Cardiovascular failure. Key points in treatment

Heart failure– spicy or chronic condition caused by weakening contractility myocardium and congestion in the pulmonary or systemic circulation. It manifests itself as shortness of breath at rest or with slight exertion, fatigue, swelling, cyanosis (blueness) of the nails and nasolabial triangle. Acute heart failure is dangerous due to the development of pulmonary edema and cardiogenic shock, while chronic heart failure leads to the development of organ hypoxia. Heart failure is one of the most common causes of human death.

A decrease in the contractile (pumping) function of the heart in heart failure leads to the development of an imbalance between the hemodynamic needs of the body and the ability of the heart to fulfill them. This imbalance is manifested by an excess of venous flow to the heart and the resistance that the myocardium must overcome to expel blood into the heart. vascular bed, over the heart's ability to move blood into the arterial system.

Not being independent disease, heart failure develops as a complication various pathologies blood vessels and heart: valvular heart defects, coronary disease, cardiomyopathy, arterial hypertension, etc.

For some diseases (for example, arterial hypertension) the increase in the phenomena of heart failure occurs gradually, over the years, while in others (acute myocardial infarction), accompanied by the death of part functional cells, this time is reduced to days and hours. With a sharp progression of heart failure (within minutes, hours, days), they speak of its acute form. In other cases, heart failure is considered chronic.

Chronic heart failure affects 0.5 to 2% of the population, and after 75 years its prevalence is about 10%. The significance of the problem of heart failure morbidity is determined by the steady increase in the number of patients suffering from it, high rate mortality and disability of patients.

Causes

Among the most common causes of heart failure, occurring in 60-70% of patients, are myocardial infarction and coronary artery disease. These are followed by rheumatic heart disease (14%) and dilated cardiomyopathy (11%). IN age group over 60 years of age, in addition to ischemic heart disease, heart failure is also caused by hypertension (4%). In elderly patients, a common cause of heart failure is type 2 diabetes mellitus and its combination with arterial hypertension.

Factors that provoke the development of heart failure cause its manifestation when the compensatory mechanisms of the heart decrease. Unlike causes, risk factors are potentially reversible, and their reduction or elimination can delay the worsening of heart failure and even save the patient's life. These include: overexertion of physical and psycho-emotional capabilities; arrhythmias, pulmonary embolism, hypertensive crises, progression of ischemic heart disease; pneumonia, ARVI, anemia, renal failure, hyperthyroidism; taking cardiotoxic drugs, drugs that promote fluid retention (NSAIDs, estrogens, corticosteroids), increasing blood pressure (isadrine, ephedrine, adrenaline); pronounced and rapidly progressive weight gain, alcoholism; a sharp increase in blood volume during massive infusion therapy; myocarditis, rheumatism, infective endocarditis; non-compliance with recommendations for the treatment of chronic heart failure.

Pathogenesis

The development of acute heart failure is often observed against the background of myocardial infarction, acute myocarditis, severe arrhythmias (ventricular fibrillation, paroxysmal tachycardia, etc.). In this case, there is a sharp drop in minute output and blood flow into the arterial system. Acute heart failure is clinically similar to acute vascular failure and is sometimes referred to as acute cardiac collapse.

In chronic heart failure, changes developing in the heart are compensated for a long time by its intensive work and adaptive mechanisms of the vascular system: an increase in the strength of heart contractions, an increase in rhythm, a decrease in pressure in diastole due to the expansion of capillaries and arterioles, which facilitates emptying of the heart during systole, and an increase in perfusion fabrics.

Further increase in the phenomena of heart failure is characterized by a decrease in the volume of cardiac output, an increase in the residual amount of blood in the ventricles, their overflow during diastole and overstretching of the myocardial muscle fibers. Constant overstrain of the myocardium, trying to push blood into the vascular bed and maintain blood circulation, causes its compensatory hypertrophy. However, at a certain moment, a stage of decompensation occurs, due to the weakening of the myocardium, the development of the processes of degeneration and sclerosis in it. The myocardium itself begins to experience a lack of blood supply and energy supply.

At this stage in pathological process turn on neurohumoral mechanisms. Activation of the mechanisms of the sympathetic-adrenal system causes vasoconstriction in the periphery, which helps maintain stable blood pressure in the systemic circulation while reducing cardiac output. The resulting renal vasoconstriction leads to renal ischemia, which contributes to interstitial fluid retention.

