Diagnosis and treatment of heart failure (Alexandrov)

Heart failure is a disease that is accompanied by insufficient contractility of the heart, which does not meet the metabolic needs of the body

A healthy heart easily pumps blood from the left ventricle through the body to the organs. This allows you to provide them with oxygen and essential nutrients. After fulfilling its saturation function, the blood returns to the heart, but to the right side. From there, the blood is sent to the lungs, where it is saturated with oxygen and again begins its path through the left ventricle.

In other words, the disease is a weakening of the very pumping function of the heart. The lesion occurs either on the right side of the heart or on the left (right and left ventricular heart failure, respectively). Progressive disease may involve damage to both sides of the heart. In addition, deficiency can be chronic or acute.

Overview of Heart Failure

A decrease in the contractile force of the heart muscle leads to a decrease in the volume of blood ejection and venous stagnation in the pulmonary and systemic circulation. The internal organs do not receive enough oxygen and nutrients, and due to increased venous pressure, edema develops. Stagnation of blood in the lungs leads to respiratory failure and oxygen starvation of tissues. A slowdown in blood flow in the vessels of the legs provokes the formation of blood clots, which can then break off and clog the arteries of the heart, lungs, and brain, causing death.

The mechanism of pathology development

Normally, blood moves from the right side of the heart to the left ventricle, then is released into the aorta and moves in a large circle, providing nutrition to all organs and systems, including the brain.

LVAD develops as a result of exposure to a negative factor, usually mitral or aortic valve insufficiency or pathology of the interventricular septum.

The result of the violation is, on the one hand, a decrease in myocardial contractility as a result of overload. Accordingly, not enough blood is released.

On the other hand, stagnation of liquid connective tissue, which leads to dilatation (expansion) of cardiac structures and an even greater decrease in the organ’s ability to function normally.

The heart cannot function like this for a long time. Therefore, within a few years, death occurs. The progression is rapid.

The condition needs to be treated from the very first months, or preferably weeks, in a hospital setting. The basis of therapy is eliminating the cause of the phenomenon.

Classification of heart failure

According to the speed of development, acute and chronic heart failure

. The first appears and progresses quickly - within a few days or hours, the chronic one develops gradually.

Acute heart failure (AHF)

can develop according to the right or left ventricular type, depending on the location of myocardial damage.

The following stages are distinguished in the development of chronic heart failure (CHF):

• Symptoms of hemodynamic disturbances appear only during physical activity; nothing bothers the person at rest.
• Signs of venous stagnation: in one of the circulation circles; in large and small circles.
• Development of irreversible dystrophic changes in internal organs.

Pathogenesis

Pathogenetic mechanisms are associated with a sharp, critical drop in blood pressure and subsequent weakening of blood flow in organs and tissues. The leading factor is not hypotension , but rather a decrease in blood circulating through the vessels in a certain period of time. Compensatory-adaptive reactions are triggered in response to deteriorating perfusion.

The body directs all its reserve reserves to provide nutrition to vital organs: the brain and heart. In this case, skeletal muscles, limbs and skin experience oxygen starvation. In response, peripheral capillaries and arteries spasm. All this leads to activation of neuroendocrine systems, water and sodium ions are retained in the body, and acidosis .

Diuresis may decrease to 0.5 ml/kg per hour or less. Patients are diagnosed with oliguria , anuria multiple organ failure develops . Excessive vasodilation occurs in later stages and is triggered by cytokine and acidosis .

Causes of acute heart failure

The immediate causes of acute heart failure may be:

• complications of CHF (pulmonary embolism - blockage by a blood clot);
• myocarditis, pericarditis - inflammatory diseases of heart tissue;
• hypertension in the acute phase (hypertensive crisis);
• arrhythmia;
• myocardial infarction, coronary heart disease, major stroke.

Treatment

Medicines are used for treatment. The most commonly prescribed medications are ACE inhibitors, beta blockers, digoxin and diuretics (diuretics). Drug treatment helps prevent complications and improve quality of life.

Rhythm therapy and pacemaker implantation are also used for treatment. The second method allows you to activate the atria and ventricles. Often, a defibrillator is implanted as part of the pacemaker. It counteracts serious heart rhythm disturbances.

Unfortunately, heart failure cannot be completely cured. However, timely treatment can increase the patient's life expectancy. The prognosis depends not only on the type of disease, but also on age, lifestyle and bad habits.

Causes of chronic heart failure

The development of CHF is caused by chronic lung diseases, congenital and acquired heart defects and other pathologies, including:

• stenosis and/or insufficiency of heart valves;
• hypertension;
• myocarditis, pericarditis;
• cardiac ischemia;
• hyperthyroidism is an excess of thyroid hormones in the blood.

At first, the compensatory capabilities of the heart allow one to maintain hemodynamics at the proper level, but over time they become depleted and signs of illness appear.

Forecast

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Left ventricular failure causes death in 70% of cases. The outcome directly depends on many factors:

• General health.
• Presence of somatic pathologies.
• Working blood pressure level.
• Family history.
• Time course of pulmonary hypertension and other diseases.
• The quality of the treatment provided.
• Age.
• Floor.
• Body type, weight, overweight and obesity.
• Nature of nutrition.
• Bad habits, lifestyle.
• Emotional condition.
• Hormonal background.
• Type of professional activity.

In combination, these factors give a unique, unique picture. Accordingly, the forecast depends on the mass of moments.

To roughly formalize the numbers: the probability of survival at the first stage is 95% with proper treatment. The process is stopped completely.

Starting from the second, the values ​​decrease proportionally:

Symptoms of heart failure

The clinical picture of this pathology depends on what type of insufficiency develops and in what circle of blood circulation venous stagnation develops.

