Home fertilizers Symptoms of heart failure. Causes and symptoms of heart failure. Questioning and general examination of the patient: how to recognize the disease

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Symptoms of heart failure. Causes and symptoms of heart failure. Questioning and general examination of the patient: how to recognize the disease

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. The 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 condition of the pancreas, spleen, liver, kidneys, 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. The amount of table salt is limited to 1-2 g per day, and fluid intake is limited 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.

Video from YouTube on the topic of the article:

The heart in our body plays the role of a pump - in a normal healthy state, it is capable of pumping up to 10 tons of blood per day. But as a result of the development of many primary diseases, especially cardiovascular, some parts of the organ die off or its vessels narrow, or other pathological changes occur. The result is obvious - the heart can no longer pump blood in the right volume, which is called heart failure.

What is "heart failure"?

The answer to the question of what heart failure means is already in the very name of this disease. This is a condition of the heart in which it is not able to cope with its pumping functions necessary for normal blood circulation. In heart failure, the human heart cannot pump blood efficiently, which leads to a deterioration in the delivery of oxygen and nutrients to all organs and tissues of the body, causing congestion in the bloodstream.

Causes of heart failure

By itself, heart failure is not an independent disease, but acts as a complication or natural outcome of primary diseases or pathological conditions. What causes heart failure? Most often, the causes of heart failure are diseases of the cardiovascular system, but not only:

heart defects;
arterial hypertension;
rheumatism;
cardiomyopathy (in rare cases, heart failure becomes one of the early manifestations of dilated cardiomyopathy);
lung diseases.

Quite often, with hypertension, manifestations of heart failure may appear several years after its onset, i.e., a person may not know about such an ailment for many years.

After suffering an acute myocardial infarction, which is marked by the death of a significant portion of the heart muscle, the development of heart failure can occur in a few days.

In addition to heart disease, heart failure can be caused or worsened by:

anemia;
feverish conditions;
alcohol abuse;
hyperthyroidism (excessive thyroid function), etc.

Visual video about what heart failure is:

By localization

For a disease such as heart failure, the classification can be based on the localization of the site of the pathology:

Right ventricular. In this case, an excess volume of blood accumulates in the systemic circulation, which leads to the appearance of edema in the ankles and feet - this is how heart failure manifests itself in the first stage. In addition to these signs, fatigue begins to appear due to insufficient oxygen in the blood and a feeling of pulsation and fullness in the neck.
Left ventricular. There is a retention of blood in the pulmonary circulation associated with the lungs, so the blood begins to be enriched with oxygen worse. Therefore, here the first sign of heart failure is shortness of breath, which increases with increasing physical activity, fatigue and general weakness also appear.
Total. Blood stasis occurs both in the large and in the small circles of blood circulation.

According to the course of the disease

Depending on how the disease manifests itself, there are:

sharp heart failure is a rapid process of development of pathology that develops over a short period of time (from minutes to days).
chronic when heart failure develops much more slowly - over months or even years.

According to the degree of compensation

Heart failure can be divided into compensated and decompensated according to the degree of compensation of developed disorders. At compensated heart failure, signs of circulatory disorders begin to appear only under load, and with decompensated form, such signs of heart failure in men and women are present even at rest.

Symptoms

An important question is how to determine heart failure in humans. In children, it can be expressed in a lag in physical development, insufficient weight gain and anemia. In children, peripheral and central blood supply and respiratory functions are also disturbed.

It is important to understand how heart failure manifests itself in adults, since it is somewhat different - in the form of acrocyanosis (blueness of the skin) and polycythemia. A common symptom for patients at any age is pallor of the skin.

Chronic heart failure at an early stage of development manifests itself only at the time of physical exertion. Later, her symptoms become stable, and even when the patient lies still, they can persist - as a result, he develops shortness of breath.

Edema

Edema is one of the first signs of right ventricular heart failure. Initially, they are minor, most often occurring on the legs and feet, to the same extent on both legs. They appear in the evening and disappear in the morning. At the next stage of heart failure, the edema becomes more and more pronounced and does not completely disappear by morning.

Patients begin to notice that their usual shoes become small, and their feet feel comfortable only in soft slippers. Edema gradually moves up the body, the girth of the legs first increases, and then the hips. Then the fluid begins to accumulate in the abdominal cavity, that is, ascites begins. With developed swelling, the patient prefers to sit, because in the supine position he begins to experience a sharp lack of oxygen.

Gradually, hepatomegaly begins - due to the overflow of the blood plasma of the venous network of the liver, it increases in size. Patients with hepatomegaly begin to feel heaviness, discomfort and other unpleasant sensations in the right hypochondrium. At this stage, bilirubin begins to accumulate in the blood, staining the sclera of the eyes yellowish. Such jaundice, reminiscent of hepatitis, often frightens the patient, forcing him to consult a doctor.

Fatigue

Rapid fatigue is characteristic of both left ventricular and right ventricular heart failure. At first, a person notices a lack of strength when performing a load that he previously performed without difficulty. Gradually, he has to reduce the duration of the moments of physical activity, making longer pauses for rest.

Dyspnea

The main and often the very first sign of chronic left ventricular heart failure is shortness of breath. Patients with it breathe more often than usual, trying to fill the lungs with as much oxygen as possible. At first, shortness of breath comes only after intense physical exertion (rapid climbing stairs, running), but as the disease progresses, shortness of breath begins to appear during normal conversation or even in a state of complete rest. It is curious that often the patients themselves do not notice their shortness of breath, but it becomes obvious to the people around them.

Cough

After performing an intense load, a paroxysmal cough may occur, however, often the patient perceives it as a manifestation of a pulmonary disease, for example, bronchitis. For this reason, many patients (mostly smokers) do not complain about coughing at all, believing that it has nothing to do with heart disease. The same applies to sinus tachycardia - a rapid heartbeat, which a person perceives as a "flutter" in the chest that occurs during motor activity, and after its completion gradually disappears. Many patients, getting used to tachycardia, stop paying attention to it.

Video about what are the signs and treatment of heart failure:

Diagnostics

Often, before diagnosing heart failure, it is enough to undergo a routine medical examination, which will indicate the primary disease. Further, to clarify the diagnosis, a number of instrumental and other studies will be required.

Using electrocardiography, doctors can establish various arrhythmias, as well as indirect signs of myocardial hypertrophy and ischemia (insufficient blood supply). Similar signs on the ECG can appear with various cardiovascular diseases, so they cannot be considered specific for heart failure.
Load tests, in which the load on the subject gradually increases. For this, bicycle ergometers (bicycle version) and treadmill (treadmill) are used. With the help of such tests, it is possible to clarify the reserves of the pumping function of the myocardium.
Echocardiography (EchoCG) can not only detect the cause of heart failure, but also evaluate the contractile function of the heart ventricles.
An x-ray examination of the chest organs can detect cardiomegaly (an increase in the size of the heart cavities) and congestion in the pulmonary circulation.
Radioisotope methods for studying the heart are widely used, among which ventriculography is known, which makes it possible to assess with great accuracy the contractile function of the cardiac ventricles, as well as the volume of blood that they can hold. In all radioisotope studies, solutions with radioactive isotopes are introduced into the vascular system of the subject.
The method of positron emission tomography (PET) is very expensive, because there are antimatter particles - positrons, annihilating with electrons, and therefore not widely used. This method makes it possible to detect viable myocardium in patients with heart failure in order to more accurately carry out therapy.

Heart failure treatment

The patient should immediately contact the patient with complaints: first, to the therapist at the place of residence, and he will refer the patient to a cardiologist.

Another thing to do with heart failure is to agree to periodic hospitalization in a cardiological hospital, where it will be possible to conduct a better examination and treatment.

