a BCC deficiency.

arrhythmic shock - it is based on rhythm and conduction disturbances, which causes a decrease in blood pressure and the appearance of signs of shock. Treatment of cardiac arrhythmias, as a rule, stops the signs of shock.

The main clinical sign of shock is a significant decrease in systolic pressure, combined with signs of a sharp deterioration in the blood supply to organs and tissues.

Systolic pressure in shock - below 90 mm Hg. Art. the difference between systolic and diastolic pressure (pulse pressure) is reduced to 20 mm Hg. Art. or even less (at the same time, the blood pressure values ​​obtained by the auscultatory method of N.S. Korotkov are always lower than the true ones, since the blood flow in the periphery is disturbed during shock!).

Tachycardia, thready pulse.

In addition to arterial hypotension, for the diagnosis of shock, the presence of signs of a sharp deterioration in the perfusion of organs and tissues is mandatory: the following are of primary importance: diuresis less than 20 ml/h;

Symptoms of deterioration of peripheral circulation:

Pale cyanotic, "marbled, speckled, moist skin";

Collapsed peripheral veins;

A sharp decrease in the temperature of the skin of the hands and feet;

Decreased blood flow velocity (determined by the time the disappearance of the white spot after pressing on the nail bed or the center of the palm - normally 2 s);

Impairment of consciousness (from mild lethargy to psychosis and coma), focal neurological symptoms may appear.

Additional research methods:

Laboratory research methods for CABG can reveal:

signs of myocardial infarction;

signs of multiple organ failure (renal, hepatic);

signs of DIC syndrome;

urinalysis - increased specific gravity, proteinuria ("shock kidney").

signs of myocardial infarction;

cardiac arrhythmias and conduction disturbances.

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The forced recumbency of elderly patients, cardiac pathology leads to the fact that blood stagnation occurs in the small pulmonary circle in the circulatory system, in the venous outflow. If treatment is not started on time, pulmonary edema may begin, ending in death.

Congestion in the lungs is a life-threatening condition that is associated with insufficient ventilation of the lung tissue as a result of stagnation of blood in the lungs. Stagnation is often caused by forced inactivity of the elderly, chronic diseases of the cardiovascular and respiratory systems.

Causes of congestion

Along with the elderly over 60 years of age, patients after surgery, trauma and in the terminal stage of oncology are at risk for pulmonary diseases. According to statistics, death occurs in more than half of cases from stagnation. Especially if the congestion is caused by a condition such as pulmonary embolism.

The forced recumbency of elderly patients and concomitant cardiac pathology leads to the development of cardiopulmonary insufficiency, i.e. there is stagnation of blood in the small pulmonary circle in the circulatory system and venous outflow is disturbed. The physiological mechanism is that at first the venules expand, which causes compression of the lung structures, then the transudate finds an outlet into the intercellular space and edema occurs. All this disrupts gas exchange in the lungs, oxygen cannot enter the blood in sufficient quantities, and carbon dioxide cannot be removed from the body.

Thus, impaired lung ventilation and physical inactivity in the elderly are the main factors in the development and progression of stagnation. Under the influence of microorganisms for which stagnation is a favorable environment for reproduction, pneumonia (pneumonia) begins. At the sites of formation of fibrous tissue, pneumosclerosis occurs, affecting the structure of the pulmonary alveoli and bronchi. If treatment is not started on time, pulmonary edema may begin, ending in death.

The disease can also be associated with heart failure, under the influence of the following factors:

• cardiomyopathy, pathology of the structure of the heart;
• hypertensive crisis;
• renal failure and vascular sclerosis;
• poisoning with chemicals through the respiratory system, taking medications, injuries.

Symptoms of stagnation

Initially, the symptoms are similar to pneumonia. In many cases, early diagnosis is difficult. Along with the examination, listening to breathing, body temperature is measured, blood tests are taken and x-rays of the lungs are taken. Both diagnosis and treatment, as well as the prognosis of congestion, depend on how the body is able to cope with pathogenic microflora. In cases with reduced functions of the immune status, the disease may occur already on the 3rd day.

Older persons are prone to stagnation after a few weeks and its symptoms are as follows:

• the temperature background is stable, rarely outside the norm;
• shortness of breath with tachycardia;
• the sick person speaks with stops, he is anxious, cold sweat comes out;
• there is a cough with exudate, then with blood, bloody foam;
• patients complain of increased fatigue and weakness, it is difficult for them to lie on a low pillow (when sitting, the symptoms of shortness of breath gradually disappear);
• on examination, the skin is pale, the nasolabial triangle is cyanotic, there are signs of swelling of the lower extremities;
• pleurisy, pericarditis may occur against the background of hypoxia and pathological processes of insufficiency.

If the first symptoms of respiratory failure associated with the lungs appear, then urgent medical attention is needed.

Treatment approaches

At any stage of the disease, treatment is best carried out in stationary conditions. In difficult cases - in the intensive care unit or in intensive care. To increase the volume of breathing, an oxygen mask or artificial respiration apparatus is prescribed.

During hospitalization, the patient is prescribed an x-ray of the lungs, an ECG, an ultrasound of the heart. A clinical blood test and biochemistry show signs of an inflammatory process: an increase in ESR, leukocytes, a positive reaction of C-reactive protein.

Establishing the cause of stagnation should be the main focus of therapy. If the symptoms are caused by heart failure problems, then the attacks are stopped, a cardiotherapy complex is prescribed.

Regardless of the source of the disease in the lungs, a group of antibiotic therapy is prescribed, which suppresses the pathogenic effect of microbes on the lung tissue. To them are added agents that reduce the density of sputum.

Cough is important to cure, not suppress. Treatment is carried out with the use of mucolytics, herbal preparations, extracts of coltsfoot, plantain, thyme, which are recognized as the most effective phytotherapeutic agents. Mandatory diuretics, vitamins to enhance the immune response to pathogenic microflora in an elderly person.