An increase in the secretion of antidiuretic hormone by the pituitary gland increases the processes of water reabsorption, which entails an increase in the volume of circulating blood, an increase in capillary and venous pressure, and increased transudation of fluid into the tissue.

Thus, severe heart failure leads to severe hemodynamic disturbances in the body:

gas exchange disorder

When blood flow slows down, tissue absorption of oxygen from capillaries increases from 30% normally to 60-70%. The arteriovenous difference in blood oxygen saturation increases, which leads to the development of acidosis. The accumulation of under-oxidized metabolites in the blood and increased work of the respiratory muscles cause activation of the basal metabolism. A vicious circle arises: the body experiences an increased need for oxygen, and the circulatory system is unable to satisfy it. The development of the so-called oxygen debt leads to the appearance of cyanosis and shortness of breath. Cyanosis in heart failure can be central (with stagnation in the pulmonary circulation and impaired blood oxygenation) and peripheral (with slow blood flow and increased utilization of oxygen in the tissues). Since circulatory failure is more pronounced in the periphery, patients with heart failure experience acrocyanosis: cyanosis of the extremities, ears, and tip of the nose.

swelling

Edema develops as a result of a number of factors: interstitial fluid retention with increased capillary pressure and slower blood flow; water and sodium retention due to impaired water-salt metabolism; disturbances in the oncotic pressure of blood plasma due to protein metabolism disorders; reducing the inactivation of aldosterone and antidiuretic hormone with decreased liver function. Edema in heart failure is initially hidden and is expressed by a rapid increase in body weight and a decrease in the amount of urine. Appearance visible swelling begin with lower limbs, if the patient is walking, or from the sacrum if the patient is lying down. Subsequently, cavitary dropsy develops: ascites ( abdominal cavity), hydrothorax (pleural cavity), hydropericardium (pericardial cavity).

stagnant changes in organs

Congestion in the lungs is associated with impaired hemodynamics of the pulmonary circulation. Characterized by lung rigidity, decreased breathing excursion chest, limited mobility of the pulmonary edges. Manifested by congestive bronchitis, cardiogenic pneumosclerosis, hemoptysis. Congestion of the systemic circulation causes hepatomegaly, manifested by heaviness and pain in the right hypochondrium, and then cardiac fibrosis of the liver with the development of connective tissue in it.

Expansion of the cavities of the ventricles and atria in heart failure can lead to relative insufficiency of the atrioventricular valves, which is manifested by swelling of the veins of the neck, tachycardia, and expansion of the boundaries of the heart. With the development of congestive gastritis, nausea, loss of appetite, vomiting, a tendency to constipation, flatulence, and weight loss appear. With progressive heart failure, a severe degree of exhaustion develops - cardiac cachexia.

Congestive processes in the kidneys cause oliguria, increased relative density of urine, proteinuria, hematuria, and cylindruria. Dysfunction of the central nervous system in heart failure is characterized by fatigue, decreased mental and physical activity, increased irritability, sleep disorders, depressive states.

Classification

According to the rate of increase in signs of decompensation, acute and chronic heart failure are distinguished.

The development of acute heart failure can occur in two types:

left type (acute left ventricular or left atrial failure)
acute right ventricular failure

According to the Vasilenko-Strazhesko classification, there are three stages in the development of chronic heart failure:

I (initial) stage– hidden signs of circulatory failure, manifesting themselves only during physical activity: shortness of breath, palpitations, excessive fatigue; at rest there are no hemodynamic disturbances.

II (pronounced) stage– signs of prolonged circulatory failure and hemodynamic disorders (stagnation of the pulmonary and systemic circulation) are expressed at rest; severe limitation of working capacity:

Period II A – moderate hemodynamic disturbances in one part of the heart (left or right ventricular failure). Shortness of breath develops during normal physical activity, and performance is sharply reduced. Objective signs– cyanosis, swelling of the legs, initial signs of hepatomegaly, hard breathing.
Period II B – deep hemodynamic disorders involving the entire cardiovascular system (large and small circle). Objective signs – shortness of breath at rest, severe edema, cyanosis, ascites; complete disability.

III (dystrophic, final) stage– persistent circulatory and metabolic failure, morphologically irreversible disorders of the structure of organs (liver, lungs, kidneys), exhaustion.