If this is ignored, then heart failure can have the most deplorable consequences.

limit physical activity;
perform therapeutic and preventive physical education;
follow a diet that limits the intake of fluids, salt and fatty foods;
take medicines that relieve stress from the heart and lower blood pressure;
use drugs that increase heart contractions;
use medications that restore the water-salt balance and remove excess fluid from the body;
take trace elements, vitamins and drugs that help restore normal metabolism in the myocardium;
In order to prevent death from heart failure, the signs of the primary disease that caused it must be purposefully eliminated, otherwise the secondary disease will not be defeated.

What to take for heart failure? For medication, the following groups of drugs are widely used:

diuretics that help eliminate congestion in the body (torsemide, etc.);
ACE inhibitors that improve cardiac activity, reduce blood pressure and enhance the effect of diuretics (lisinopril, ramipril, enalapril);
beta-blockers, which reduce the heart's need for oxygen, improve its performance and are aimed at treating shortness of breath;
thrombolytics, which do not allow blood clots to form in the vascular system;
cardiac glycosides that improve diuresis and help relieve edema, as well as helping the heart.

If you are interested in how to remove shortness of breath in heart failure, use oxygen inhalation - this will increase its access to tissues and reduce the tension of the respiratory muscles.

At the initial stage of the development of heart failure, not only medications and diet can be effective, but also alternative methods of treating this disease.

In case of heart failure, decoctions and tinctures of dried lily of the valley or foxglove are used to normalize the pulse and increase the contractility of the heart, and if you think about it, using baths with sea salt and herbal preparations, you can fight swelling of the legs.

In many cases, conservative methods of therapy do not bring the desired effect. How to help the heart with heart failure in this case? Then there is only one way - surgery.

Forecast

Naturally, patients are interested in questions such as: how long do they live with heart failure or how do they die from heart failure. In general, the prognosis depends on the course of the underlying disease and on how the patient went to the doctor in time. Statistics show that up to 50% of patients with heart failure die within 5 years without proper treatment.

If the disease is treatable, then the patient's chances of recovery increase - even in the most severe forms, mortality is reduced by 30%. But more often than not, medicine can only slow down the inevitable progress of the disease.

The patient initially retains his ability to work, but gradually loses it. When a severe form of heart failure sets in, the patient becomes disabled. In the end, death comes.

Have you or someone close to you been diagnosed with heart failure? How do you deal with this disease? Tell your story in the comments - help other readers!

From the modern clinical point of view, chronic heart failure (CHF) is a disease with a complex of characteristic symptoms (shortness of breath, fatigue and decreased physical activity, edema, etc.), which are associated with inadequate perfusion of organs and tissues at rest or during exercise and often with fluid retention in the body.
The root cause is a deterioration in the ability of the heart to fill or empty, due to damage to the myocardium, as well as an imbalance in the vasoconstrictor and vasodilating neurohumoral systems.

Classification

Classification of CHF by the New York Heart Association by severity.

I functional class. Ordinary physical activity is not accompanied by fatigue, palpitations, shortness of breath or angina pectoris. This functional class occurs in patients with heart disease that does not lead to limitation of physical activity.

II functional class. At rest, patients feel well, but ordinary physical activity causes fatigue, shortness of breath, palpitations, or angina pectoris. This functional class occurs in patients with heart disease that causes mild limitation of physical activity.

III functional class. This functional class occurs in patients with heart disease that causes significant limitation of physical activity. At rest, patients feel well, but a small (less than usual) load causes fatigue, shortness of breath, palpitations or angina pectoris.

IV functional class. This functional class occurs in patients with heart disease, due to which they are unable to perform any kind of physical activity without discomfort. Symptoms of heart failure or angina occur at rest; with any physical activity, these symptoms are aggravated.

Classification of CHF by the Society of Heart Failure Specialists (Russia, 2002)

Functional classes of CHF (may change with treatment)	Characteristic
	There are no restrictions on physical activity: habitual physical activity is not accompanied by rapid fatigue, the appearance of shortness of breath or palpitations. The patient tolerates increased physical activity, but it may be accompanied by shortness of breath and / or delayed recovery
	Slight limitation of physical activity: no symptoms at rest, habitual physical activity is accompanied by fatigue, shortness of breath or palpitations
	Significant limitation of physical activity: at rest, there are no symptoms, physical activity of less intensity than habitual loads is accompanied by the appearance of symptoms of the disease
	Inability to perform any physical activity without discomfort; symptoms are present at rest and worsen with minimal physical activity
CHF stages (does not change during treatment)	Characteristic
	The initial stage of the disease (damage) of the heart. Hemodynamics is not disturbed. Latent heart failure. Asymptomatic left ventricular dysfunction
	Clinically pronounced stage of the disease (lesion) of the heart. Violations of hemodynamics in one of the circles of blood circulation, expressed moderately. Adaptive remodeling of the heart and blood vessels
	Severe stage of the disease (lesion) of the heart. Pronounced changes in hemodynamics in both circles of blood circulation. Maladaptive remodeling of the heart and blood vessels
	The final stage of heart damage. Pronounced changes in hemodynamics and severe (irreversible) structural changes in target organs (heart, lungs, blood vessels, brain, kidneys). Final stage of organ remodeling

For a more complete assessment of the patient's condition, it is necessary to allocate types of heart failure:
left heart type- characterized by transient or constant hypervolemia of the pulmonary circulation, due to a decrease in contractile function or impaired relaxation of the left heart.
Right hand type- characterized by transient or constant hypervolemia of the systemic circulation, due to a violation of the systolic or diastolic function of the right heart.
combined type- characterized by the presence of combined signs of both left ventricular and right ventricular heart failure.

Etiology and pathogenesis

The etiology of chronic heart failure is diverse:

Damage to the heart muscle (myocardial failure)
1. Primary:
- myocarditis,
- idiopathic dilated cardiomyopathy.
2. Secondary:
- acute myocardial infarction,
- chronic ischemia of the heart muscle,
- postinfarction and atherosclerotic cardiosclerosis,
- hypo- or hyperthyroidism,
- damage to the heart in systemic diseases of the connective tissue,
- toxic-allergic damage to the myocardium.

Hemodynamic overload of the ventricles of the heart

1, Increasing ejection resistance (increasing afterload):

Systemic arterial hypertension (AH),
- pulmonary arterial hypertension,
- aortic stenosis
- stenosis of the pulmonary artery.
2. Increased filling of the chambers of the heart (increased preload):
- mitral valve insufficiency,
- insufficiency of the aortic valve,
- insufficiency of the valve of the pulmonary artery,
- tricuspid valve insufficiency,
- congenital malformations with discharge of blood from left to right.

Violations of the filling of the ventricles of the heart.

Stenosis of the left or right atrioventricular orifice.
Exudative or constrictive pericarditis.
Pericardial effusion (cardiac tamponade).
Diseases with increased myocardial stiffness and diastolic dysfunction:

hypertrophic cardiomyopathy,
- amyloidosis of the heart,
- fibroelastosis,
- endomyocardial fibrosis,
- severe myocardial hypertrophy, including in aortic stenosis and other diseases.

Increased metabolic demands of tissues (heart failure with high MR)
1. Hypoxic conditions:
- anemia,
- chronic cor pulmonale.
2. Boost Metabolism:
- hyperthyroidism.
3. Pregnancy.

However, in the developed countries of the world, the most important and frequent causes of chronic heart failure are coronary heart disease, arterial hypertension, and rheumatic heart disease. These diseases together account for about 70-90% of all cases of heart failure (HF).