Prevention of pulmonary congestion

In order to avoid stagnant processes in the lungs, the patient, who is forced to constantly be in bed, needs to make as many movements as possible. If it is not possible to do them yourself, then they resort to the help of caregivers. It is useful to roll over every 4 hours, change the position of the body, sit down. You can not sleep on low pillows, be motionless for a long time, which weakens the functions of breathing and chest movement.

A physiotherapy specialist can teach simple exercises that will help to avoid pathology in the elderly and bedridden. Active independent breathing is important, and for this you can offer to inflate a balloon, breathe through a straw from a cocktail into a glass of water. Such exercises help to enrich the bronchi and lungs with oxygen, expand the range of motion of the chest, including the diaphragm. Stagnation in the lungs in the initial stage is eliminated only by activity.

Of particular importance is a diet rich in protein and carbohydrates, multivitamins, which will give vital energy to cells. You can use medical cups, mustard plasters, physiotherapy and active massage with tapping.

Despite the causes of the disease, bedridden people should drink hot tea with lemon and honey. It will promote the expansion of blood vessels, strengthen their walls, and resist the formation of sputum.

It is necessary to use every opportunity to organize prevention in order to avoid more serious consequences.

Congestive heart failure is a serious pathology of the heart muscle, manifested by the loss of the ability to pump the necessary amount of blood to saturate the entire body with oxygen. Stagnant processes can be left-sided or right-sided.

Since the circulatory system has two circles of blood circulation, the pathology can manifest itself in any of them separately or in both at once. Congestive heart failure can occur acutely, but most often the pathology occurs in a chronic form.

Often this disease is diagnosed in people aged 60 years and above, and, unfortunately, the prognosis for this age category is completely disappointing.

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Causes

The main cause of CHF is considered to be a hereditary factor. If close relatives suffered from heart disease, which necessarily developed into heart failure, then the next generation, with a high probability, will have the same problems with this organ.

Acquired heart disease can also lead to CHF. Any ailment that disrupts the contractility of the heart ends with its strong weakening, manifested by poor blood circulation and its stagnation.

Common causes of congestive heart failure:

Often, a stagnant process develops in people suffering from diabetes mellitus, hypertension and disorders in the thyroid gland. A course of radiation and chemotherapy can provoke CHF. People living with HIV also often suffer from this pathology.

Patients with congestive heart failure are often diagnosed with an abnormal fluid-salt balance at the time of diagnosis. This dysfunction leads to increased excretion of potassium from the body, as well as to the stagnation of water and sodium salts. All this negatively affects the work of the main human muscle - the heart.

Lifestyle plays a significant role in the development of CHF. In people who have a sedentary job and do not play sports, stagnant processes in the heart are most often diagnosed. The same applies to people who are overweight and those who have a lot of junk food in their diet.

The normal functioning of the heart is disturbed by smoking and alcohol abuse. Addictions change the structure of the muscle walls, which leads to poor blood permeability and stagnation.

Symptoms of congestive heart failure

Symptoms of CHF in patients with right-sided and left-sided heart failure can differ significantly. The intensity and severity of symptoms depends on the degree of damage, which medicine divides into three stages of development.

The following general signs of a stagnant process are noted:

• weakness and fatigue;
• chronic fatigue;
• body's susceptibility to stress;
• rapid heartbeat;
• cyanosis of the skin and mucous membranes;
• wheezing and shortness of breath after exercise;
• (dry or frothy);
• loss of appetite;
• nausea, sometimes vomiting;
• lethargy;
• nocturnal attacks of suffocation;
• causeless anxiety or irritability.

Congestion in the lungs with heart failure is also quite common. Such a symptom is accompanied by a wet cough, which, depending on the neglect of the disease, may have bloody discharge. The presence of these symptoms indicates left-sided congestive heart failure.

Also, shortness of breath and wheezing, which are permanent in nature, testify to the left-sided congestive process. Even at rest, the patient cannot breathe normally.

Right-sided CHF has its own characteristics in the manifestation of symptoms. The patient has frequent urination, especially at night, and due to stagnation. There are complaints of pain in the abdomen and a constant feeling of heaviness in the stomach.

A patient with right-sided congestive heart failure is rapidly gaining weight, but this is not due to the deposition of fat, but due to the accumulation of excess fluid. Swollen veins in the neck are another reliable symptom of a right-sided congestive process.

In the pulmonary circulation

With a stagnant process in the pulmonary circulation, which has arisen due to heart failure, the liquid component of the blood is released into the alveoli - small spherical cavities that are filled with air and are responsible for gas exchange in the body.

Subsequently, the alveoli, due to the large accumulation of fluid, swell and become denser, which adversely affects the performance of their main function.

Chronic congestive heart failure, which adversely affects the pulmonary circulation, leads to irreversible processes in the lungs (changes in tissue structure) and blood vessels. Also, against the background of this pathology, congestive sclerosis and diffuse compaction in the lungs develop.

Signs of stagnation in the pulmonary circulation:

In a large circle of blood flow

The symptomatology of the congestive process in the systemic circulation has its own characteristics. This pathology is manifested by the accumulation of blood in the internal organs, which, as the disease progresses, acquire irreversible changes. In addition, the liquid component of blood fills the extracellular spaces, which provokes the appearance of edema.

Signs of stagnation in the systemic circulation:

• obvious and hidden edema;
• pain syndrome in the right hypochondrium;
• cardiopalmus;
• fast fatiguability;
• dyspeptic manifestation;
• kidney dysfunction.

At the beginning of the development of edema, only the area of ​​\u200b\u200bthe feet suffers. Then, with the progression of the disease, the edema rises higher, reaching the anterior wall of the peritoneum. Prolonged swelling leads to the formation of ulcers, skin tears and cracks, which often bleed.

Pain in the right hypochondrium indicates that due to stagnation, the liver filled with blood, and it significantly increased in size.