Symptoms of heart failure

Acute heart failure

Acute heart failure is caused by weakening of the function of one of the parts of the heart: the left atrium or ventricle, the right ventricle. Acute left ventricular failure develops in diseases with a predominant load on the left ventricle ( hypertension, aortic disease, myocardial infarction). When the functions of the left ventricle are weakened, the pressure in the pulmonary veins, arterioles and capillaries increases, their permeability increases, which leads to sweating of the liquid part of the blood and the development of first interstitial and then alveolar edema.

Clinical manifestations of acute left ventricular failure are cardiac asthma and alveolar pulmonary edema. An attack of cardiac asthma is usually provoked by physical or neuropsychic stress. An attack of sudden suffocation often occurs at night, forcing the patient to wake up in fear. Cardiac asthma is manifested by a feeling of lack of air, palpitations, cough with phlegm difficult to clear, severe weakness, and cold sweat. The patient assumes an orthopneic position - sitting with legs down. On examination - pale skin with a grayish tint, cold sweat, acrocyanosis, severe shortness of breath. A weak, fast-filling arrhythmic pulse, expansion of the borders of the heart to the left, dull heart sounds, and a gallop rhythm are detected; blood pressure tends to decrease. There is harsh breathing in the lungs with isolated dry wheezing.

Further increase in pulmonary congestion contributes to the development of pulmonary edema. Sharp suffocation is accompanied by coughing with the release of copious amounts of foamy Pink colour sputum (due to the presence of blood). From a distance, bubbling breathing with moist wheezing can be heard (a symptom of a “boiling samovar”). The patient's position is orthopneic, the face is cyanotic, the veins of the neck are swollen, the skin is covered with cold sweat. The pulse is threadlike, arrhythmic, frequent, blood pressure is reduced, and there are moist rales of various sizes in the lungs. Pulmonary edema is an emergency condition that requires intensive care measures, as it can be fatal.

Acute left atrial heart failure occurs with mitral stenosis (left atrioventricular valve). Clinically manifested by the same conditions as acute left ventricular failure. Acute right ventricular failure often occurs with thromboembolism of large branches pulmonary artery. Stagnation develops in vascular system systemic circulation, which is manifested by swelling of the legs, pain in the right hypochondrium, a feeling of fullness, swelling and pulsation of the neck veins, shortness of breath, cyanosis, pain or pressure in the heart area. The peripheral pulse is weak and frequent, blood pressure is sharply reduced, central venous pressure is increased, the heart is enlarged to the right.

In diseases that cause decompensation of the right ventricle, heart failure manifests itself earlier than in left ventricular failure. This is explained by the large compensatory capabilities of the left ventricle, the most powerful part of the heart. However, with a decrease in left ventricular function, heart failure progresses at a catastrophic rate.

Chronic heart failure

The initial stages of chronic heart failure can develop according to the left and right ventricular, left and right atrial types. For aortic disease, insufficiency mitral valve, arterial hypertension, coronary insufficiency develops congestion in the vessels of the pulmonary circle and chronic left ventricular failure. It is characterized by vascular and gas changes in the lungs. There is shortness of breath, attacks of suffocation (usually at night), cyanosis, palpitations, cough (dry, sometimes with hemoptysis), increased fatigue.

Even more pronounced congestion in the pulmonary circulation develops in chronic left atrial failure in patients with mitral valve stenosis. Shortness of breath, cyanosis, cough, and hemoptysis appear. With prolonged venous stagnation in the vessels of the small circle, sclerosis of the lungs and blood vessels occurs. An additional pulmonary obstruction to blood circulation in the pulmonary circle arises. High blood pressure in the pulmonary artery system causes an increased load on the right ventricle, causing its failure.

With predominant damage to the right ventricle (right ventricular failure), congestion develops in the systemic circulation. Right ventricular failure may accompany mitral valves heart disease, pneumosclerosis, pulmonary emphysema, etc. There are complaints of pain and heaviness in the right hypochondrium, the appearance of edema, decreased diuresis, distension and enlargement of the abdomen, shortness of breath when moving. Cyanosis develops, sometimes with an icteric-cyanotic tint, ascites, the cervical and peripheral veins swell, and the liver increases in size.

Functional failure of one part of the heart cannot remain isolated for long, and over time, total chronic heart failure develops with venous stagnation in the pulmonary and systemic circulation. Also, the development of chronic heart failure is observed with damage to the heart muscle: myocarditis, cardiomyopathy, ischemic heart disease, intoxication.