Leading link pathogenesis Heart failure is currently considered to be the activation of the most important neurohumoral systems of the body - renin-angiotensin-aldosterone (RAAS) and sympathetic-adrenal (SAS) - against the background of a decrease in cardiac output. As a result, the formation of a biologically active substance - angiotensin II, which is a powerful vasoconstrictor, stimulates the release of aldosterone, increases the activity of the SAS (stimulates the release of norepinephrine). Norepinephrine, in turn, can activate the RAAS (stimulates the synthesis of renin). It should also be taken into account that local hormonal systems (primarily RAAS), which exist in various organs and tissues of the body, are also activated. Activation of tissue RAAS occurs in parallel with plasma (circulating), but the action of these systems is different. Plasma RAAS is activated quickly, but its effect does not last long (see figure). The activity of tissue RAAS persists for a long time. Synthesized in the myocardium, angiotensin II stimulates hypertrophy and fibrosis of muscle fibers. In addition, it activates the local synthesis of norepinephrine. Similar changes are observed in the smooth muscles of peripheral vessels and lead to its hypertrophy. Ultimately, an increase in the activity of these two body systems causes powerful vasoconstriction, sodium and water retention, hypokalemia, an increase in heart rate (HR), which leads to an increase in cardiac output, which maintains circulatory function at an optimal level. However, a long-term decrease in cardiac output causes almost constant activation of the RAAS and SAS and forms a pathological process. "Disruption" of compensatory reactions leads to the appearance of clinical signs of heart failure.

Epidemiology

According to an epidemiological study, from 0.4% to 2% of the adult population have chronic heart failure, and among people over the age of 75 years, its prevalence can reach 10%. Despite significant advances in the treatment of cardiac diseases, the prevalence of chronic heart failure is not decreasing, but continues to grow. The incidence of chronic heart failure is doubling every decade. It is expected that in the next 20-30 years the prevalence of chronic heart failure will increase by 40-60%.
The social significance of chronic heart failure is very high and is determined, first of all, by a large number of hospitalizations and the high financial costs associated with this. The problem of chronic heart failure is of great importance due to the steady increase in the number of cases of chronic heart failure, the continuing high morbidity and mortality, despite advances in treatment, and the high cost of treating decompensated patients.

Factors and risk groups

Factors contributing to the progression of chronic heart failure:

Physical overexertion;

Psycho-emotional stressful situations;

Progression of coronary heart disease;

Heart rhythm disturbances;

Pulmonary embolism;

A sharp rise in blood pressure, hypertensive crisis;

Inflammation of the lungs, acute respiratory viral infections;

Severe anemia;

Renal failure (acute and chronic);

Overloading the bloodstream with intravenous administration of large amounts of fluid;

alcohol abuse;

Taking drugs that have a cardiotoxic effect that promote fluid retention (non-steroidal anti-inflammatory drugs, estrogens, corticosteroids), which increase blood pressure;

Violation of therapeutic nutrition and irregular intake of medications recommended by a doctor for the treatment of chronic heart failure;

Weight gain (especially rapidly progressive and pronounced).

Clinical picture

Clinical Criteria for Diagnosis

Shortness of breath, edema, sleep apnea syndrome, edema, hepatomegaly, cyanosis, ascites, rhythm disturbances.

Symptoms, course

Complaints of patients with chronic heart failure are quite characteristic and, if carefully analyzed, they can confidently recognize this condition.
Dyspnea- the most frequent and early symptom of chronic heart failure. At the beginning, shortness of breath appears only during physical exertion (with FC I chronic heart failure - with unusual, excessive, with II FC - with everyday, habitual, with III FC - with less intense compared to normal daily exercise), usually at the beginning disappears at rest, then as chronic heart failure progresses, shortness of breath manifests itself at rest and increases even more with the slightest physical exertion.
Rapid fatigue of patients, severe general and muscle weakness, appearing even with slight physical exertion (with a general severe condition, patients complain of fatigue and weakness even at rest) is the second characteristic and rather early symptom of chronic heart failure.
palpitations most often caused by sinus tachycardia arising from the activation of the SAS. Heartbeat disturbs patients at first during physical and emotional stress or at the time of a rapid rise in blood pressure, and then, as chronic heart failure progresses and its FC worsens, even at rest.
Breathlessness at night- this is how patients designate attacks of pronounced shortness of breath, which occur mostly at night, indicating a significant decrease in the contractile function of the LV myocardium and severe stagnation in the lungs. Attacks of suffocation at night - cardiac asthma - are a reflection of a pronounced exacerbation of chronic heart failure. Cardiac asthma is accompanied by a feeling of lack of air, a feeling of fear of death. Cardiac asthma is observed not only in severe exacerbation of chronic heart failure, but also in acute LVHF.
Cough- due to the presence of venous congestion in the lungs, swelling of the bronchial mucosa and irritation of cough receptors. Usually, the cough is dry and most often appears after or during physical exertion, and in a serious condition of patients even in the supine position, during unrest, excitement of the patient, conversation. Sometimes the cough is accompanied by the separation of a small amount of mucous sputum.
Peripheral edema- a characteristic complaint of patients with chronic heart failure. The initial stages of heart failure are characterized by mild pastosity, then local swelling in the feet and legs. Patients note the appearance or intensification of edema mainly in the evening, by the end of the working day, by morning the edema completely disappears or significantly decreases. The more severe the stage of chronic heart failure, the more pronounced the swelling. As chronic heart failure progresses, edema becomes more common and can be localized not only in the feet, ankles, legs, but also in the thighs, scrotum, anterior abdominal wall, and in the lumbar region. The extreme degree of edematous syndrome - anasarka.
Violation of the separation of urine- a characteristic and peculiar complaint of patients, which they present at all stages of chronic heart failure. There is both a violation of the daily rhythm of urination, and a decrease in the daily amount of urine. Already in the early stages of chronic heart failure, nocturia appears. However, as chronic heart failure progresses, the blood supply to the kidneys continues to steadily decline day and night, and oliguria develops.

Early stages of heart failure may not show outward signs.
In typical cases, draws attention to itself forced position of patients. They prefer a forced sitting or semi-sitting position with legs down, or a horizontal position with the head of the head raised high, which reduces the venous return of blood to the heart and thus facilitates its work. Patients with severe chronic heart failure sometimes spend the whole night or even the whole day in a forced sitting or semi-sitting position ( orthopnea).
The hallmark of chronic heart failure is cyanosis of the skin and visible mucous membranes. Cyanosis is caused by a decrease in perfusion of peripheral tissues, slowing of blood flow in them, increased oxygen extraction by tissues and, as a result, an increase in the concentration of reduced hemoglobin. Cyanosis has characteristic features, it is most pronounced in the area of the distal extremities (palms, feet), lips, tip of the nose, auricles, subungual spaces (acrocyanosis) and is accompanied by cooling of the skin of the extremities (cold cyanosis). Acrocyanosis is often combined with trophic disorders of the skin (dryness, peeling) and nails (brittleness, dullness of nails).

Edema that appear in chronic heart failure ("cardiac" edema) have very characteristic features:

First of all, they appear in areas with the highest hydrostatic pressure in the veins (in the distal parts of the lower extremities);

Edema in the early stages of chronic heart failure is slightly expressed, appear by the end of the working day and disappear overnight;

Edemas are located symmetrically;

After pressing with a finger, a deep hole is left, which is then gradually smoothed out;

The skin in the area of edema is smooth, shiny, at first soft, with prolonged existence of edema, the skin becomes dense, and a fossa after pressure is formed with difficulty;

Massive edema in the lower extremities can be complicated by the formation of blisters that open and fluid flows out of them;

Edema in the legs is combined with acrocyanosis and cooling of the skin;

The location of edema can change under the influence of gravity - when positioned on the back, they are localized mainly in the region of the sacrum, when positioned on the side, they are located on the side on which the patient lies.

In severe chronic heart failure develops anasarka- that is, massive, widespread edema, not only completely capturing the lower limbs, the lumbosacral region, the anterior abdominal wall, but even the chest area. Anasarca is usually accompanied by the appearance of ascites and hydrothorax.