A rapid heartbeat is a characteristic sign of CHF in the systemic circulation in women, men with such a complaint are treated much less frequently. This symptom occurs due to the frequent contraction of the heart muscle or the high susceptibility of the nervous system.

Fatigue occurs due to excessive filling of the muscles with blood. Dyspeptic phenomena (pathologies of the gastrointestinal tract) are manifested due to a lack of oxygen in the vessels, since it is directly related to the work of peristalsis.

The work of the kidneys is disrupted due to spasm in the vessels, which reduces the production of urine and increases its reabsorption in the tubules.

Diagnostics

To establish an accurate diagnosis, the doctor conducts a survey, to collect an anamnesis, an external examination of the patient and prescribes additional necessary examination methods.

If congestive heart failure is suspected, the patient should undergo the following diagnostic methods:

• echocardiogram;
• coronary angiography;
• chest x-ray;
• electrocardiogram;
• analyzes for laboratory research;
• angiography of vessels and heart.

Also, the patient may be assigned to undergo a procedure for physical endurance. The method consists in measuring blood pressure, pulse, heart rate, taking a cardiogram and fixing the amount of oxygen consumed while the patient is walking on a treadmill.

Such a diagnosis is not always carried out, if heart failure has an obvious, severe clinical picture, then such a procedure is not resorted to.

When diagnosing, it is not necessary to exclude the genetic factor of heart disease. It is also important during the interview to tell as accurately as possible about the existing symptoms, when they manifested themselves and what could provoke the disease.

Treatment

Treatment is prescribed only after a complete diagnosis and diagnosis. It is carried out strictly in a hospital under the supervision of specialists. Therapy is necessarily complex, consisting of medicines and a special diet.

First of all, the patient is prescribed medications that relieve acute symptoms of CHF. After a slight improvement in the condition, the patient is given drugs that suppress the main cause of the development of the disease.

Treatment for CHF includes:

• cardiac glycosides;
• diuretics (diuretics);
• beta blockers;
• ACE inhibitors;
• potassium preparations.

They are the main drugs in the fight against congestive heart failure. In parallel with them, diuretics are prescribed to remove the accumulated fluid from the body and thereby remove the extra load from the heart.

Treatment with folk remedies is also acceptable, but only with the permission of a doctor. Many herbal tinctures and decoctions perfectly remove fluid from the body and eliminate some symptoms. Alternative recipes against CHF can greatly improve the quality of drug therapy and speed up recovery.

When the disease is neglected, the patient is prescribed oxygen masks to improve his condition, especially during sleep, in order to avoid an attack of suffocation.

In addition to drug treatment, the patient is recommended to change, and after discharge from the hospital, introduce light physical activity beyond the norm. A person with CHF should reduce their salt intake, eat often but in small amounts, and completely eliminate caffeine from the diet.

Heart failure is a pathological condition that develops as a result of a sudden or long-term weakening of the contractile activity of the myocardium and is accompanied by congestion in the systemic or pulmonary circulation.

Heart failure is not an independent disease, but develops as a complication of pathologies of the heart and blood vessels (arterial hypertension, cardiomyopathy, coronary heart disease, congenital or acquired heart defects).

Picture of heart failure

Acute heart failure

The clinical manifestations of acute heart failure are similar to acute vascular insufficiency, which is why it is sometimes called acute collapse.

Chronic heart failure

II. Stage of pronounced changes. Signs of long-term hemodynamic disturbances and circulatory failure are well expressed even at rest. Stagnation in the small and large circles of blood circulation causes a sharp decrease in working capacity. There are two periods during this stage:

• IIA - moderately pronounced hemodynamic disturbances in one of the parts of the heart, performance is sharply reduced, even ordinary loads lead to severe shortness of breath. The main symptoms: hard breathing, slight enlargement of the liver, swelling of the lower extremities, cyanosis.
• IIB - pronounced hemodynamic disturbances both in the large and in the pulmonary circulation, the ability to work is completely lost. Main Clinical signs: pronounced edema, ascites, cyanosis, shortness of breath at rest.

III. Stage of dystrophic changes (terminal or final). Persistent circulatory failure is formed, leading to serious metabolic disorders and irreversible disturbances in the morphological structure of internal organs (kidneys, lungs, liver), exhaustion.

In heart failure at the stage of initial manifestations, physical activity is recommended that does not cause a deterioration in well-being.

Severe heart failure is accompanied by:

• disorder of gas exchange;
• edema;
• stagnant changes in the internal organs.

Disorder of gas exchange

The slowing down of the blood flow velocity in the microvasculature doubles the uptake of oxygen by the tissues. As a result, the difference between arterial and venous oxygen saturation increases, which contributes to the development of acidosis. Underoxidized metabolites accumulate in the blood, activating the rate of basal metabolism. As a result, a vicious circle is formed, the body needs more oxygen, and the circulatory system cannot provide these needs. Disorder of gas exchange leads to the appearance of such symptoms of heart failure as shortness of breath and cyanosis.

With stagnation of blood in the pulmonary circulation system and deterioration of its oxygenation (oxygen saturation), central cyanosis occurs. Increased utilization of oxygen in the tissues of the body and slowing of blood flow cause peripheral cyanosis (acrocyanosis).

Edema

To the development of edema against the background of heart failure lead to:

• slowing blood flow and increasing capillary pressure, which contributes to increased plasma extravasation into the interstitial space;
• violation of water-salt metabolism, leading to a delay in the body of sodium and water;
• a disorder of protein metabolism that violates the osmotic pressure of the plasma;
• decreased hepatic inactivation of antidiuretic hormone and aldosterone.

In the initial stage of heart failure, edema is latent and manifests itself as a pathological weight gain, a decrease in diuresis. Later they become visible. First, the lower limbs or the sacral region swell (in bedridden patients). In the future, fluid accumulates in the body cavities, which leads to the development of hydropericardium, hydrothorax and / or ascites. This condition is called abdominal dropsy.

