Classification of chronic heart failure - signs, degrees and functional classes

Shortness of breath, constant weakness, unexplained swelling, chest pain - grounds for a cardiological examination. The listed phenomena may indicate a risk of chronic heart failure. The first mild symptoms should not be ignored. Without appropriate therapy, the condition will worsen. The IMMA medical clinics provide therapeutic and cardiological appointments.

In our clinics you can:

• Get a consultation with a cardiologist;
• Take an ECG and get a professional interpretation of the results;
• Complete the ABPM procedure;
• Undergo Holter monitoring;
• Take advantage of other services of our clinics.

For more details and any questions, please contact the number listed on the website

Congestive heart failure - decreased contractions of the heart muscle. This pathological condition is not an independent disease, it is a consequence of various disorders of the cardiovascular system.

The prevalence of heart failure among the population is constantly growing, the disease is considered a social problem along with oncology and AIDS. The reasons for the spread are different: poor environmental conditions, sedentary lifestyle, ignoring healthy eating rules, bad habits. Inattention to health leads to various damage to the circulatory system. Heart failure is a common complication.

About the structure of the cardiovascular system

The heart is a unique organ on which human life depends. It works without rest, has its own control center, which sends electrical impulses that stimulate muscle contractility.

The structure of the heart is widely known: it has two ventricles and two atria. By contracting, they ensure blood circulation through two vascular systems: the small and large blood circles. To more accurately explain the characteristics of different types of heart failure, it is necessary to mention the characteristics of blood flow.

The systemic circulation involves the flow of blood from the left ventricle into the aorta, oxygenation of all important organs and limbs and the return of venous blood to the right atrium. The pulmonary circulation is the flow of blood from the right ventricle to the lungs and the movement of oxygenated blood into the left atrium.

Symptoms of heart failure depend on which part of the heart is affected. This is reflected in disruption of the functioning of blood circulation.

Heart failure, depending on the nature of its course, can be of two types. The chronic form develops over a long period of time and has several stages. Acute heart failure progresses rapidly. The duration of the process is from an hour to two days. This condition requires urgent hospitalization.

The classification of heart failure based on the localization of the pathology distinguishes several types:

• Left ventricular failure;
• Right ventricular failure
• Total form.

As the disease progresses, isolated variants lead to the formation of a general, total form of the lesion. Damage to the left ventricle causes disturbances in the systemic circulation. Pathology of the right ventricle - affects the lungs or pulmonary circulation.

Treatment

First medical aid for AHF directly depends on the type of pathology.

Fainting

First aid for fainting

As a rule, treatment of fainting occurs without the use of medications.

Emergency care for fainting type of fainting consists of the following actions:

• place the patient in a horizontal position with the leg end raised;
• unbutton the buttons of your shirt and free yourself from clothing that is constricting your chest;
• provide access to fresh cool air;
• Spray your face with water or wipe your forehead and cheeks with a wet cloth;
• give warm sweet tea or weak coffee to drink if the patient is conscious;
• in the absence of consciousness, pat your cheeks and apply cold to your temples.

Cup of hot sweet coffee

If the above actions are ineffective, you can inject vasoconstrictor drugs, for example, Cordiamin.

Collapse

The woman in the photo suddenly felt ill

First aid for collapse is aimed at eliminating the causes that provoked the development of this condition. First aid for collapse consists of immediately placing the patient in a horizontal position, raising the leg end and warming the patient.

If the person is conscious, then you can give him hot sweet tea. Before transport to the hospital, the patient is given an injection of a vasoconstrictor drug.