To judge the decrease or increase in edema, it is necessary not only to assess the severity of edema during a daily medical examination, but also to monitor diuresis, the amount of fluid drunk per day, to make daily weighing of patients and note the dynamics of body weight.
When examining patients with chronic heart failure, one can see swelling of the neck veins- an important clinical sign due to an increase in central venous pressure, a violation of the outflow of blood from the superior vena cava due to high pressure in the right atrium. Swollen jugular veins may pulsate (venous pulse).
Positive symptom of Plesh(hepatic-jugular test) - characteristic of severe BZSN or PZHSN, is an indicator of venous congestion, high central venous pressure. With calm breathing of the patient for 10 seconds, pressure is made with the palm of the hand on the enlarged liver, which causes an increase in central venous pressure and increased swelling of the cervical veins.
Skeletal muscle atrophy, weight loss- characteristic signs of long-term heart failure. Dystrophic changes and a decrease in muscle strength are observed in almost all muscle groups, but the most pronounced atrophy of the biceps, thenar muscles, hypothenar, interosseous muscles of the hands, temporal and masticatory muscles. There is also a pronounced decrease and even complete disappearance of subcutaneous fat - "cardiac cachexia". As a rule, it is observed in the terminal stage of chronic heart failure. The appearance of the patient becomes very characteristic: a thin face, sunken temples and cheeks (sometimes puffiness of the face), cyanotic lips, auricles, the tip of the nose, a yellowish-pale shade of the skin of the face, cachexia, especially noticeable when viewed from the upper half of the body (sharply pronounced swelling lower extremities, the anterior wall of the abdominal cavity mask the disappearance of subcutaneous fat and muscle atrophy in the lower half of the body).
Often, when examining patients, one can see hemorrhages on the skin(sometimes these are extensive hemorrhagic spots, in some cases - a petechial rash), caused by hypoprothrombinemia, increased capillary permeability, in some patients - thrombocytopenia.

On examination, attention is drawn to tachypnea - an increase in the frequency of breathing. Dyspnea in most patients, it is inspiratory, which is due to the rigidity of the lung tissue and its overflow with blood (stagnation in the lungs). Inspiratory dyspnea is most pronounced in severe, progressive chronic heart failure. In the absence of pronounced venous congestion in the lungs, shortness of breath is noted without predominant difficulty in inhaling or exhaling.

In severe chronic heart failure, usually in the terminal stage, respiratory rhythm disturbances appear in the form of periods of apnea (short-term respiratory arrest) or Cheyne-Stokes breathing. Patients with severe chronic heart failure are characterized by sleep apnea syndrome or alternating periods of apnea and tachypnea. Night sleep is restless, accompanied by nightmares, periods of apnea, frequent awakenings; in the afternoon, on the contrary, drowsiness, weakness, fatigue are observed. Sleep apnea contributes to an even greater increase in SAS activity, which exacerbates myocardial dysfunction.
Percussion of the lungs often reveals dullness of percussion sound from behind in the lower parts of the lungs, which may be due to congestion and some compaction of the lung tissue. If this symptom is detected, it is advisable to perform an x-ray of the lungs to exclude pneumonia, which often complicates the course of chronic heart failure.
In severe HF, transudate may appear in the pleural cavities. (hydrothorax). It can be one- or two-sided. A characteristic feature of hydrothorax, in contrast to exudative pleurisy, is that when the patient's position changes, the direction of the upper limit of dullness after 15-30 minutes. changes.
During auscultation of the lungs in patients with chronic LVHF in the lower sections, crepitus and moist small bubbling rales are often heard against the background of hard or weakened vesicular breathing. Crepitus is caused by chronic venous stasis of blood in the lungs, interstitial edema and impregnation of the walls of the alveoli with fluid. Along with crepitus, moist small bubbling rales can be heard in the lower sections of both lungs, they are due to increased formation of liquid bronchial secretions in conditions of venous congestion in the lungs.
Sometimes in patients due to venous congestion in the lungs, dry rales are heard due to edema and swelling of the bronchial mucosa, which leads to their narrowing.

The results of physical examination of CVS in patients with chronic heart failure largely depend on the underlying disease that caused its development. This section provides data that are common and characteristic of systolic heart failure in general, regardless of its etiology.

A characteristic sign of severe heart failure is i alternating pulse- that is, a regular alternation of pulse waves of small and normal amplitude in sinus rhythm. The alternating pulse is combined with a regular change in the volume of heart sounds and the magnitude of the shock output and is better detected in the patient's standing position against the background of holding the breath in the middle of exhalation. The mechanism of development of the alternating pulse has not been finally elucidated. Perhaps it is due to the appearance in the myocardium of areas in a state of hibernation, which leads to heterogeneity of the LV myocardium and periodic inferior contractions in response to an electrical impulse. Some patients develop a bradycardic form of CHF, in which bradycardia and a rare pulse are observed (with complete atrioventricular blockade, bradysystolic form of atrial fibrillation.
Availability arterial hypertension in patients with heart failure, to a certain extent, it can be considered a favorable sign (preservation of myocardial reserves).
Inspection and palpation of the heart area. In chronic heart failure, there is LV hypertrophy and dilatation, which leads to a shift of the cardiac (and apical) impulse to the left, sometimes simultaneously downwards; the heartbeat becomes diffuse. With significant hypertrophy and dilatation of the heart, pulsation of the entire region of the heart can be noticeable, with predominant or isolated hypertrophy of the pancreas (for example, in chronic pulmonary heart), epigastric pulsation is clearly visible, which can significantly increase at the height of inspiration. With severe chronic heart failure, hypertrophy of the left atrium also develops, which causes the appearance of a pulsation in the II intercostal space to the left of the sternum.
Percussion of the heart. In connection with the dilatation of the left ventricle, a shift in the left border of the relative dullness of the heart is detected. With pronounced chronic heart failure in diseases leading to severe dilatation of the heart, there is a significant shift in both the left and right boundaries of the relative dullness of the heart. With dilatation of the heart, the diameter of the relative dullness of the heart increases.
Auscultation of the heart. As a rule, tachycardia and very often arrhythmia are detected. Tachycardia and cardiac arrhythmias contribute to the aggravation of hemodynamic disorders and worsen the prognosis of patients with chronic heart failure. In severe myocardial damage, a pendulum heart rhythm and embryocardia can be detected. With a pendulum rhythm, diastole is shortened so much that it becomes equal to systole, and the auscultatory picture resembles a uniform swing of the pendulum. If the pendulum rhythm is accompanied by severe tachycardia, this phenomenon is called embryocardia.
Heart rhythm disorders- an extremely characteristic feature of the clinical picture of heart failure, especially in patients with III and IV functional classes. Patients with chronic heart failure are characterized by a high risk of death, especially in FC III, IV, in such patients the risk of death ranges from 10 to 50% per year, with half of deaths occurring suddenly. The main causes of sudden death in chronic heart failure are ventricular fibrillation, thromboembolism developing against the background of atrial fibrillation (primarily pulmonary embolism), and bradyarrhythmias.
About 80-90% of cardiac arrhythmias occur in permanent or paroxysmal forms of atrial fibrillation, the second place in frequency is shared by various types of ventricular extrasystole and ventricular paroxysmal tachycardia
In almost all patients with chronic heart failure, a weakening of the I and II tones is determined (they are perceived as deaf, especially the I tone), however, with the development of pulmonary hypertension, an accent of the II tone appears on the pulmonary artery.
A characteristic auscultatory manifestation of severe heart failure is the gallop rhythm. gallop rhythm- a pathological three-membered rhythm, consisting of a weakened I tone, II tone and an pathological additional tone (III or IV), appearing against the background of tachycardia and resembling a gallop of a galloping horse. Most often, the protodiastolic gallop rhythm is heard (pathological III tone occurs at the end of diastole and is due to loss of ventricular muscle tone). Listening to III pathological tone is of great diagnostic value as a sign of myocardial damage and severe LV dysfunction. In some cases, in patients with chronic heart failure, an abnormal IV tone and, accordingly, a presystolic gallop rhythm are heard. The appearance of IV tone is due to rigidity and a pronounced decrease in the ability of the left ventricle to relax in diastole and contain the volume of blood coming from the left atrium. Under these conditions, the left atrium hypertrophies and contracts intensively, which leads to the appearance of the IV tone, and in the presence of tachycardia, to the presystolic gallop rhythm. The presystolic gallop rhythm is characteristic, first of all, for diastolic dysfunction of the left ventricle. In systolic heart failure, the protodiastolic gallop rhythm is still more often heard.
With severe LV dilatation, relative mitral insufficiency develops and a systolic murmur of mitral regurgitation is heard in the region of the apex of the heart. With significant dilatation of the pancreas, a relative insufficiency of the tricuspid valve is formed, which causes the appearance of a systolic murmur of tricuspid regurgitation.

