Chronic heart failure

Chronic heart failure is a symptomatic complex characterized by a pathological condition, which is characterized by structural, functional and neurohumoral disturbance of SSS regulation, which causes inadequate perfusion of tissues and organs, on which their metabolic needs do not depend.

Chronic heart failure is a disease with various characteristic symptoms in the form of fatigue, edema, dyspnea, reduced working capacity and at rest, and when loads are applied. In this state, fluid retention in the tissues of the body is noted. The primary cause of chronic heart failure is the reduced ability of the heart to fill or empty as a result of damage to the heart muscle, as well as in the imbalance of vasodilating and vasoconstrictor systems of a neurohumoral nature.

Chronic heart failure is widespread. Its decompensation serves as an indicator for the hospitalization of almost 49% of patients in the department of cardiology. But in 80% of patients chronic heart failure develops as a consequence of the preserved contractility of the heart muscle. On average in Russia with a diagnosis of severe chronic heart failure in just one year almost 30% of patients die.

Chronic heart failure causes

The etiological causes of this syndrome are a variety of diseases, which are characterized by heart damage and violation of processes associated with contractile function.

First, the causes of chronic heart failure include myocardial damage due to a genetic or acquired anomaly( myocarditis, IHD, myocardial dystrophy, cardiomyopathy, etc.).Secondly, the characteristic causes of chronic heart failure include cardiac muscle overloads with pressure( pulmonary hypertension of aortic stenosis, arterial hypertension) and volume( increased BCC, portal or mitral regurgitation, etc.).In addition, thirdly, if the processes of filling the ventricles with non-miocardial genesis( cardiac tumors, pericarditis, etc.) are violated,

The main causative factors of chronic heart failure include coronary artery disease, heart valve defects and cardiomyopathies, arterial hypertension, myocarditis and others..

Among the possible causes of the disease are bradyarrhythmias, cardiac myxomes, anemia, tachyarrhythmias, thyrotoxicosis, alcohol abuse and pericarditis of a constrictive nature.

Chronic heart failure symptoms

Symptoms consist of complaints from patients and data from diagnostic studies, which is due to a severe picture of chronic heart failure( CHF).The disease is classified into three stages: the initial stage( the first stage), the marked clinical symptoms( the second stage) and the terminal( the third) stage. In addition, it must be taken into account that the symptomatic picture of chronic heart failure will also consist of the signs of the underlying disease, which has become the cause of insufficient circulatory circulation in chronic form.

Patients with this diagnosis in the first stage complain about fatigue, which basically always comes too quickly, frequent heartbeats, and sometimes sleep disturbance. With such physical exertions as rapid movement, climbing the stairs upward, physical labor is somewhat strengthened, characteristic symptoms appear in the form of shortness of breath and rapid heart rate. When diagnosing chronic heart failure, there are manifestations of the underlying pathology, which has become the cause of insufficient circulatory function.

In the second stage of the disease, all the previous clinical symptoms in the form of patient complaints only increase. This is manifested by the rapid onset of shortness of breath and almost always you can observe tachycardia, and the size of the chambers of the heart greatly increase. In case of insufficient functioning of the right ventricle, stagnation in the venous vessels of the BCC( great circle of blood circulation) is noted;There is the appearance of swelling on the lower limbs. First they are formed in the evening, and then by day. In addition, the amount of urine released decreases as a result of fluid retention in the body, followed by hepatomegaly and a "stagnant kidney" syndrome with minor proteinuria and hyaline cylinders.

At a visual inspection, the patient's face shows a slight cyanoticity of the lips, ears and nose, as well as fingertips. With insufficient circulation of the LV, stagnant processes are observed in the vessels of the ICC and are characterized by a cough with separation of sputum, dyspnea;When using methods of auscultation in the lungs, small-bubbly, wet rales of a stagnant character are determined.

With appropriate therapeutic treatment and bed rest, the symptomatology of chronic heart failure may somewhat decrease, but finally it will not disappear forever, what distinguishes this stage of the disease from the first.

The third stage of chronic heart failure is all the previous phenomena with a significant increase. In this case, cyanosis is significantly increased, it becomes more difficult for a patient to breathe, even in a calm state, and patients can fall asleep, taking only a semi-sitting position. In addition, there is an increase in edema with the appearance of ascites and hydrothorax. In this case, the processes of stagnant phenomena also become stronger in organs such as the lungs, kidneys and liver. Stagnation in these organs, which are in the abdominal cavity, causes a sharp drop in appetite and the patient is very sick, and the intestine is unable to perform absorption due to abnormalities in it, so diarrhea appears. Gradually decreases the subcutaneous fat layer( cardiac cachexia), the mass of muscles decreases. Thus, the patients become, as it were, "dried up".Cardiac dimensions significantly increase, the pulse is characterized by its arrhythmia, softness with low filling. With the use of characteristic therapeutic measures, by which the goal can not be achieved, there is a significant mortality among patients in the background of the phenomena of increasing insufficient function of the heart.