Congestive changes in the internal organs

Hemodynamic disorders in the pulmonary circulation lead to the development of congestion in the lungs. Against this background, the mobility of the lung edges is limited, the respiratory excursion of the chest decreases, and rigidity of the lungs is formed. Patients develop hemoptysis, develop cardiogenic pneumosclerosis, congestive bronchitis.

Stagnation in the systemic circulation begins with an increase in the size of the liver (hepatomegaly). In the future, the death of hepatocytes occurs with their replacement by connective tissue, i.e., cardiac fibrosis of the liver is formed.

In chronic heart failure, the cavities of the atria and ventricles gradually expand, which leads to relative insufficiency of the atrioventricular valves. Clinically, this is manifested by the expansion of the boundaries of the heart, tachycardia, swelling of the jugular veins.

For the diagnosis of acquired or congenital malformations, coronary heart disease and a number of other diseases, magnetic resonance imaging is indicated.

Chest x-rays in patients with heart failure show cardiomegaly (enlarged heart shadow) and congestion in the lungs.

To determine the volumetric capacity of the ventricles and assess the strength of their contractions, radioisotope ventriculography is performed.

In the later stages of chronic heart failure, an ultrasound examination is performed to assess the state of the pancreas, spleen, liver, kidneys, and to detect free fluid in the abdominal cavity (ascites).

Heart failure treatment

In heart failure, therapy is aimed primarily at the underlying disease (myocarditis, rheumatism, hypertension, coronary heart disease). Indications for surgical intervention may be adhesive pericarditis, cardiac aneurysm, heart defects.

Strict bed rest and emotional rest are prescribed only for patients with acute and severe chronic heart failure. In all other cases, physical activity is recommended that does not cause a deterioration in well-being.

Heart failure is a serious medical and social problem, as it is accompanied by high rates of disability and mortality.

Properly organized dietary nutrition plays an important role in the treatment of heart failure. Meals should be easily digestible. The diet should include fresh fruits and vegetables as a source of vitamins and minerals. Quantity table salt limit to 1-2 g per day, and fluid intake to 500-600 ml.

Pharmacotherapy, which includes the following groups of drugs, can improve the quality of life and prolong it:

• cardiac glycosides - enhance the contractile and pumping function of the myocardium, stimulate diuresis, allow you to increase the level of exercise tolerance;
• ACE inhibitors (angiotensin-converting enzyme) and vasodilators - reduce vascular tone, expand the lumen of blood vessels, thereby reducing vascular resistance and increasing cardiac output;
• nitrates - dilate the coronary arteries, increase the output of the heart and improve the filling of the ventricles with blood;
• diuretics - remove excess fluid from the body, thereby reducing swelling;
• β-blockers - increase cardiac output, improve the filling of the chambers of the heart with blood, slow down the heart rate;
• anticoagulants - reduce the risk of blood clots in the vessels and, accordingly, thromboembolic complications;
• means that improve metabolic processes in the heart muscle (potassium preparations, vitamins).

With the development of cardiac asthma or pulmonary edema (acute left ventricular failure), the patient needs emergency hospitalization. Prescribe drugs that increase cardiac output, diuretics, nitrates. Oxygen therapy is mandatory.

Removal of fluid from body cavities (abdominal, pleural, pericardial) is carried out by punctures.

Prevention

Prevention of the formation and progression of heart failure consists in the prevention, early detection and active treatment of the diseases of the cardiovascular system that cause it.

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Heart failure- a condition in which the cardiovascular system is not able to provide sufficient blood circulation. Violations develop due to the fact that the heart does not contract strongly enough and pushes less blood into the arteries than is necessary to meet the needs of the body.

Signs of heart failure: increased fatigue, intolerance to physical activity, shortness of breath, edema. People live with this disease for decades, but without proper treatment, heart failure can lead to life-threatening consequences: pulmonary edema and cardiogenic shock.

Reasons for the development of heart failure associated with prolonged overload of the heart and cardiovascular diseases: coronary heart disease, hypertension, heart disease.

Prevalence. Heart failure is one of the most common pathologies. In this regard, it competes with the most common infectious diseases. Of the entire population, 2-3% suffer from chronic heart failure, and among people over 65 years old, this figure reaches 6-10%. The cost of treating heart failure is twice that of the funds allocated to treat all forms of cancer.

Anatomy of the heart

Heart- This is a hollow four-chamber organ, which consists of 2 atria and 2 ventricles. The atria (upper parts of the heart) are separated from the ventricles by septa with valves (bicuspid and tricuspid) that let blood into the ventricles and close to prevent backflow.

The right half is tightly separated from the left, so venous and arterial blood do not mix.

Functions of the heart:

• Contractility. The heart muscle contracts, the cavities decrease in volume, pushing blood into the arteries. The heart pumps blood around the body, acting as a pump.
• Automatism. The heart is capable of producing electrical impulses on its own, causing it to contract. This function is provided by the sinus node.
• Conductivity. In special ways, impulses from the sinus node are conducted to the contractile myocardium.
• Excitability- the ability of the heart muscle to be excited under the influence of impulses.

Circles of blood circulation.

The heart pumps blood through two circles of blood circulation: large and small.

• Systemic circulation- from the left ventricle, blood enters the aorta, and from it through the arteries to all tissues and organs. Here it gives off oxygen and nutrients, after which it returns through the veins to the right half of the heart - to the right atrium.
• Small circle of blood circulation- Blood flows from the right ventricle to the lungs. Here, in the small capillaries that entangle the pulmonary alveoli, the blood loses carbon dioxide and is again saturated with oxygen. After that, it returns through the pulmonary veins to the heart, to the left atrium.

The structure of the heart.

The heart consists of three membranes and a pericardial sac.

