Chronic heart failure (CHF) is a disease characterized by the inability of the heart to pump a certain volume of blood sufficient to provide the body with oxygen. CHF can be caused by many diseases of the cardiovascular system, the most common of which include coronary heart disease, hypertension, endocarditis and rheumatoid heart defects. Weakening of the heart muscle leads to the impossibility of normal pumping of blood, as a result of which the amount of blood released into the vessels gradually decreases.
The development of heart failure occurs gradually; in the early stages, the disease can manifest itself only during physical exertion, then it begins to be felt at rest.
The appearance of characteristic symptoms at rest indicates that the disease has entered a severe stage. The progression of chronic heart failure threatens a significant deterioration of the patient’s condition, a decrease in his working capacity and even disability. The development of chronic liver and kidney failure, blood clots, and strokes may occur.
Conducting timely comprehensive diagnostics and competent treatment ensures a slowdown in the development of CHF and the prevention of dangerous complications of this serious disease.
In order to stabilize the condition, a patient diagnosed with “acute and chronic heart failure” must adhere to the correct lifestyle: normalize his weight, follow a low-salt diet, limit physical and emotional stress.
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Chronic heart failure: risk group
The following risk factors, or at least one of them, can provoke the development of CHF. When several factors are combined, the likelihood of chronic heart failure increases significantly.
The risk group for the development of CHF includes patients suffering from the following diseases:
- cardiac ischemia;
- history of myocardial infarction;
- high blood pressure;
- heart rhythm disturbance;
- diabetes;
- Congenital heart defect;
- frequent viral diseases;
- chronic renal failure;
- alcohol addiction.
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Chronic heart failure: treatment, drugs
CHF is a disease in which patients need to constantly take medications. For chronic heart failure, drugs are used that help slow the progression of the process and improve the patient's condition. In some patients with CHF, treatment requires surgical intervention.
Medicines for chronic deficiency are primary, auxiliary and additional.
The main drugs include ACE inhibitors (angiotensin-converting enzyme), angiotensin receptor antagonists, beta-blockers, aldosterone receptor antagonists, diuretics, ethyl esters of polyunsaturated fatty acids, cardiac glycosides. Cardiac glycoside for the treatment of chronic heart failure is used most often in patients with atrial fibrillation.
Auxiliary drugs for chronic heart failure are used in special clinical situations with complications of CHF. These include nitrates, calcium antagonists, antiarrhythmic drugs, antiplatelet agents, and non-glycoside inotropic stimulants.
Additional medications for chronic insufficiency: statins, indirect anticoagulants.
For patients diagnosed with chronic heart failure, clinical recommendations from doctors relate not only to taking medications, but also to revising their lifestyle in general:
- it is necessary to stop smoking and drinking alcohol;
- bring your weight back to normal;
- follow a salt-free diet. Nutrition for CHF should be balanced, contain a sufficient amount of proteins and vitamins;
- walk more in the fresh air.
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Diagnosis of chronic heart failure
When diagnosing CHF, doctors at the Yusupov Hospital take into account medical history, characteristic symptoms and the results of a physical examination, instrumental and laboratory tests.
Laboratory tests include the following tests:
- General blood test - as a rule, there are no changes. Sometimes the presence of moderate anemia is determined;
- ESR (erythrocyte sedimentation rate) - an increase in ESR is observed with rheumatic heart disease or infective endocarditis, which resulted in the development of heart failure;
- general urinalysis - performed to diagnose kidney complications and exclude the renal origin of edema. The most common possible manifestation of CHF is an increase in protein levels in the urine;
- study of total protein and protein fractions - in CHF their indicators decrease, which is associated with redistribution into the edematous fluid;
- blood glucose level – important in order to exclude such a risk factor for CHF as diabetes mellitus;
- indicators of cholesterol, low and high density lipoproteins - a clear relationship has been proven between high cholesterol levels and atherosclerosis, hypertension, coronary heart disease; Elevated levels of lipoproteins and cholesterol in CHF may indicate a more severe course of the disease;
- the level of sodium and potassium in the blood - edema that occurs in patients with CHF is the cause of a significant decrease in the level of these microelements. Monitoring blood composition is especially important when taking diuretic drugs, as well as in cases where the patient has chronic heart and kidney failure;
- study of the level of brain natriuretic propeptide, a protein whose formation in the heart muscle is associated with its excessive stretching and overload. Its circulation in the blood is quite long, so laboratory testing can easily determine its level. With increasing cardiac overload, the secretion of propeptide is activated. Therefore, its indicators are important for determining the severity of CHF.