Syringe for intravenous injection

In a hospital setting, the patient is administered medications that eliminate both the symptoms of vascular insufficiency and the causes of this pathological condition:

• drugs that stimulate the respiratory and cardiovascular centers - these drugs increase the tone of the arteries and increase the stroke volume of the heart;
• vasoconstrictors - adrenaline, Dopamine, Norepinephrine and other drugs that quickly increase blood pressure and stimulate the heart are administered intravenously;
• infusion of blood and red blood cells - required in case of blood loss to prevent shock;
• carrying out detoxification therapy - droppers and solutions are prescribed that quickly remove toxic substances from the blood and replenish the volume of circulating fluid;
• Oxygen therapy – prescribed to improve metabolic processes in the body and saturate the blood with oxygen.

Possible nursing problems with AHF of the collapse type are the difficulty of giving the patient something to drink if his consciousness is impaired, and of administering the drug intravenously at low pressure - it is not always possible to immediately find a vein and get into the vessel.

Important! Saline solutions are not effective if the collapse is caused by the deposition of blood into the intercellular space and internal organs. In such a situation, to improve the patient's condition, it is necessary to inject colloidal solutions into the plasma.

Shock

Treatment of shock consists of taking measures aimed at improving the systemic functions of the body and eliminating the causes of this condition.

The patient is prescribed:

• painkillers – in case of injuries and burns, before carrying out any actions, it is necessary to administer painkillers to the patient, which will help prevent the development of shock or stop it in the erectile stage;
• oxygen therapy – the patient is given humidified oxygen through a mask to saturate the blood with oxygen and normalize the functioning of vital organs; if consciousness is depressed, the patient is given artificial ventilation;
• normalization of hemodynamics - medications are administered that improve blood circulation, for example, red blood cells, colloidal solutions, saline solutions, glucose and others;
• administration of hormonal drugs - these drugs help to quickly restore blood pressure, improve hemodynamics, and relieve acute allergic reactions;
• diuretics - prescribed for the prevention and elimination of edema.

Important! With the development of AHF, all medications should be administered intravenously, since due to impaired microcirculation of tissues and internal organs, the absorption of medications into the systemic bloodstream changes.

Degrees of chronic pathology

There are several degrees of chronic heart failure. The earlier a problem is identified, the easier it is to treat. In the later stages of the disease, mortality is 50%.

The first stage of chronic insufficiency is characterized by shortness of breath and rapid fatigue after active physical work or sports. Treatment at this time is most effective. Early detection of symptoms of chronic deficiency will not only help to cope with it, but also to determine the true cause.

In the second stage of heart failure, symptoms become more pronounced:

• cyanosis, or blue discoloration of the fingertips, nose and nasolabial folds, lips. The reason is a change in blood composition, insufficient oxygen content.
• With low-intensity loads, typical symptoms appear: shortness of breath, rapid heartbeat, weakness.
• Dry cough not associated with a cold.

The second stage is characterized by damage to the pulmonary circulation, the lungs suffer, so a cough occurs, and the blood is poorly saturated with oxygen.

Another variant of the manifestation of the second stage is damage to the systemic circulation. First of all, swelling appears. They can be hidden: fluid accumulates in body cavities, for example, filling the abdominal cavity. Swelling of the legs is more noticeable. This condition is called dropsy.

In addition, stagnation begins in all organs: liver, kidneys, digestive system, brain. Associated pathologies develop and the functioning of these organs is disrupted.

At the third stage, irreversible changes occur. Usually the functioning of the entire circulatory system is disrupted. Lesion of the small circle is characterized by a strong cough with sputum production, the appearance of pink foam not only when coughing, but also at rest. This is explained by a violation of the permeability of numerous vessels, lymphatic fluid fills the lungs, and edema occurs. The condition is fatal and requires urgent hospitalization. Shortness of breath accompanies a person at rest. Worsens when lying down. Periodically there are attacks of suffocation, accompanied by fear of death. They force the patient into a sitting position with his legs down.

At the same time, all vital organs suffer. Signs of congestive liver damage:

• increase in organ volume;
• formation of sclerotic and connective tissue;
• cirrhosis of the liver.