In right ventricular AHF

The volume of venous blood in the systemic circulation increases, resulting in the following symptoms:

• feeling of increased heartbeat;
• swelling of the limbs;
• swelling of the neck veins;
• a sharp drop in blood pressure, pallor, weakness, dizziness.

For left ventricular AHF

Blood stagnation occurs in the pulmonary circulation (pulmonary), so the following signs appear:

• chest pain;
• cough with pale pink frothy sputum;
• dyspnea;
• the appearance of foam in the corners of the mouth;
• disturbance of consciousness, confusion;
• the patient takes a forced sitting position, slightly leaning forward, in which the condition improves slightly.

A person with AHF needs urgent medical attention. If such symptoms appear, do not hesitate, you must call an ambulance.

Symptoms of chronic heart failure:

• shortness of breath, at first only during physical activity, later - at rest;
• cyanosis of the nasolabial triangle, fingertips;
• swelling of the legs, which appears in the evening and disappears in the morning;
• an increase in the volume of the abdomen due to the accumulation of fluid in it (ascites);
• signs of dysfunction of the liver, kidneys, central nervous system.

If such symptoms appear, it is recommended to consult a cardiologist or therapist.

Stages of LVN

Pathological processes can also be classified according to severity. Based on this criterion, they call 4 stages, sometimes three.

First

Easy. Does not produce clinically significant symptoms. Organic defects are already present, but not yet critical. The likely manifestation of left ventricular failure at this stage is shortness of breath.

Tachycardia and increased heart rate may develop. Restoration is carried out after identification.

This is the best time to begin treatment for left ventricular failure. Rarely gives attacks. The prognosis is favorable.

Second

Can be divided into two phases.

• A. Pronounced organic changes. The clinical picture is quite clear. Left ventricular heart failure is accompanied by intense chest pain and shortness of breath with moderate physical exertion.

The patient can still perform daily activities, but mechanical work is no longer possible. There is a nonproductive cough and swelling of the lower extremities.

• B Complemented by right ventricular failure. Severe shortness of breath develops after minor physical activity, stable arrhythmia. Pressing pain in the chest. Cough.

The heart is unable to function normally, like other organs. Treatment of such a pathology is futile. The effectiveness is minimal; it is possible to partially alleviate the condition, but complete recovery cannot be achieved.

Third or terminal

Accompanied by total dysfunction of the entire body. There is no strength not only to work, but also to take care of oneself in everyday life, even to move. The patient lies down most of the time, death occurs within a few weeks or months.

Effective treatment is possible only at the first stage. This classification is used to quickly assess the patient’s health status and recovery prospects.

Diagnosis of heart failure

The examination program for a person with suspected heart failure includes:

• collection of complaints and symptoms;
• initial examination, listening to heart sounds and breathing sounds;
• ECG of the heart;
• Cardiac echocardiography (Echo-CG);
• X-ray of the chest organs;
• Ultrasound of the abdominal organs.

Make an appointment with a cardiologist

The best cardiologists at the private Multidisciplinary Medical Center in Moscow invite patients with any type of cardiac dysfunction to diagnose and treat them. If signs of heart failure are detected, the patient is prescribed a comprehensive examination, after which experienced specialists will monitor the disease through medication and other effective therapy.

You can make an appointment with a cardiologist for a fee by phone or using the feedback form. Check the price of initial and repeat appointments on the clinic’s website. If the patient’s condition is acute, cardiologists will see him without an appointment at any time of arrival at our center.

Moscow, st. Krasnodarskaya, house. 52, bldg. 2

+7

We work on weekdays and weekends from 8.00 to 21.00

Diagnosis and treatment of heart failure in Medical

Our doctors select an individual examination and treatment regimen based on the characteristics of each patient.

All diagnostics and treatment are carried out using expert-class equipment certified in Russia and approved for use by the Ministry of Health of the Russian Federation.

When should you see a doctor?

The reason for visiting a cardiologist should be alarming symptoms from the cardiovascular system: pain in the heart, dizziness, pressure surges, swelling, palpitations, etc. You should not delay your visit to the doctor, because in the early stages it is much easier to treat and control the disease.

Drug therapy for heart failure

Treatment of heart failure is carried out by prescribing drugs that facilitate the work of the heart, improve the rheological properties of the blood and hemodynamics. Such drugs include:

• B-adrenergic receptor blockers;
• cardiac glycosides;
• angiotensin receptor blockers;
• diuretics;
• nitrates.

Dosages and combinations of drugs are selected by the doctor; during the treatment process, it is often necessary to adjust the prescriptions taking into account the person’s condition.

It is unacceptable to prescribe medications to yourself after reading about the symptoms and treatment of diseases on the Internet or on the advice of a pharmacist at a pharmacy. Do not deprive yourself of the opportunities of modern world cardiology - contact a cardiologist for medical help at the Paracelsus Clinic.

First aid for an attack

There is little you can do on your own. The goal is to stabilize the patient's condition. There is no chance of elimination without special intervention. The main thing to do is to call a team of doctors.

Before the ambulance arrives, the emergency algorithm is as follows:

• Sit the patient down and place a cushion made from available materials under his back. A blanket or clothing will do.
• Be sure to lower your arms and legs. There should be no intense peripheral circulation, as this will negatively affect the state of the cardiovascular system.
• Open a vent or window to provide fresh air into the room.
• Against the background of pain, give a Nitroglycerin tablet. One.
• Measure blood pressure.
• If symptoms of cardiogenic shock develop (loss of consciousness, indifference to what is happening, a sharp drop in blood pressure and heart rate), the patient must be taken to the hospital as quickly as possible. If possible, it is better to do this on your own, without waiting for an ambulance.