Diagnostics

Since heart failure is a secondary syndrome that develops with known diseases, diagnostic measures should be aimed at its early detection, even in the absence of obvious signs.

When collecting a clinical history, attention should be paid to fatigue and dyspnea as the most early signs heart failure; the patient has coronary artery disease, hypertension, previous myocardial infarction and rheumatic attack, cardiomyopathy. Detection of swelling of the legs, ascites, rapid low-amplitude pulse, listening to the third heart sound and displacement of the borders of the heart are specific signs of heart failure.

If heart failure is suspected, the electrolyte and gas composition of the blood is determined, acid-base balance, urea, creatinine, cardiospecific enzymes, indicators of protein-carbohydrate metabolism.

Based on specific changes, an ECG helps to identify hypertrophy and insufficiency of blood supply (ischemia) of the myocardium, as well as arrhythmias. Based on electrocardiography, various stress tests using an exercise bike (veloergometry) and a treadmill (treadmill test) are widely used. Such tests with a gradually increasing level of load make it possible to judge the reserve capabilities of heart function.

Prognosis and prevention

The five-year survival rate for patients with heart failure is 50%. Long-term prognosis is variable, it is influenced by the severity of heart failure, concomitant background, effectiveness of therapy, lifestyle, etc. Treatment of heart failure in the early stages can completely compensate for the patient’s condition; the worst prognosis is observed with Stage III heart failure.

Measures to prevent heart failure include preventing the development of diseases that cause it (coronary artery disease, hypertension, heart defects, etc.), as well as factors that contribute to its occurrence. To avoid the progression of already developed heart failure, it is necessary to adhere to an optimal regimen of physical activity, take prescribed medications, and constant monitoring by a cardiologist.

Acute cardiac vascular insufficiency- a serious condition of the body, which is caused by many reasons. Pathological disturbances in cardiac activity and blood vessels are so pronounced that without therapeutic effects they lead to inevitable death.

This term expresses the underlying cause of death. A pronounced stage of changes in the functioning of the cardiovascular system stops blood circulation in organs and tissues and causes a general oxygen “starvation”.

Primary pathology can affect only one component of the system, but then another necessarily joins.

How are the heart and blood vessels connected?

Normally, the heart acts as a pump, pumping blood through the force of the myocardium. One contraction pushes up to 80 ml of blood into the aorta, about 5 liters per minute. But the heart does not rest, so it has to pump up to 7000 liters per day.

Arterial vessels contain 15% of the blood flow. The smallest ones (arterioles) carry oxygen to the tissues. They can redistribute blood due to spastic contraction: then a state of ischemia will arise in the tissues, and excess blood will be discharged into the veins through arteriovenous shunts. If the tone of the arterioles leads to the expansion of the lumen, then the blood supply increases.

The body has its own tone regulators:

impulses from the nervous system and hormonal substances (adrenaline and norepinephrine, angiotensin-2, serotonin);
oxidation products.

This natural mechanism is reflexively triggered during stress, when the bulk of blood flows from the central vessels to the peripheral ones.

There are toxic poisons medicinal substances, having the same property.

Even more small vessels- capillaries - deliver blood cells before cellular level and leaching of waste substances, their collection into the venous system. They contain 12% of the blood mass. But with loss of tone, the volume increases significantly.

The main blood (up to 70%) collects in the veins; they independently adapt to the amount of blood received. Flow into the right atrium through the vena cava system is regulated by central venous pressure.

The pressure in the veins increases when:

heart failure;
mechanical obstruction of further outflow to the lungs (pulmonary artery thrombosis);
excess fluid in the body.

Decreases when:

severe blood loss;
decreased tone of arteries and veins on the periphery (due to the outflow of their center);
loss of fluid with vomiting, diarrhea, sweat.

Arterial vessels are shown in red, venous vessels in blue.

Increased peripheral vascular tone leads to sharp increase load on the myocardium. Due to increased peripheral resistance, it requires additional effort to push blood.

A decrease in capillary tone with expansion of their lumen causes retention of the bulk of blood. The heart does not receive the required volume, and the coronary vessels stop supplying the muscle with oxygen.

Such interdependence in diseases with dysregulation contributes to severe consequences and does not disappear on its own.