In patients with chronic heart failure, bloating (flatulence) is often observed due to a decrease in intestinal tone, pain in the epigastrium (it may be due to chronic gastritis, gastric or duodenal ulcer), in the right hypochondrium (due to an increase in the liver). Liver in patients chronic heart failure with the development of stagnation in the venous system of the systemic circulation is enlarged, painful on palpation, its surface is smooth, the edge is rounded. As chronic heart failure progresses, cardiac cirrhosis may develop. For liver cirrhosis its significant density and sharp edge are characteristic.

In severe HF, there is ascites Its characteristic features are an increase in the size of the abdomen, a pronounced dullness of percussion sound in sloping areas of the abdomen, a positive symptom of fluctuation. To detect ascites, a technique based on the movement of ascitic fluid with a change in body position is also used. The appearance of ascites in a patient with chronic heart failure indicates the development of severe suprahepatic portal hypertension.

Clinical manifestations of chronic left ventricular failure

In chronic LVHF, the symptoms of stagnation of blood in the pulmonary circulation are predominant, and signs of LV myocardial damage (hypertrophy, dilatation, etc.) are pronounced, depending on the disease that caused the development of heart failure.
The main clinical symptoms of HFSN:

Shortness of breath (often inspiratory);

Dry cough that occurs mainly in a horizontal position, as well as after physical and emotional stress;

Choking attacks (often at night), i.e. cardiac asthma

Orthopnea position;

Crepitus and fine bubbling rales in the lower parts of both lungs;

LV dilatation;

Accent II tone on the pulmonary artery;

The appearance of a pathological W tone and a proto-diastolic gallop rhythm (left ventricular, better heard in the region of the apex of the heart);

Alternating pulse;
- absence of peripheral edema, congestive hepatomegaly, ascites.

Clinical manifestations of chronic right ventricular failure

In chronic PZhSN, the clinical picture is dominated by the symptoms of blood stagnation in the systemic circulation:

Severe acrocyanosis;

swollen neck veins;

peripheral edema;

Hydrothorax;

congestive hepatomegaly;

Positive Plesh test;

Dilatation of the pancreas;

Epigastric pulsation, synchronous with the activity of the heart;

Systolic noise of relative insufficiency of the tricuspid valve;

Right ventricular protodiastolic gallop rhythm (better auscultated above the xiphoid process and in the 5th intercostal space at the left edge of the sternum).

Diagnostics

To diagnose heart failure, the following tests are performed:

Electrocardiography

One way or another, myocardial dysfunction will always be reflected on the ECG: a normal ECG in chronic heart failure is an exception to the rule .. ECG changes are largely determined by the underlying disease, but there are a number of signs that allow, to a certain extent, to objectify the diagnosis of chronic heart failure:
- low voltage of the QRS complex in limb leads (less than 0.8 mV);
- high voltage of the QRS complex in the precordial leads (SI+RV5 >35 mm, indicating LV myocardial hypertrophy);
- a weak increase in the amplitude of the R wave in leads V1-V4.

To objectify patients with chronic heart failure, one should also take into account such ECG changes as signs of cicatricial myocardial damage and blockade of the left bundle branch block as predictors of low myocardial contractility in coronary heart disease.
ECG also reveals various cardiac arrhythmias.
Consideration should be given to the effect on the ECG of electrolyte imbalance, which may occur, especially with frequent and prolonged use of diuretics.

Chest X-ray

The main radiographic features confirming the presence of chronic heart failure are cardiomegaly and venous pulmonary congestion.
Cardiomegaly is due to myocardial hypertrophy and dilatation of the heart cavities. Cardiomegaly can be judged on the basis of an increase in the cardiothoracic index of more than 50%. or if there is an increase in the diameter of the heart more than 15.5 cm in men and more than 14.5 cm in women. However, the size of the heart may be normal or slightly enlarged even with a pronounced clinical picture in patients with chronic heart failure (with diastolic heart failure). Normal heart size for systolic chronic heart failure is not typical.
Venous stasis - venous plethora of the lungs - a characteristic sign of chronic heart failure. With a decrease in the contractility of the LV myocardium, the filling pressure of the LV increases and then the average pressure in the left atrium and in the pulmonary veins, as a result of which blood stasis develops in the venous bed of the small circle. Subsequently, with further progression of heart failure, pulmonary arterial hypertension, caused by spasm and morphological changes in arterioles, joins venous congestion. The initial stage of venous congestion in the lungs is characterized by perivascular edema, dilatation of the pulmonary veins, especially in the upper lobes, redistribution of blood flow to the upper sections of the lungs.
There are signs of pulmonary hypertension (dilation of the trunk and large branches of the pulmonary artery; depletion of the pulmonary pattern on the periphery of the lung fields and an increase in their transparency due to a pronounced narrowing of the peripheral branches of the pulmonary artery; an increase in the right ventricle; increased pulsation of the pulmonary artery trunk).
With the development of interstitial pulmonary edema, the “septal” Kerley lines are clearly visible on radiographs - long and thin strips from 0.5 to 3.0 cm long, located horizontally in the lower lateral sections. Kerley's lines are due to the accumulation of fluid in the interlobular septa and the growth of lymphatic vessels. Subsequently, with a continuing progressive increase in pressure in the left atrium, alveolar pulmonary edema develops, while there is a significant expansion of the roots of the lungs, their fuzziness, they take the form of a “butterfly”, the appearance of rounded foci scattered throughout the lung tissue is possible (symptom of “snow storm”).
Often found hydrothorax, often on the right.
Cardiac x-ray helps in identifying the underlying disease that led to the development of chronic heart failure (eg, postinfarction LV aneurysm, pericardial effusion).

echocardiography

To obtain the most complete information about the state of the heart, it is necessary to conduct a comprehensive ultrasound examination using three main modes of echocardiography: M-mode (one-dimensional echocardiography), B-mode (two-dimensional echocardiography) and Doppler mode. Echocardiography allows you to clarify the causes of myocardial damage, the nature of dysfunction (systolic, diastolic, mixed), the state of the valvular apparatus, changes in the endocardium and pericardium, the pathology of large vessels, assess the size of the heart cavities, the thickness of the walls of the ventricles, determine the pressure in the heart cavities and main vessels.
To assess the systolic function of the LV myocardium, the following echocardiographic indicators are used: ejection fraction (EF, according to Simpson 45% or more, according to Teicholz 55% or more), cardiac index (CI, 2.5-4.5 l / min / m2), stroke volume (SV, 70-90 ml), minute volume (MO, 4.5-5.5 l), end-systolic and end-diastolic dimensions (ECD, 38-56 mm; CSR, 26-40 mm) and LV volumes (ESO, 50-60 ml; EDV, 110-145 ml), the size of the left atrium (LA, 20-38 mm), the degree of shortening of the anteroposterior size (% ΔZ, 28-43%), etc. The most important hemodynamic parameters , reflecting the systolic function of the myocardium are EF and cardiac output.
CHF is characterized by a decrease in EF, CI, UO, MO, %ΔZ and an increase in EDD (EDV) and ESR (ESD).
The most accurate way to assess ejection fraction is quantitative two-dimensional echocardiography using the Simpson method (disc method), because using this method, the accuracy of EDV measurements does not depend on the shape of the left ventricle. An ejection fraction of less than 45% indicates LV systolic dysfunction.
There are 3 degrees of LV systolic dysfunction:

light: ejection fraction 35-45%;

moderate severity: ejection fraction 25-35%;

heavy; ejection fraction< 25%.