Congestive kidney damage leads to chronic renal failure. At the same time, the amount of urine excreted decreases, swelling increases and no longer goes away under the influence of medications. Intestinal dysfunction occurs, constipation or diarrhea is possible.

The third stage is irreversible. A person completely loses the ability to be active. Even household chores become beyond his power. Usually the patient is assigned a certain form of disability. The survival rate in this case is 50%. Medicine in this case can only offer supportive therapy.

Important! The third stage of the formation of congestive heart failure occurs as a result of the lack of treatment for the disease. If you consult a doctor in a timely manner in the early stages, you can not only stop the progression of the disease, but also be completely cured.

If you notice the following signs of heart failure, you should immediately contact a cardiologist:

• Shortness of breath with minor physical exertion;
• Blueness of fingers, lips, nose;
• Unreasonable dry cough, sometimes accompanied by sputum production;
• Pain in the chest, under the shoulder blade;
• Swelling of the legs, enlargement of the abdomen, which may be hidden edema.

Mild heart failure responds well to treatment, so a preventive examination by a therapist and cardiologist and the necessary diagnostic methods will help avoid serious consequences.

The mechanism of pathology formation

Chronic cardiovascular failure develops slowly due to the body's compensatory mechanisms.

At the compensatory stage of the myocardium, the heart muscle begins to hypertrophy. The vessels expand, causing their walls to become more fragile and permeable over time. Hormones are produced that change the composition of the blood, which becomes more liquid, its volume increases due to increased work of the bone marrow and an increase in the amount of water due to retention.

Compensatory possibilities dry up, and the decompensatory stage begins, which is characterized by a weakening of the functions of the entire cardiovascular system.

As the muscle mass of the myocardium grows, its small vessels lag behind in development, as a result, the heart muscle lacks oxygen and nutrients. Pathological changes occur: the proliferation of connective and sclerotic tissue. The heart becomes unable to pump the increasing volume of blood. Extensive oxygen starvation begins, which covers all organs.

Along with this, the walls of blood vessels become more fragile and permeable. Lymph leaks from the vessels. Swelling begins. These phenomena are especially dangerous in the lungs. They quickly fill with liquid and stretch. A person is tormented by a severe cough, and the discharge of sputum does not provide relief.

Causes of the disease

The causes of congestive heart failure are pathologies of the cardiovascular and endocrine systems. They can be congenital or acquired:

• genetic predisposition;
• ischemic disease.
• myocarditis
• diseases resulting in thickening of the walls of the myocardium and pericardium;
• thyroid diseases;
• diabetes.

Factors that provoke the occurrence of pathological processes include:

• bad habits, smoking and alcoholism;
• sedentary lifestyle;
• excessive body weight;
• severe infections (usually viral);
• heavy physical activity;
• frequent stress, improper daily routine, lack of sleep.

Congestive heart failure is more common in old age, occurring in 10% of people after sixty years of age. However, the disease also affects young people. In adolescence, it is necessary to carefully monitor the state of the cardiovascular system. The rapid growth of bone and muscle tissue, hormonal changes increase the load on the heart, which does not have time to grow with such rapid growth of the body as a whole.

Young athletes are at risk. Typically, training for teenagers is more gentle; children undergo annual examinations. If signs of congestive heart failure are detected, not only urgent treatment is necessary, but also a temporary refusal to exercise. Doctors recommend taking a break for about a year.

Prevention measures

At a consultation with a cardiologist

In order to prevent the development of acute vascular insufficiency, it is important to follow the doctor’s recommendations:

• promptly identify and treat diseases of the cardiovascular system;
• do not take any medications without a doctor’s prescription, especially for the treatment of arterial hypertension;
• do not stay in direct sunlight for a long time, in a bathhouse, sauna, especially if there are any disturbances in the functioning of the heart and blood vessels;
• Before a blood transfusion, be sure to take tests to make sure that the donor’s blood matches the group and Rh factor.