Additionally, instrumental studies are prescribed, the scope of which is determined by the attending physician:
- plain chest x-ray - to assess the position and size of the heart, exclude or confirm concomitant changes in the lungs (if the patient is suspected of chronic pulmonary heart failure);
- electrocardiography (ECG) - to determine heart rhythm disturbances and the consequences of a previous myocardial infarction;
- echocardiography - to differentiate systolic and diastolic heart failure, assess the activity of all parts of the heart, its size, the thickness of the heart muscle and its valves;
- stress tests – allow you to study the reaction of the heart muscle to increased physical activity;
- coronary angiocardiography - the essence of this x-ray study is the introduction of a special contrast agent through a catheter directly into the vessels of the heart, thanks to which it is possible to diagnose coronary heart disease;
- transesophageal echocardiography - ultrasound examination of the heart with placement of a sensor in the esophagus. Can be used if conventional cardiography does not provide a sufficiently clear image, and also helps to identify blood clots in the right atrium in patients with atrial fibrillation;
- stress echocardiography - ultrasound examination of the heart at rest and after exercise or after the use of medications with an effect similar to exercise. The study allows you to assess the reserve capabilities of the heart and identify areas of viable heart muscle;
- spiral computed tomography - during the procedure, X-rays are taken at different depths, which, in combination with MRI, provides an accurate image of the heart;
- endomyocardial biopsy - during the diagnostic procedure, tissues of the muscle and inner lining of the heart are taken for histological examination, which makes it possible to clarify the cause of the disease in complex cases.
In addition, patients at the Yusupov Hospital are given consultations with therapists and cardiac surgeons.
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Chronic heart failure: pathogenesis
The main causes of chronic heart failure: damage to the heart muscle or impairment of its ability to pump the required amount of blood through the vessels, which can occur in patients suffering from the following pathologies:
- arterial hypertension – high blood pressure;
- IHD (coronary heart disease);
- heart defects.
The development of CHF in women is most often caused by arterial hypertension. In men, chronic heart failure usually occurs as a consequence of coronary heart disease.
In addition, chronic heart failure can develop due to the presence of the following diseases and dependencies:
- diabetes mellitus;
- arrhythmias (heart rhythm disturbances);
- cardiomyopathies;
- myocarditis;
- alcoholism and smoking.
Chronic heart failure: recommendations for prevention
Prevention of chronic heart failure is based on the basic principles that every person should adhere to, especially after 40-45 years:
- engage in physical activity regularly;
- control blood pressure;
- lead a lifestyle that prevents the development of coronary artery disease;
- normalize metabolism (reduce excess weight, control cholesterol levels, limit salt intake);
- give up frequent consumption of coffee, alcoholic beverages, quit smoking.
Thanks to the clear and consistent implementation of the above recommendations, it is possible to significantly slow down the pathological process and improve the patient’s quality of life.
Diagnosis and treatment of CHF in Moscow is offered by the Yusupov Hospital Therapy Clinic, a leading multidisciplinary center equipped with the latest equipment. The use of innovative techniques and the vast experience of the clinic’s team of specialists - therapists, cardiologists, diagnosticians - allows us to achieve impressive results in the treatment of chronic heart failure. Each patient at the Yusupov Hospital is provided with professional nursing care. In case of chronic heart failure, not only drug treatment is necessary, but also a review of the diet, which our qualified nutritionists help to cope with, who develop a special nutrition plan for each patient with CHF.