Important indicators of LV systolic function are EDD (EDV) and ESR (EDV), their increase indicates the development of left ventricular dilatation.
The systolic function of the right ventricular myocardium can be judged on the basis of determining its CDR (15-30 mm), with PZhSN and BZSN there is dilatation of the right ventricle and its CDR increases.
Echocardiography is the main method for diagnosing LV diastolic dysfunction. The diastolic form of chronic heart failure is characterized by 2 main types: type I delayed relaxation (characteristic of the initial stages of LV diastolic dysfunction) and type II restrictive diastolic dysfunction (develops with severe chronic heart failure, restrictive cardiomyopathy). Left ventricular systolic function assessed by EF in diastolic heart failure remains normal. Echocardiography reveals myocardial hypertrophy (the thickness of the interventricular septum - TMZhP- and the posterior wall of the left ventricle - TZLZh - more than 1.2 cm) and hypertrophy and dilatation of the LA.
Currently, tissue Doppler echocardiography is used to detect local myocardial perfusion disorders in chronic heart failure.

Transesophageal echocardiography
- should not be considered as a routine diagnostic method; it is usually resorted to only if an insufficiently clear image is obtained with a standard Echo-KG in diagnostically unclear cases, to exclude thrombosis of the LA appendage at a high risk of thromboembolism.

Stress echocardiography
- (load or pharmacological) is a highly informative technique for clarifying the ischemic or non-ischemic etiology of heart failure, as well as for assessing the effectiveness of therapeutic measures (revascularization, medical restoration of the contractile reserve). However, despite the high sensitivity and specificity of this technique for detecting viable myocardium in patients with coronary artery disease and systolic heart failure, it cannot be recommended as a routine diagnostic method.

Radioisotope methods
Radioisotope ventriculography allows a fairly accurate measurement of LV EF, final LV volumes and is considered a good method for assessing RV function. Radioisotope scintigraphy of the myocardium with technetium allows the assessment of LV function. Radioisotope scintigraphy of the myocardium with thallium makes it possible to assess the viability of the myocardium, to identify foci of ischemia and fibrosis, and, in combination with physical activity, to state the reversibility of ischemia and the effectiveness of treatment. The information content of radioisotope research methods exceeds that of Echo-KG.

Magnetic resonance imaging (MRI)
MRI is the most accurate method with maximum reproducibility of calculations for calculating the volumes of the heart, the thickness of its walls and the mass of the left ventricle, surpassing Echo-KG and radioisotope research methods in this parameter. In addition, the method allows to detect thickening of the pericardium, to assess the extent of myocardial necrosis, the state of its blood supply and features of functioning. However, given the high cost and low availability, diagnostic MRI is justified only in cases of insufficient information content of other imaging techniques.

Lung Function Assessment
This test is useful to rule out pulmonary dyspnoea. It has been established that forced vital capacity and forced expiratory volume in 1 second correlate with peak oxygen consumption in patients with chronic heart failure. In chronic heart failure, expiratory flow rate in 1 second and forced vital capacity may decrease, but not to the same extent as in obstructive pulmonary diseases. There is also a decrease in lung capacity. After successful treatment of chronic heart failure, these indicators may improve, probably due to an improvement in the condition of the respiratory muscles, a decrease in dyspnea and general weakness.

Load tests
Carrying out stress tests in patients with chronic heart failure is justified not to clarify the diagnosis, but to assess the functional status of the patient and the effectiveness of treatment, as well as to determine the degree of risk. However, a normal exercise test result in an untreated patient almost completely rules out the diagnosis of chronic heart failure.
It is recommended to conduct bicycle ergometry, treadmill test, especially under the control of gas exchange indicators (spiroveloergometry). Oxygen consumption at the height of maximum load most accurately characterizes the FC of heart failure.
Carrying out tests with physical activity is possible only with a stable condition of the patient for at least 2 weeks (no complaints at rest, no signs of stagnation in the lungs, etc.), no need to use inotropic agents and diuretics intravenously, and a stable level of creatinine in the blood.
For daily practice, the 6-minute walk test is recommended as a standard routine test.

Invasive procedures
In general, there is no special need for invasive studies in patients with an already established diagnosis of heart failure, but in some cases they are indicated to clarify the genesis of heart failure or the patient's prognosis.
Of the existing invasive procedures, coronary angiography (CAG) with ventriculography (VG), hemodynamic monitoring (using a Swan-Gans catheter), and endomyocardial biopsy are commonly used. None of these methods should be used routinely.
CAG and VG allow in difficult cases to clarify the genesis of heart failure. Ivasive monitoring of hemodynamics using a Swan-Gans catheter is more often used in acute heart failure (cardiogenic shock, acute pulmonary edema).
An endomyocardial biopsy is indicated in the case of an unclear genesis of heart failure - to exclude inflammatory, infiltrative or toxic damage to the myocardium.

Daily ECG monitoring
Holter monitoring, ECG has a diagnostic meaning only in the presence of symptoms, probably associated with the presence of arrhythmias (subjective sensations of interruptions, accompanied by dizziness, fainting, a history of syncopation, etc.).
Holter monitoring allows you to judge the nature, frequency of occurrence and duration of atrial and ventricular arrhythmias, which can cause symptoms of heart failure or aggravate its course.

Heart rate variability (HRV)
It is not a mandatory technique for the diagnosis of chronic heart failure, since the clinical significance of this method has not yet been fully determined. But. the definition of HRV makes it possible to draw a conclusion about the presence of dysfunction of the autonomic nervous system. It has been established that with low HRV, the risk of sudden cardiac death increases.

Laboratory diagnostics

Data from laboratory studies in chronic heart failure do not reveal any pathognomonic changes and, of course, are primarily due to the underlying disease that led to heart failure. However, heart failure can interfere with laboratory results to some extent.

General blood analysis. Perhaps the development of iron deficiency anemia with advanced heart failure due to impaired absorption of iron in the intestine or insufficient intake of iron from food (patients often have reduced appetite, they eat little, including eating insufficient foods containing iron). Initially existing severe anemia (as an independent disease) can lead to the development of chronic heart failure with high cardiac output. With cachexia, an increase in ESR may be noted. With decompensated chronic pulmonary heart, an increase in the level of hemoglobin, hematocrit, and erythrocytes is possible. Due to the low level of fibrinogen in the blood in severe heart failure, ESR decreases.

General urine analysis. Perhaps the appearance of proteinuria, cylindruria as markers of violations of the functional state of the kidneys in chronic heart failure ("congestive kidney").

Blood chemistry. It is possible to reduce the content of total protein, albumin (due to impaired liver function, due to the development of malabsorption syndrome; hypoproteinemia is pronounced with cachexia); increased levels of bilirubin, alanine and aspartic aminotransferases, thymol test, γ-glutamyl transpeptidase, LDH, decreased prothrombin levels (these changes are due to impaired liver function); an increase in cholesterol levels (with a significant violation of liver function - hypocholesterolemia), triglycerides, low and very low density lipoproteins, a decrease in high density lipoproteins (in the elderly and in coronary heart disease); in severe heart failure, an increase in the blood content of the cardiospecific MB fraction of creatine phosphokinase is possible; decrease in the content of potassium, sodium, chlorides, magnesium (especially with massive diuretic therapy); increased levels of creatinine and urea (a sign of impaired renal function, with severe liver damage, a decrease in urea levels is possible).