Chronic heart failure in children

In the presence of chronic heart failure, children tend to lag behind in physical development, they have anemia and body weight deficiency. The symptomatology of respiration, blood circulation in systems of central and peripheral character is broken.

When examining such children, paleness is noted as a result of centralization of circulatory and anemia processes. It is these symptoms that distinguish pediatric chronic heart failure from this pathology in adults, in which acrocyanosis and polycythemia of compensatory properties are very often observed.

Symptoms of chronic heart failure in children are: sleep disorders due to anxiety and irritability. A lack of blood circulation is characterized by signs of anorexia, nausea, vomiting, and in rare cases - abdominal pain.

One of the earliest signs of chronic heart failure in children is shortness of breath, depending on the degree of hemodynamic disorders. The cause of development of labored breathing is stagnation in the vessels of the ICC, as well as impaired gas exchange in the lungs. Thus, in the blood of a child, lactic acid accumulates as a result of these disorders, the carbonic acid content rises, the pH decreases and this leads to the excitation of a respiratory center with a reduced oxygen capacity of the blood.

At the very onset of chronic heart failure, in the first stage, all these processes occur when performing a certain physical load. But already in the subsequent stages, stagnation in the blood of the ICC is stable and pronounced, so sick children, taking a horizontal position, begin hard and difficult to breathe, which is caused by a venous inflow to the heart. Coping an attack or reducing it, at the very beginning of the pathology is achieved by going to the sitting position.

Orthopnea is characteristic of insufficient LV circulation. With the addition and progression of RV insufficiency, this symptom is sometimes reduced as a result of the reduced ability to inject blood into the right ventricle and reduced stagnation in the ICC.But the formation of sclerotic changes in pulmonary vessels and stagnant phenomena in the ICC are considered the main causes of dyspnea of ​​late stages of the pathological process. In addition, in children with this anomaly, with disturbed left heart functions, cardiac asthma develops, and then pulmonary edema is possible.

First of all, in chronic heart failure in a sick child, there is a cyanotic state of the skin with a characteristic venous and arterial cyanosis. This is explained by the increase in the blood of the quantitative content of reduced hemoglobin. Peripheral cyanosis( acrocyanosis) is characterized by cyanotic bruises, feet, the outer surface of the cheeks, nose and lips. The cause of arterial cyanosis is the inadequate delivery of blood to the pulmonary capillaries with respiratory diseases, stagnant processes in the ICC, or as a result of mixing blood from the veins and arteries with congenital blue heart defects. In this case, cyanosis is localized on the trunk, mucous, limbs, tongue and face, which is gaining strength when the child cries, screams, eats, and also under other physical and emotional stresses.

The appearance of edema in children indicates chronic heart failure, caused by excessive accumulation of fluid outside the cells of tissues in the body, and sodium, as a result of a decreased minute cardiac volume. In the earliest period of the disease, edema is almost hidden and the fluid is retained in the child's body imperceptibly during visual examination. The detection of this symptom, perhaps by controlling the patient's body weight.

With progression of the pathology, edema appears on the ankles, lower legs, lower back, but this is very rare in childhood. However, it is also impossible to exclude this feature. In infants and newborns, the swelling is fixed around the eyes, sacrum, scrotum and perineum. Then their localization extends to the subcutaneous layer, serous cavities, and the abdominal cavity is covered earlier than the pleural cavity. Edema associated with PZHN develop later than detect hepatomegaly. At the same time they are quite extensive, dense and with ulcerative signs. But those edema caused by reduced contractile function of the LV, soft, very mobile with pale skin above them.

Hepatomegaly refers to one of the leading clinical signs of insufficient right heart function. In the future, ascites is formed.

Comprehensive assessment of hemodynamics occurring within the heart, based on clinical and radiological data, invasive diagnostic methods, electrocardiogram, FCG with signs of impaired blood circulation, makes it possible to diagnose chronic heart failure, taking into account the etiology and pathogenesis of the disease. Without all this, it is impossible to determine and prescribe the optimal treatment for a child, and then stabilize the disturbed blood circulation.

Chronic heart failure diagnosis

This pathological condition is a consequence of many diseases of S.S.S.And is considered the most frequent cause of hospitalization of patients, their disability and mortality. Thus, in order to reduce these indicators, in particular, the lethal outcome, and the timely appointment of qualified treatment, it is necessary to conduct a proper diagnosis of the disease.