• Pericardial sac - pericardium. The outer fibrous layer of the pericardial sac loosely surrounds the heart. It is attached to the diaphragm and sternum and fixes the heart in the chest.
• The outer shell is the epicardium. This is a thin transparent film of connective tissue, which is tightly fused with the muscular membrane. Together with the pericardial sac, it provides unhindered sliding of the heart during expansion.
• The muscular layer is the myocardium. The powerful heart muscle occupies most of the heart wall. In the atria, 2 layers are distinguished deep and superficial. There are 3 layers in the muscular membrane of the stomachs: deep, middle and outer. Thinning or growth and coarsening of the myocardium causes heart failure.
• The inner shell is the endocardium. It consists of collagen and elastic fibers that provide smoothness to the cavities of the heart. This is necessary for blood to glide inside the chambers, into otherwise thrombi may form.

The mechanism of development of heart failure

It develops slowly over several weeks or months. There are several phases in the development of chronic heart failure:

1. Myocardial damage develops as a result of heart disease or prolonged overload.


2. Violation of the contractile function left ventricle. It contracts weakly and sends insufficient blood into the arteries.


3. stage of compensation. Compensation mechanisms are activated to ensure the normal functioning of the heart in the prevailing conditions. The muscular layer of the left ventricle hypertrophies due to an increase in the size of viable cardiomyocytes. The release of adrenaline increases, which makes the heart beat harder and faster. The pituitary gland secretes antidiuretic hormone, which increases the water content in the blood. Thus, the volume of pumped blood increases.


4. depletion of reserves. The heart exhausts its ability to supply cardiomyocytes with oxygen and nutrients. They are deficient in oxygen and energy.


5. Stage of decompensation- circulatory disorders can no longer be compensated. The muscular layer of the heart is not able to function normally. Contractions and relaxations become weak and slow.


6. Heart failure develops. The heart beats weaker and slower. All organs and tissues receive insufficient oxygen and nutrients.

Acute heart failure develops within a few minutes and does not go through the stages characteristic of CHF. Heart attack, acute myocarditis, or severe arrhythmias cause the heart's contractions to become sluggish. At the same time, the volume of blood entering the arterial system drops sharply.

Types of heart failure

Chronic heart failure- a consequence of cardiovascular disease. It develops gradually and slowly progresses. The wall of the heart thickens due to the growth of the muscle layer. The formation of capillaries that provide nutrition to the heart lags behind the growth of muscle mass. The nutrition of the heart muscle is disturbed, and it becomes stiff and less elastic. The heart is unable to pump blood.

Disease severity. Mortality in people with chronic heart failure is 4-8 times higher than in their peers. Without proper and timely treatment in the stage of decompensation, the survival rate for a year is 50%, which is comparable to some cancers.

The mechanism of development of CHF:

• The throughput (pumping) capacity of the heart decreases - the first symptoms of the disease appear: intolerance to physical exertion, shortness of breath.
• Compensatory mechanisms are activated aimed at maintaining the normal functioning of the heart: strengthening the heart muscle, increasing the level of adrenaline, 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 deteriorates significantly - with each push it pushes out insufficient blood.

Types of chronic heart failure

Depending on the phase of cardiac contraction in which the violation occurs:

• systolic heart failure (systole - contraction of the heart). The chambers of the heart contract weakly.
• diastolic heart failure (diastole - phase of relaxation of the heart) the heart muscle is not elastic, it does not relax and stretch well. Therefore, during diastole, the ventricles are not sufficiently filled with blood.

Depending on the cause of the disease:

• Myocardial heart failure - heart disease weakens the muscular layer of the heart: myocarditis, heart defects, coronary disease.
• reloading heart failure - the myocardium is weakened as a result of overload: increased blood viscosity, mechanical obstruction of the outflow of blood from the heart, hypertension.

Acute heart failure (AHF)- a life-threatening condition associated with a rapid and progressive violation of the pumping function of the heart.

DOS Development Mechanism:

• The myocardium does not contract strongly enough.
• The amount of blood ejected into the arteries decreases sharply.
• Slow passage of blood through body tissues.
• Increased blood pressure in the capillaries of the lungs.
• Stagnation of blood and the development of edema in the tissues.

The severity of the disease. Any manifestation of acute heart failure is life-threatening and can quickly lead to death.

There are two types of OSS:

1. Right ventricular failure.

   It develops when the right ventricle is damaged as a result of blockage of the terminal branches of the pulmonary artery (pulmonary embolism) and infarction of the right half of the heart. This reduces the volume of blood pumped by the right ventricle from the vena cava, which carry blood from the organs to the lungs.

2. Left ventricular failure caused by impaired blood flow in the coronary vessels of the left ventricle.

   Development mechanism: the right ventricle continues to pump blood into the vessels of the lungs, the outflow from which is impaired. The pulmonary vessels are congested. At the same time, the left atrium is not able to accept the increased volume of blood and stagnation develops in the pulmonary circulation.

Options for the course of acute heart failure:

• Cardiogenic shock- a significant decrease in cardiac output, systolic pressure less than 90 mm. rt. st, cold skin, lethargy, lethargy.
• Pulmonary edema- filling of the alveoli with fluid that has seeped through the walls of the capillaries, accompanied by severe respiratory failure.
• Hypertensive crisis- against the background of high pressure, pulmonary edema develops; the function of the right ventricle is preserved.
• Heart failure with high cardiac output- warm skin, tachycardia, congestion in the lungs, sometimes high blood pressure (with sepsis).
• Acute decompensation of chronic heart failure - symptoms of AHF are moderate.