Determination of the level of natriuretic peptides

At present, a close relationship between the severity of cardiac dysfunction (primarily LV) and the content of NUP and plasma has been fully proven, which allows us to recommend the determination of the concentration of these peptides as a "laboratory test" for chronic heart failure.

The most widely used in studies with myocardial dysfunction is the definition of cerebral NUP.

The definition of NLP in general and brain NLP in particular allows:

- conduct effective screening among previously untreated patients suspected of having left ventricular dysfunction;
- to carry out differential diagnosis of complex forms of chronic heart failure (diastolic, asymptomatic);
- Accurately assess the severity of LV dysfunction;
- determine the indications for the treatment of chronic heart failure and evaluate its effectiveness;
- evaluate the long-term prognosis of chronic heart failure.

Determination of the activity of other neurohormonal systems for diagnostic and prognostic purposes in heart failure is not shown.

Differential Diagnosis

Diseases that can simulate heart failure or exacerbate it

Diseases
Bronchopulmonary diseases	Chest X-ray Maximum expiratory flow (FEV), forced expiratory volume (FEV1), or lung function tests Complete blood count (to detect secondary erythrocytosis)
kidney disease	Analysis of urine Biochemical blood test (creatinine, urea, potassium, sodium)
Liver disease	Biochemical blood test (albumin, bilirubin, alanine and aspartic aminotransferases, alkaline phosphatase, g-glutamine transpeptidase)
	General blood analysis
Thyroid disease	Thyroxine (T4), triiodothyronine (T3), thyroid-stimulating hormone (TSH)

Complications

With a long course of CHF, complications may develop, which are essentially a manifestation of damage to organs and systems in conditions of chronic venous stasis, insufficient blood supply and hypoxia. These complications include:

Electrolyte metabolism and acid-base disorders;

Thrombosis and embolism;

Syndrome of disseminated intravascular coagulation;

Rhythm and conduction disorders;

Cardiac cirrhosis of the liver with the possible development of liver failure.

Treatment abroad

Heart failure (HF) is a condition accompanied by tissue hypoxia due to insufficient blood supply. A decrease in the volume of pumped blood to a critical level can lead to cardiac arrest and.

Causes

Heart failure is most often associated with the occurrence of other diseases in humans. The most common cause of heart failure is coronary artery disease, which is a disorder that narrows the arteries that supply blood and oxygen to the heart. Other conditions that may increase your risk of developing heart failure include:

cardiomyopathy, which is a disorder of the heart muscle that causes the heart to weaken;
congenital heart defect;
heart and vascular disease;
certain types of arrhythmias or irregular heart rhythms;
high blood pressure;
emphysema, ;
an overactive or inactive thyroid;
severe forms are red blood cell deficiency;
some cancer treatments, such as chemotherapy;
drug or alcohol abuse.

Symptoms

The first signs of heart failure syndrome appear in the presence of congestive processes in the systemic or pulmonary circulation, as well as with reduced myocardial contractility.

The occurrence of these pathological conditions is possible as a result of organic damage to certain parts of the heart and blood vessels (for example, with progressive atherosclerosis of the coronary arteries and other heart diseases).

You should pay attention to the following symptoms:

constant lethargy, apathy;
sleep disturbance in a supine position;
blue nasolabial triangle;
dyspnea;
wheezing when inhaling and exhaling;
sudden weight gain;
loss of appetite;
persistent cough;
irregular pulse;
shaky breathing.

If one or more of the above symptoms are detected, it is urgent to show the doctor so that he confirms or refutes the presence of abnormalities in the work of the cardiovascular system. With prolonged untreated cough and wheezing, there is a high risk of rupture of the walls of the left ventricle, which can lead to pulmonary edema and cardiogenic shock.

Features of the course of pathology in women, men, children and the elderly

As a rule, obvious pathological symptoms in women appear only in adulthood, mainly in menopause. This is due to a sharp decrease in the level of hormones, which, being in perfect balance up to a certain point, supported general immunity and the work of cardiovascular activity as well.

According to statistics, heart failure in women is detected closer to the age of 60 and in rare cases can be observed during the period of bearing a child, accompanied by high blood pressure, edema and thrombus formation.

Due to various factors, men suffer from cardiovascular diseases more often than women, so the average life expectancy for the stronger sex is lower. This is due to the fact that young people are more susceptible to excessive physical exertion (for example, when serving in the army), which contributes to premature wear and tear of the heart muscle and the appearance of scars on it.

An important role is also played by addiction to alcoholic beverages, smoking and unhealthy foods - all that women try to avoid, fearing for their health and, as a result, the health of their unborn child. Wrong lifestyle negatively affects the state of blood vessels and provokes the development of stenosis. Heart failure in men first manifests itself at the age of 40-45 and, if left untreated, can progress rapidly, especially in the presence of other chronic diseases.

Heart failure in children is less common than in adults and usually refers to congenital heart defects. It is difficult to diagnose pathology at an early stage of development, since the child cannot explain what exactly worries him. Most often, HF is expressed in a dry cough, which indicates stagnation of blood in the lungs, but is taken by parents for a respiratory disease.

Heart failure in the elderly is much more common than in young people, since the pathology develops for a long time almost asymptomatically. Men and women are equally susceptible to it, but the clinical picture may have some differences.

The main types and stages of heart failure

With various circulatory disorders in the body, compensatory mechanisms are activated, the main purpose of which is to reduce the intensity of the load on the heart muscle by redistributing it to other parts of the organ. This is accompanied by capillary expansion, increased tissue perfusion and, accordingly, a change. If this phenomenon is permanent, then chronic heart failure (CHF) develops.

For a long time, a person may not notice a significant deterioration in well-being, but, working at the peak of his capabilities, the heart wears out: the volume of pumped blood decreases, and its stagnation in the ventricles is observed. In medicine, there are three stages of CHF:

Initial. Pathology is asymptomatic, characteristic signs appear only during physical exertion in the form of increased heart rate, shortness of breath and fatigue.
Expressed. This stage of pathology is divided into two categories. The first is accompanied by visible signs of hemodynamic disturbances in the form of a blue nasolabial triangle and during normal physical activity. The second category includes the same manifestations, but only at rest.
Dystrophic. In this case, irreversible pathological changes in the structure of the tissues of internal organs occur as a result of their prolonged hypoxia due to circulatory failure. Natural biological processes slow down, clinical death can occur at any moment of wakefulness or sleep.

With a sharp decrease in compensatory mechanisms (decompensation) as a result of myocardial dystrophy and hyperextension of the walls of the arteries, acute heart failure (AHF) develops, which can develop according to the left or right type. In this case, the pathology progresses rapidly and may result in cardiac asthma, pulmonary edema, or cardiogenic shock, followed by death.

How is heart failure diagnosed?

An echocardiogram is the most effective way to diagnose heart failure. The method uses sound waves to create detailed pictures of your heart that help your doctor assess damage to your heart and determine the underlying causes of your condition.

Heart failure treatment

Treatment of heart failure begins with a cardiological examination, which includes a set of the following diagnostic procedures:

echocardiography (this is the main method, as mentioned above);
ECG (electrocardiogram);
bicycle ergometry;
ventriculography (x-ray examination of the heart using a contrast agent);
radiography and MRI (magnetic resonance imaging).

These diagnostic methods allow you to identify various abnormalities in the work of the heart muscle, assess the condition of the vessels, see the damaged areas of the myocardium, and more. When HF is detected, traditional medicine offers pharmacotherapy, that is, the prevention and treatment of heart failure with drugs from the following groups:

anticoagulants;
diuretics;
cardiac glycosides;
B-blockers;
nitrates;
ACE inhibitors;
vasodilators;
potassium preparations and.

If heart failure is caused by a serious disease such as a heart aneurysm or atherosclerosis obliterans, urgent surgery is performed to eliminate the underlying cause of the pathology.

