Chronic heart failure is one of the most frequent complications of diseases of the cardiovascular system. Any disease of the heart reduces the heart's ability to provide the body sufficient blood flow. That is, to reduce its pumping function.
Increasing heart failure over time exceeds the risk to the patient's life is a disease that is caused heart failure. Most chronic heart failure cause coronary heart disease, myocardial infarction, hypertension, cardiomyopathy, valvular heart disease.
In many cases, heart failure is the cause of death, according to American researchers reduces the quality of life of patients by 81%.
Typically, heart failure develops slowly. The mechanism of its development involves many steps. Available in a patient of heart disease lead to increased pressure on the left ventricle. To cope with the increased workload of the heart muscle hypertrophy (increase in volume, thickens) and for some time supports normal blood circulation. However, in the most hypertrophied heart muscle breaks down food and oxygen delivery, because the vascular system of the heart is not designed for its increasing volume.
There is sclerosis, muscular tissue, and a cascade of other changes that eventually lead to dysfunction of the heart muscle, primarily to the disruption of its contraction, which causes a deficiency in the ejection of blood vessels, and relaxation, which causes deterioration of the power of the heart. For a while, the body tries to help his heart: changing the amount of hormones in the blood, small arteries are compressed, changing the kidneys, lungs and muscles.
In the further course of the disease compensatory reserve of the organism is exhausted. The heart begins to beat faster. It does not have time to pump all the blood first from the systemic circulation (because a loaded left ventricle suffers first), and then from the small. There are shortness of breath, especially at night when lying down. This is a consequence of stagnation of blood in the lungs. Due to the stagnation of blood in the systemic circulation in a patient feel cold hands and feet, swelling appear. First, they are only on the legs, the evening can be shared. Increased liver and pain in the right upper quadrant. On examination, the patient reveals cyanosis - a blue tint color of hands and feet. When listening, instead of two tones of heart listen to three. This is called "gallop." An electrocardiogram showed signs of disease, which led to chronic heart failure: myocardial infarction, arrhythmias, or signs of increased left heart. On radiographs reveal an increase in heart size, pulmonary edema. On the echocardiogram are myocardial infarction, heart disease, cardiomyopathy, damage to the outer membrane of the heart (pericarditis). An echocardiogram allows us to estimate the degree of disruption of the heart.
According to the classification of the New York Heart Association, there are four classes of chronic heart failure:
1 class. Shortness of breath occurs when climbing stairs above the third floor. Physical activity is not limited to the patient. Grade 2. Slight decrease in physical activity. Signs of heart failure occur during normal daily load. Shortness of breath occurs when walking fast or climbing one floor. Grade 3. Physical activity is sharply limited by the patient, the symptoms of heart failure occur at lower loads, even at normal walking. At rest, heart failure symptoms disappear. Grade 4. Signs of heart failure appear alone, but with little physical activity sharply.
Treatment.
The goal of treatment of heart failure increase the life expectancy of the patient and improve quality of life. First of all, try to treat the underlying disease that led to this state. Frequently used surgical methods. In the treatment of heart failure itself is important to reduce the load on the heart and increase its contractility. The patient is recommended to reduce the physical stress, more rest. Reduce the amount of salt and fat in food. Maintain a healthy lifestyle.
Previously, all patients used cardiac glycosides (digoxin). Now they are used less often and not in the initial stages of treatment, and when other drugs are ineffective or the work of the left ventricle decreased by 75%. Cardiac glycosides increase the work of the heart muscle, increase exercise tolerance. The patient should be aware that the application of cardiac glycosides are cumulative (the accumulation of drug in the body). If you accumulate a lot of drugs, poisoning can occur with cardiac glycosides. Symptoms of poisoning: a decrease of appetite, nausea, slow pulse, and sometimes cuts to the heart. In these cases, you must seek immediate medical attention.
The second class of drugs - a diuretic (diuretic). They are appointed for signs of fluid retention (swelling of the legs, lungs, rapid weight gain, a sharp increase in the size of the stomach). This medication furosemide, diakarb, veroshpiron etc.
In recent years, the main drugs for treating heart failure are angiotensin converting enzyme inhibitors (enalapril, berlipril, lisinopril). These drugs cause dilation of the arteries, reduce peripheral vascular resistance, facilitating the work of the heart to push blood in them. They restore the impaired function of the inner lining of blood vessels. Angiotensin converting enzyme inhibitors prescribed to almost all patients. Some patients used beta-blockers (metoprolol, Concor, carvedilol). It slows the heart rate, decrease the oxygen starvation of the heart muscle, lower blood pressure.
Applicable, and other classes of drugs. It is important that the patient would have time to go to the doctor, was kept under observation.