Maintaining an active lifestyle, giving up bad habits, and a nutritious and balanced diet will help prevent disorders of the cardiovascular system and blood pressure.

Acute form

Along with chronic, there is an acute form of heart failure. The reasons for its occurrence are:

• myocardial infarction;
• major stroke;
• structural defects of the heart, congenital and acquired;
• hypertension.

A distinctive feature of acute cardiovascular failure is the suddenness of the attack and the absence of the listed stages of development. The person's condition quickly deteriorates and death is possible within a few minutes. The occurrence of pathology is indicated by a sharp deterioration in condition, suffocation, severe cough with foam or red sputum, blue discoloration of the skin, and cold sweat.

In such cases, first aid is to call an ambulance. Then the victim should be taken out into the open air, the collar and other tight clothing should be unbuttoned. The best pose is considered to be sitting, with legs down. A nitroglycerin tablet should be given under the tongue. Repeat the dose every 10 minutes until the ambulance arrives.

Important! In acute heart failure, you should not take a supine position.

First aid for AHF

A patient with AHF must immediately receive emergency care, since cardiogenic shock may occur during a heart attack. At the same time, his skin turns pale, his blood pressure drops sharply, severe pain appears, and his pulse is practically not palpable. If you do not respond in time, swelling of the kidneys and lungs can quickly develop, which can lead to death.

In case of AHF, first aid is provided at the scene of the incident, while it is necessary to reduce the load and ensure the redistribution of blood flow by performing the following actions:

• Place the patient in a comfortable sitting position; to do this, lower his legs to the floor and raise his back.
• It is better to immerse your feet in a basin of hot water, reducing the flow of blood to the heart.
• Remove the patient from clothing and open the windows, ensuring maximum flow of fresh air.
• Call emergency doctors and report the symptoms of an attack.
• Apply a tourniquet in the groin area to each leg alternately (20 minutes), which will reduce the flow of blood into the myocardium.
• Provide the patient with emotional and physical peace; he is strictly forbidden to get up and walk.

If there are signs of AHF, you need to measure your blood pressure. If the upper reading is more than 90 mmHg, then 1 tablet of nitroglycerin should be placed under the patient’s tongue. After this, you need to monitor the pressure all the time. If necessary, you can give 1 more tablet after 7 minutes, but not more than 4 times.

Patients suffering from heart disease or hypertension with severe swelling of the legs and shortness of breath should always carry a first aid kit with medications prescribed by the attending physician. Then, at the first signs of AHF, people around you will be able to provide emergency assistance.

Age and gender factor

Statistical studies prove the connection between the spread of the disease and the gender and age of the patient.

In the age group up to 65 years, women suffer from congestive heart failure to a lesser extent; above this age, the rates become equal. Death as a result of acute heart failure is recorded in men after 45 years.

In old age, symptoms of congestive heart failure are more common, this is explained by chronic diseases, poor lifestyle, and reduced immunity.

Diagnostics

Symptoms of congestive heart failure are observed by the therapist when examining the patient and listening to heart sounds. He refers the patient to a cardiologist. A number of studies are being carried out:

• ECG;
• ECHOCG
• HMEKG
• Radiography
• Coronary angiography
• MRI, MSCT

Research is being conducted on the characteristics of the heartbeat during physical activity. To do this, the patient is asked to perform a series of simple exercises, such as squats. After this, monitor the change and restoration of the pulse. More in-depth examinations of this kind are performed using a treadmill or exercise bike.

What awaits patients

Half of all patients diagnosed with heart failure live more than five years. It is difficult to talk about maximum life expectancy; this indicator is determined by many factors. These include the severity of the disease, concomitant background, and the effectiveness of the prescribed treatment. The kind of life the patient leads and much more is of great importance.

If the disease is detected in the initial stage, with the help of therapy the patient’s condition can be completely compensated. At stage 3 of the disease, experts talk about a worse prognosis.