Surgery

Some people with heart failure will need surgery, such as a coronary bypass. During this operation, your surgeon will take the healthy part of the artery and attach it to the blocked artery. This allows blood to bypass the blocked, damaged artery and flow through the new one.

Folk methods of treatment

At an early stage in the development of heart failure, it is possible to reverse pathological processes with the regular use of natural remedies prepared according to traditional medicine recipes.

The dosage and composition of herbal teas, decoctions and infusions must be agreed with the cardiologist without fail, since some home-made medicines may be identical to pharmacy medicines in terms of pharmacological properties.

The basis of the treatment and prevention of heart failure with folk remedies is intensive restorative therapy, which gives positive results with mild signs of pathology.

If a person suffers from acute heart failure, the alternative method of treatment is used only together with the main one - medication, since there is a high risk of severe complications and a rapid deterioration in well-being. Here are some popular recipes for homemade decoctions and infusions used to prevent and treat heart failure:

Viburnum infusion. Mash a tablespoon of fresh or thawed viburnum berries at the bottom of a glass, adding 30 gr. lime honey. The mixture is poured with hot boiled water and infused for one hour.
A decoction of birch leaves and spruce needles. Grind raw materials, put in a saucepan with water and cook over low heat for thirty minutes. The resulting decoction should be consumed up to five times a day for 1/4 cup.
Infusion of elecampane on oats. Pour the dried and chopped elecampane roots with a pre-prepared decoction of oats, then put the mixture on the fire and bring to a boil, but do not boil. The resulting product must be insisted for two hours, then strain and add 2-3 tablespoons of honey. The recommended course of treatment is two months, the dosage is determined by the doctor.

Prevention of heart failure

Depending on whether a person suffers from the first manifestations of pathology or just wants to prevent their occurrence, the prevention of heart failure is divided into primary and secondary.

The main goal of primary prevention is the timely detection and treatment of current cardiovascular diseases, which are the trigger for the development of CHF (chronic heart failure). To do this, you must follow the basic principles of a healthy lifestyle and nutrition, which include:

systematic moderate physical activity;
control of BMI (body mass index);
exclusion from the diet of excessively sweet and fatty foods;
refusal to use carbonated and alcoholic beverages;
compliance with the rest regime;
smoking cessation.

Each person should try to avoid stressful situations, because with nervous excitement, cortisol is produced - a stress hormone, which in large quantities leads to cardiac failure and even acute. provokes a strong spasm of the walls of the arteries, which can lead to chronic vascular insufficiency.

If a person already suffers from one or several diseases at once, secondary prevention of heart failure is carried out, which includes a number of therapeutic measures aimed at eliminating the main causes of the pathology and suppressing individual symptoms.

Forecast

The life prognosis of the patient is variable, since much depends on how soon the treatment was started and what is the cause of the developed heart failure. With a pronounced form of pathology (second or third degree), the survival threshold of patients is about 5-7 years.

With the timely elimination of the root cause of HF and maintaining a healthy lifestyle, it is possible to improve the general condition of the cardiovascular system, which will avoid serious consequences, improve the quality and increase life expectancy.

Timely prevention of heart failure can prevent potentially life-threatening conditions such as pulmonary edema or cardiac asthma, which are often fatal. A lot of time passes from the onset of the development of pathology to the manifestation of the first symptoms, therefore, heart failure syndrome is often diagnosed at a late stage, when it is almost impossible to avoid complications.

Anatomy of the heart

A 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 lining 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 slide inside the chambers, otherwise parietal blood clots 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:

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

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

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.

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

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.

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 is 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 oncological diseases.

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 - the relaxation phase 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 muscle 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:

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.
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 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- disrupts the outflow of blood from the left ventricle and the activity of the heart as a whole.

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.

Group	A drug	Mechanism of therapeutic action	How is it prescribed
Pressor (sympathomimetic) amines	dopamine	Increases cardiac output, narrows the lumen of large veins, stimulating the promotion of venous blood.	Intravenous drip. The dose depends on the condition of the patient 2-10 mcg / kg.
Phosphodiesterase III inhibitors	Milrinone	Increases the tone of the heart, Reduces spasm of the pulmonary vessels.	Enter intravenously drip. First, a "loading dose" of 50 mcg/kg. In the future, 0.375-0.75 mcg / kg per minute.
Non-glycoside structure cardiotonic drugs	Levosimendan (Simdax)	Increases the sensitivity of contractile proteins (myofibrils) to calcium. Increases the strength of contractions of the ventricles, does not affect their relaxation.	Initial dose 6–12 mcg/kg. In the future, continuous intravenous administration at a rate of 0.1 μg / kg / min.
Vasodilators Nitrates	Sodium nitroprusside	Expand veins and arterioles, lowering blood pressure. Improves cardiac output. Often prescribed together with diuretics (diuretics) to reduce pulmonary edema.	Intravenous drip at 0.1-5 mcg / kg per minute.
Vasodilators Nitrates	Nitroglycerine		1 tablet under the tongue every 10 minutes or 20-200 mcg/min intravenously.
Diuretics	Furosemide	Helps to remove excess water in the urine. Reduce vascular resistance, reduce the load on the heart, relieve edema.	Loading dose 1 mg/kg. In the future, the dose is reduced.
Diuretics	Torasemide		Take wither in tablets of 5-20 mg.
Narcotic analgesics	Morphine	Eliminates pain, severe shortness of breath, has a calming effect. Reduces the heart rate during tachycardia.	Enter 3 mg intravenously.

Procedures that help stop an attack of acute heart failure:

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.
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.
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.
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.
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 heart pain and arrhythmia, reduces 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.
Beta blockers	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, sweet and puff pastry products, pancakes
fatty meats: pork, lamb, goose, duck, liver, kidneys, sausages
fatty fish, smoked, salted and canned fish, canned food
fatty and salty cheeses
sorrel, radish, spinach, salted, pickled and pickled vegetables.
hot spices: 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:

Lying on your back. The arms are extended along the body. Raise your arms on inhalation, lower them on exhalation.
Lying on your back. Bicycle exercise. Lying on your back, perform an imitation of cycling.
Move to a sitting position from a lying position.
Sitting on a chair. The arms are bent at the elbow joints, hands to the shoulders. Elbow rotation 5-6 times in each direction.
Sitting on a chair. On the inhale - hands up, torso tilt to the knees. As you exhale, return to the starting position.
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.
Walking in place. Gradually switch to walking on toes.

All exercises are repeated 4-6 times. If dizziness, shortness of breath and pain behind the sternum occur during physiotherapy exercises, then it is necessary to stop classes. If, when doing exercises, the pulse accelerates by 25-30 beats, and after 2 minutes returns to normal, then the exercises have a positive effect. 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

Acute heart failure

Chronic heart failure

Disorder of gas exchange

Edema

Congestive changes in the internal organs

Heart failure treatment

Prevention

What is "heart failure"?

Causes of heart failure

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According to the course of the disease

According to the degree of compensation

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Diagnostics

Heart failure treatment

Forecast

Classification

Etiology and pathogenesis

Epidemiology

Factors and risk groups

Clinical picture

Clinical Criteria for Diagnosis

Symptoms, course

Diagnostics

Laboratory diagnostics

Differential Diagnosis

Complications

Causes

Symptoms

Features of the course of pathology in women, men, children and the elderly

The main types and stages of heart failure

How is heart failure diagnosed?

Heart failure treatment

Surgery

Folk methods of treatment

Prevention of heart failure

Forecast

Related videos

Anatomy of the heart

Types of heart failure

Causes of heart failure

Causes of chronic heart failure

Causes of acute heart failure

Diagnosis of heart failure

Is hospitalization necessary?

Stages of care for a patient with acute heart failure

Treatment of chronic heart failure

Is hospitalization necessary for the treatment of chronic heart failure?

Treatment of pathology with medicines

Nutrition and daily routine in heart failure.

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