Causes of heart failure

Causes of chronic heart failure

• Diseases of the heart valves- lead to the flow of excess blood into the ventricles and their hemodynamic overload.
• Arterial hypertension(hypertension) - the outflow of blood from the heart is disturbed, the volume of blood in it increases. Working in an enhanced mode leads to overwork of the heart and stretching of its chambers.
• Aortic stenosis Narrowing of the aortic lumen causes blood to pool in the left ventricle. The pressure in it rises, the ventricle is stretched, its myocardium is weakened.
• Dilated cardiomyopathy- a heart disease characterized by stretching of the heart wall without thickening it. In this case, the ejection of blood from the heart into the arteries is reduced by half.
• Myocarditis- inflammation of the heart muscle. They are accompanied by impaired conduction and contractility of the heart, as well as stretching of its walls.
• Ischemic heart disease, myocardial infarction- these diseases lead to disruption of the myocardial blood supply.
• Tachyarrhythmias- the filling of the heart with blood during diastole is disturbed.
• Hypertrophic cardiomyopathy- there is a thickening of the walls of the ventricles, their internal volume decreases.
• Pericarditis- inflammation of the pericardium creates mechanical obstacles to filling the atria and ventricles.
• Basedow's disease- the blood contains a large amount of thyroid hormones, which have a toxic effect on the heart.

These diseases weaken the heart and lead to the activation of compensation mechanisms that are aimed at restoring normal blood circulation. For a while, blood circulation improves, but soon the reserve capacity ends and the symptoms of heart failure appear with renewed vigor.

Causes of acute heart failure

Disorders in the work of the heart:

• Complication of chronic heart failure with strong psycho-emotional and physical stress.
• Pulmonary embolism(its small branches). An increase in pressure in the pulmonary vessels leads to an excessive load on the right ventricle.
• Hypertensive crisis. A sharp increase in pressure leads to a spasm of small arteries that feed the heart - ischemia develops. At the same time, the number of heartbeats increases sharply and an overload of the heart occurs.
• Acute cardiac arrhythmias- an accelerated heartbeat causes an overload of the heart.
• Acute disturbance of blood flow within the heart can be caused by damage to the valve, rupture of the chord holding the valve leaflets, perforation of the valve leaflets, infarction of the interventricular septum, avulsion of the papillary muscle responsible for the operation of the valve.
• Acute severe myocarditis- inflammation of the myocardium leads to the fact that the pumping function is sharply reduced, the heart rhythm and conduction are disturbed.
• Cardiac tamponade- accumulation of fluid between the heart and the pericardial sac. In this case, the cavities of the heart are compressed, and it cannot fully contract.
• Acute onset arrhythmia(tachycardia and bradycardia). Severe arrhythmias disrupt myocardial contractility.
• myocardial infarction- this is an acute violation of blood circulation in the heart, which leads to the death of myocardial cells.
• Aortic dissection- violates the outflow of blood from the left ventricle and the activity of the heart in general.

Non-cardiac causes of acute heart failure:

• Severe stroke. The brain carries out neurohumoral regulation of the activity of the heart, with a stroke, these mechanisms go astray.
• Alcohol abuse disrupts conduction in the myocardium and leads to severe arrhythmias - atrial flutter.
• Asthma attack nervous excitement and an acute lack of oxygen lead to rhythm disturbances.
• Poisoning by bacterial toxins, which have a toxic effect on the cells of the heart and inhibit its activity. The most common causes: pneumonia, septicemia, sepsis.
• The wrong treatment heart disease or self-medication abuse.

Risk factors for developing heart failure:

• smoking, alcohol abuse
• diseases of the pituitary gland and thyroid gland, accompanied by an increase in pressure
• any heart disease
• taking medications: anticancer, tricyclic antidepressants, glucocorticoid hormones, calcium antagonists.

Symptoms of right ventricular acute heart failure are caused by stagnation of blood in the veins of the systemic circulation:

• Increased heartbeat- the result of a deterioration in blood circulation in the coronary vessels of the heart. Patients have increasing tachycardia, which is accompanied by dizziness, shortness of breath and heaviness in the chest.
• swelling of the neck veins, which increases on inspiration, due to an increase in intrathoracic pressure and difficulty in blood flow to the heart.
• Edema. Their appearance is facilitated by a number of factors: a slowdown in blood circulation, an increase in the permeability of capillary walls, interstitial fluid retention, and a violation of water-salt metabolism. As a result, fluid accumulates in the cavities and in the extremities.
• Lowering blood pressure associated with a decrease in cardiac output. Manifestations: weakness, pallor, excessive sweating.
• There is no congestion in the lungs

Symptoms of left ventricular acute heart failure associated with stagnation of blood in the pulmonary circulation - in the vessels of the lungs. Manifested by cardiac asthma and pulmonary edema:

• An attack of cardiac asthma occurs at night or after exercise, when blood congestion in the lungs increases. There is a feeling of acute lack of air, shortness of breath is growing rapidly. The patient breathes through the mouth to provide more air flow.
• Forced sitting position(with lowered legs) in which the outflow of blood from the vessels of the lungs improves. Excess blood flows into the lower extremities.
• Cough at first dry, later with pinkish sputum. The discharge of sputum does not bring relief.
• Development of pulmonary edema. An increase in pressure in the pulmonary capillaries leads to leakage of fluid and blood cells into the alveoli and the space around the lungs. This impairs gas exchange, and the blood is not sufficiently saturated with oxygen. Moist coarse rales appear over the entire surface of the lungs. From the side you can hear the gurgling breath. The number of breaths increases to 30-40 per minute. Breathing is difficult, the respiratory muscles (diaphragm and intercostal muscles) are noticeably tense.
• Formation of foam in the lungs. With each breath, the fluid that has leaked into the alveoli foams, further disrupting the expansion of the lungs. There is a cough with foamy sputum, foam from the nose and mouth.
• Confusion and mental agitation. Left ventricular failure entails a violation of cerebral circulation. Dizziness, fear of death, fainting are signs of oxygen starvation of the brain.
• Heartache . The pain is felt in the chest. Can give in the shoulder blade, neck, elbow.