As a rule, the diagnosis of chronic heart failure is not based solely on clinical symptoms and symptoms that can not be sufficiently objective to make a diagnosis. And for this, instrumental examination methods are needed that will objectively prove serious changes in the heart and myocardial dysfunction in the confirmation of the diagnosis. Thus, these two criteria, characteristic symptoms and objective evidence, are the basis for the diagnosis of chronic heart failure.
Symptoms of this disease can be determined both at rest and during exercise. And objective data of cardiac pathologies are collected only at rest. With certain doubts, a positive result for the therapeutic use of diuretics is used to confirm the diagnosis.

At the time of diagnosis, it is necessary to find out the cause of the development of the disease, the age of the patient and the accompanying pathologies that provoke the process of decompensation and progression of chronic heart failure. The most frequent reasons contributing to the formation of the disease include myocardial infarction and ischemic heart disease. The etiological group includes: dilated cardiomyopathy and cardiac defects of rheumatic nature. In this case, patients with chronic heart failure are mainly at the age after sixty years.

In addition, various methods of laboratory testing are performed, where the gas and electrolyte composition of the blood, the balance of acid and alkaline ratios, the parameters of proteins, carbohydrates, creatinine, urea and enzymes of cardiospecific character are determined.

Electrocardiographic examination reveals myocardial hypertrophy, its ischemia and arrhythmic changes. In doing so, various ECG tests are used in the form of bicycle ergometry and treadmill test. With their help they find out the backup capabilities of the heart in the work.

Echocardiography is used to establish the cause that has contributed to the development of chronic heart failure. In addition, this diagnostic method determines how much the heart muscle can cope with the pumping function. The use of MRI successfully diagnoses coronary heart disease, malformations of various etiologies, arterial hypertension, etc.

Radiographic examination of the lungs helps to determine the stagnation of blood in the vessels of the ICC and cardiomegaly. Also, ventriculography is used, which more accurately estimates the contractile function of the ventricles and determines their volume.

To diagnose severe forms of the pathological process, to determine the concomitant lesions, assign ultrasound of the pancreas, spleen, liver and abdominal cavity.

Chronic heart failure treatment

All methods of therapeutic treatment of chronic heart failure consist of a set of measures that are aimed at creating the necessary conditions in the home that contribute to a rapid reduction in the burden on the SSH, as well as the use of medications designed to help work the myocardium andAffect the disturbed processes of water-salt metabolism. The purpose of the volume of treatment is associated with the stage of development of the disease itself.

First of all, patients are advised to follow the appropriate diet and limit physical activity.

At the first stage of chronic heart failure, there are no contraindications in physical activity. Even physically not hard work is allowed, which includes exercise without tension.

For the second stage, exceptions to physical education and physical work are typical. In this case, it is recommended to shorten the working day in time and introduce an additional day for rest.

Patients with the third stage of chronic heart failure are shown to stay at home, and in case of progressive symptoms a semi-sleeping regimen is prescribed with sufficient sleep for at least eight hours per day.

Also in chronic heart failure of the second stage, limiting the intake of daily intake of table salt, no more than three grams per day. And for the third stage - a salt-free diet in which the presence of salt is about a gram. In addition, patients with this diagnosis completely exclude the use of alcohol, strong tea and coffee, that is, funds that excite heart work.

The use of drug therapy is aimed at strengthening the contractile function and removing excess water and Na ions from the body.

In order to increase the contractility of the cardiac muscle, Strophantine and Corligicon are prescribed, which are administered intravenously slowly only with exacerbations of chronic heart failure and to obtain a rapid effect. In other cases, apply inside Digoxin, Izolanid( drugs foxglove).In the third stage, it is advisable to use only intravenously, Korglikon and Strofantin, since they have a poor absorption effect from the gastrointestinal tract and cause an increase in dyspeptic phenomena.

But to remove excess sodium and water from the body use a diet where there are restrictions in the use of salt. But to achieve the effectiveness of such excretion apply various diuretics, as a diuretic. Their appointment also depends on the stage of chronic heart failure. For example, in the first stage, diuretics are not prescribed, in the second - thiazide diuretics in the form of Hypothiazide or non-asazide sulfonamide preparations in the form of Brinaldix. However, their frequent use can lead to disruption of electrolyte metabolism and cause hypokalemia and hyponatraemia. Therefore, they must be used in combination with Triamteren, which acts as a diuretic, but with the preservation of potassium in the body.

The drug Triampur, which includes Hypothiazide and Triamteren, may be administered to patients with a second stage of chronic heart failure. If these funds are ineffective, Uregit or Furosemide is prescribed. Doses of diuretics should not be too large not to provoke dehydration of the body.

Patients with a first stage are fully able to work, at the second stage there is a limited capacity or completely lost. But in the third stage, patients with chronic heart failure need constant care.