• Dyspnea- this is a manifestation of oxygen starvation of the brain. It appears during physical exertion, and in advanced cases even at rest.
• exercise intolerance. During the load, the body needs active blood circulation, and the heart is not able to provide it. Therefore, under load, weakness, shortness of breath, pain behind the sternum quickly occur.
• Cyanosis. The skin is pale with a bluish tint due to lack of oxygen in the blood. Cyanosis is most pronounced on the fingertips, nose, and earlobes.
• Edema. First of all, swelling of the legs occurs. They are caused by overflow of the veins and the release of fluid into the intercellular space. Later, fluid accumulates in the cavities: abdominal and pleural.
• Stagnation of blood in the vessels of internal organs causes them to fail:
  • Digestive organs. Feeling of pulsation in the epigastric region, stomach pain, nausea, vomiting, constipation.
  • Liver. Rapid enlargement and soreness of the liver associated with stagnation of blood in the organ. The liver enlarges and stretches the capsule. In motion and when probing, a person experiences pain in the right hypochondrium. Gradually, connective tissue develops in the liver.
  • Kidneys. Reducing the amount of urine excreted, increasing its density. In the urine, cylinders, proteins, blood cells are found.
  • Central nervous system. Dizziness, emotional arousal, sleep disturbance, irritability, fatigue.

Diagnosis of heart failure

Inspection. Examination reveals cyanosis (blanching of the lips, tip of the nose, and areas away from the heart). Pulse frequent weak filling. Arterial pressure in acute insufficiency is reduced by 20-30 mm Hg. compared to a worker. However, heart failure can occur against the background of high blood pressure.

Listening to the heart. In acute heart failure, listening to the heart is difficult due to wheezing and breath sounds. However, you can find:

• weakening of the I tone (the sound of contraction of the ventricles) due to the weakening of their walls and damage to the heart valves
• splitting (bifurcation) of the II tone on the pulmonary artery indicates a later closure of the pulmonary valve
• IV heart sound is detected with contraction of the hypertrophied right ventricle
• diastolic murmur - the sound of blood filling during the relaxation phase - blood seeps through the pulmonary valve due to its expansion
• heart rhythm disturbances (slow or fast)

Electrocardiography (ECG) It is mandatory for all violations of the heart. However, these signs are not specific to heart failure. They can also occur with other diseases:

• signs of cicatricial lesions of the heart
• signs of myocardial thickening
• cardiac arrhythmias
• conduction disorder of the heart

ECHO-KG with Dopplerography (ultrasound of the heart + Doppler) is the most informative method for diagnosing heart failure:

• decrease in the amount of blood ejected from the ventricles is reduced by 50%
• thickening of the walls of the ventricles (the thickness of the anterior wall exceeds 5 mm)
• an increase in the volume of the chambers of the heart (the transverse size of the ventricles exceeds 30 mm)
• reduced contractility of the ventricles
• dilated pulmonary aorta
• heart valve dysfunction
• insufficient collapse of the inferior vena cava on inspiration (less than 50%) indicates stagnation of blood in the veins of the systemic circulation
• increased pressure in the pulmonary artery

X-ray examination confirms an increase in the right heart and an increase in blood pressure in the vessels of the lungs:

• bulging of the trunk and expansion of the branches of the pulmonary artery
• fuzzy contours of large pulmonary vessels
• enlargement of the heart
• areas of increased density associated with swelling
• the first edema appears around the bronchi. A characteristic "bat silhouette" is formed

Study of the level of natriuretic peptides in blood plasma- determination of the level of hormones secreted by myocardial cells.

Normal levels:

• NT-proBNP - 200 pg/ml
• BNP -25 pg/ml

The greater the deviation from the norm, the more severe the stage of the disease and the worse the prognosis. The normal content of these hormones indicates the absence of heart failure.
Treatment of acute heart failure

Is hospitalization necessary?

If symptoms of acute heart failure appear, an ambulance should be called. If the diagnosis is confirmed, then the patient must be hospitalized in the intensive care unit (with pulmonary edema) or intensive care and emergency care.

Stages of care for a patient with acute heart failure

The main goals of therapy for acute heart failure:

• rapid restoration of blood circulation in vital organs
• relief of disease symptoms
• normalization of the heart rate
• restoration of blood flow in the vessels supplying the heart

Depending on the type of acute heart failure and its manifestations, drugs are administered that improve heart function and normalize blood circulation. After it was possible to stop the attack, treatment of the underlying disease begins.

Procedures that help stop an attack of acute heart failure:

1. bloodletting indicated for urgent unloading of pulmonary vessels, lowering blood pressure, eliminating venous congestion. With the help of a lancet, the doctor opens a large vein (usually on the limbs). 350-500 ml of blood is excreted from it.
2. The imposition of tourniquets on the limbs. If there are no vascular pathologies and other contraindications, then artificially create venous congestion in the periphery. Tourniquets are applied to the limbs below the groin and armpit for 15-30 minutes. Thus, it is possible to reduce the volume of circulating blood, unload the heart and blood vessels of the lungs. A hot foot bath can be used for the same purpose.
3. Breathing pure oxygen to eliminate hypoxia of tissues and organs. To do this, use an oxygen mask with a high gas flow rate. In severe cases, a ventilator may be needed.
4. Oxygen inhalation with ethyl alcohol vapor used to extinguish the protein foam formed during pulmonary edema. Before carrying out inhalation, it is necessary to clear the upper respiratory tract of foam, otherwise the patient is threatened with suffocation. For these purposes, mechanical or electrical suction devices are used. Inhalation is carried out using nasal catheters or a mask.
5. Defibrillation necessary for heart failure with severe arrhythmias. Electrical impulse therapy depolarizes the entire myocardium (deprives it of dissociated pathological impulses) and restarts the sinus node responsible for heart rhythm.

Treatment of chronic heart failure

Treatment of CHF is a long process. It requires patience and significant financial costs. Mostly, the treatment is carried out at home. However, hospitalization is often required.

Goals of therapy for chronic heart failure:

• minimization of manifestations of the disease: shortness of breath, edema, fatigue
• protection of internal organs that suffer from insufficient blood circulation
• reduced risk of developing acute heart failure

Is hospitalization necessary for the treatment of chronic heart failure?

Chronic heart failure is the most common cause of hospitalization in the elderly.

Indications for hospitalization:

• failure of outpatient treatment
• low cardiac output requiring treatment with inotropic drugs
• pronounced edema in which intramuscular injection of diuretics is necessary
• deterioration
• cardiac arrhythmias
  

  Treatment of pathology with medicines

  Group	A drug	Mechanism of therapeutic action	How is it prescribed
  Beta blockers	metoprolol	Eliminates pain in the heart and arrhythmia, reduces the heart rate, makes the myocardium less susceptible to oxygen deficiency.	Take orally 50-200 mg per day for 2-3 doses. Dose adjustment is made individually.
  	bisoprolol	It has an anti-ischemic effect and lowers blood pressure. Reduces cardiac output and heart rate.	Take orally 0.005-0.01 g 1 time per day during breakfast.
  cardiac glycosides	Digoxin	Eliminates atrial fibrillation (uncoordinated contraction of muscle fibers). It has a vasodilating and diuretic effect.	On the first day, 1 tablet 4-5 times a day. In the future, 1-3 tablets per day.
  Angiotensin II receptor blockers	Atakand	Relaxes blood vessels and helps reduce pressure in the capillaries of the lungs.	Take 1 time per day for 8 mg with food. If necessary, the dose can be increased to 32 mg.
  Diuretics - aldosterone antagonists	Spironolactone	Removes excess water from the body, retaining potassium and magnesium.	100-200 mg for 5 days. With prolonged use, the dose is reduced to 25 mg.
  Sympathomimetic agents	dopamine	Increases heart tone, pulse pressure. Expands the vessels that feed the heart. Has a diuretic effect.	It is used only in a hospital, intravenous drip at 100-250 mcg / min.
  Nitrates	Nitroglycerine Glyceryl trinitrate	Assign with left ventricular failure. Expands the coronary vessels that feed the myocardium, redistributes blood flow to the heart in favor of areas affected by ischemia. Improves metabolic processes in the heart muscle.	Solution, drops, capsules for resorption under the tongue. In a hospital, it is administered intravenously at 0.10 to 0.20 mcg / kg / min.

  Nutrition and daily routine in heart failure.

  Treatment of acute and chronic heart failure is carried out individually. The choice of drugs depends on the stage of the disease, the severity of the symptoms, and the characteristics of the heart lesion. Self-medication can lead to worsening of the condition and progression of the disease. Nutrition in heart failure has its own characteristics. Patients are recommended diet number 10, and in the second and third degree of circulatory disorders 10a.

  Basic principles of therapeutic nutrition for heart failure:

  • The rate of fluid intake is 600 ml - 1.5 liters per day.
  • With obesity and overweight (> 25 kg / m²), it is necessary to limit the caloric intake of 1900-2500 kcal. Exclude fatty, fried foods and confectionery with cream.
  • Fats 50-70 g per day (25% vegetable oils)
  • Carbohydrates 300-400 g (80-90 g in the form of sugar and other confectionery)
  • Restriction of salt, which causes water retention in the body, an increase in the load on the heart and the appearance of edema. The norm of salt is reduced to 1-3 g per day. In severe heart failure, the salt is completely turned off.
  • The diet includes foods rich in potassium, the deficiency of which leads to myocardial dystrophy: dried apricots, raisins, sea ​​kale.
  • Ingredients that have an alkaline reaction, since metabolic disorders in HF lead to acidosis (acidification of the body). Recommended: milk, wholemeal bread, cabbage, bananas, beets.
  • In case of pathological weight loss due to fat mass and muscles (> 5 kg in 6 months), caloric nutrition is recommended 5 times a day in small portions. Since the overflow of the stomach causes the rise of the diaphragm and disruption of the heart.
  • Food should be high-calorie, easily digestible, rich in vitamins and proteins. Otherwise, the stage of decompensation develops.
  Dishes and foods that are prohibited in heart failure:
  • strong fish and meat broths
  • bean and mushroom dishes
  • fresh bread, pastry and puff pastry products, pancakes
  • fatty meats: pork, lamb, goose, duck, liver, kidneys, sausages
  • fatty varieties fish, smoked, salted and canned fish, canned food
  • fatty and salty cheeses
  • sorrel, radish, spinach, salted, pickled and pickled vegetables.
  • spicy seasonings: horseradish, mustard
  • animals and cooking oils
  • coffee, cocoa
  • alcoholic drinks
  Physical activity in heart failure:

  In acute heart failure, rest is indicated. Moreover, if the patient is in a supine position, then the condition may worsen - pulmonary edema will increase. Therefore, it is desirable to be in the floor sitting position with legs down.

  In chronic heart failure, rest is contraindicated. Lack of movement enhances congestion in the systemic and pulmonary circulation.

  Sample list of exercises:

  1. Lying on your back. The arms are extended along the body. Raise your arms on inhalation, lower them on exhalation.
  2. Lying on your back. Bicycle exercise. Lying on your back, perform an imitation of cycling.
  3. Move to a sitting position from a lying position.
  4. Sitting on a chair. Hands bent in elbow joints, brushes to the shoulders. Elbow rotation 5-6 times in each direction.
  5. Sitting on a chair. On inhalation - arms up, tilt the torso to the knees. As you exhale, return to the starting position.
  6. Standing, in the hands of a gymnastic stick. While inhaling, lift the stick and turn the torso to the side. As you exhale, return to the starting position.
  7. Walking in place. Gradually switch to walking on toes.
  All exercises are repeated 4-6 times. If during Therapeutic exercise there is dizziness, shortness of breath and pain behind the sternum, it is necessary to stop exercising. If, when doing exercises, the pulse accelerates by 25-30 beats, and after 2 minutes returns to normal, then the exercises have positive influence. Gradually, the load must be increased, expanding the list of exercises.

  Contraindications to physical activity:

  • active myocarditis
  • constriction of the heart valves
  • severe cardiac arrhythmias
  • angina attacks in patients with decreased blood output