Diagnostic methods

The state of vascular tone and cardiac muscle can be judged based on the examination results:

measurement of blood pressure - the upper level (systolic) is used to judge the muscular strength of heart contractions and ejection; the lower level (diastolic) is used to judge the amount of vascular tone or resistance;
registration of central venous pressure - a decrease indicates low tone of the vascular bed;
volume of circulating blood - the technique, if the volume is insufficient, allows one to judge the degree of blood loss or the deposition of blood in dilated capillaries;
An ECG reveals signs of myocardial overload, the degree of hypertrophy;
Cardiac ultrasound can quantify the correct flow of blood through the chambers of the heart.

Venous pressure is measured by inserting a catheter into the subclavian vein

Causes of acute heart and vascular failure

The heart and blood vessels provide macro- and microcirculation of blood in the body. A failure in one of the parts leads to an inadequate supply of oxygen to the entire body. And this is fraught first with dysfunction of organs and systems, then with cell death.

The cause of pathological changes may be:

injuries;
external or internal bleeding;
extensive burns;
mental stress;
loss of salts and fluids;
intoxication (for any infectious diseases, poisoning food products, toxic substances);
immediate allergic reaction;
acute myocardial ischemia;
heart rhythm disturbance;
changes in the regulation of vascular tone with increased hormone production.

The occurrence of acute heart failure leads to increasing damage to vascular tone and vice versa. Let us consider in more detail the types of these violations.

If the primary cause is heart failure

Acute heart failure is characterized by 2 types of course.

Left ventricular failure

Left ventricular failure is a manifestation of the inability of the left ventricle to eject into bloodstream sufficient blood volume. Characteristic of myocardial diseases with a predominant focus in the left chambers of the heart:

myocardial infarction;
mitral valve disease, aortic-mitral stenosis;
hypertonic disease;
atherosclerosis of the coronary arteries.

Common lobar pneumonia contributes to heart overload.

Blood accumulates in the left atrium, and the ventricle is unable to pump it into the aorta. At the same time, the right ventricle continues to pump blood into the pulmonary circle. Due to overload, the liquid goes into lung tissue and causes swelling.

Symptoms:

forced sitting position of the patient;
cyanosis of the face, hands, feet;
attacks of suffocation;
cough with pink sputum;
On auscultation, many moist rales are heard, bubbling breathing can be heard even without a phonendoscope at a distance.

The outcome depends on the state of vascular tone and blood pressure. With increased blood pressure(capillary tone is preserved) the patient has a greater chance of survival. If vascular insufficiency with atony is added, then the fight against pulmonary edema takes place in very difficult conditions complete absence help from the body.

High arterial tone in the pulmonary circle is supported by diseases of the lung tissue and bronchi (asthma, emphysema, pneumosclerosis)

Right ventricular failure

Right ventricular failure - occurs when the right ventricle is acutely unable to push blood into the pulmonary artery. The most common reasons:

pulmonary embolism;
myocardial infarction localized in the right ventricle;
exceeding the required fluid requirement during intravenous transfusion of solutions and blood.

Symptoms:

, faces;
dilation and visible pulsation of the veins in the neck;
suffocation;
tachycardia;
swelling in the legs;
ascites;
an enlarged liver is palpable.

Intensive therapy is carried out depending on the underlying disease. It is aimed at restoration normal pressure in the central venous system. For this purpose, agents that dilate small vessels are used. During treatment it is necessary to reduce the influx venous blood, reduce capillary tone.

We see that the types of heart failure are very dependent on the condition of the blood vessels. There is a pathology that primarily affects the vascular link and has an inverse relationship with the strength of heart contractions.

If the main cause is vascular insufficiency

The development of vascular insufficiency is based on a violation of the regulation of vascular tone on the part of the nervous and endocrine systems. Great importance is attributed to pathological changes in the vasomotor center in medulla oblongata And reflexogenic zones in area carotid sinus(on the carotid artery) and in the aortic arch.

The drop in tone affects mainly the slowdown and accumulation of blood in the vessels of the abdominal cavity. The blood flow slows down, a significant amount of blood is deposited in the portal vein, liver, and spleen. Flow to the heart decreases. Heart disease in this case is secondary.

Three conditions reflect acute vascular insufficiency: syncope, collapse and shock. Clinically, there are no boundaries separating them in accurate diagnosis. We can only talk about a more or less pronounced vascular reaction.

Fainting

Fainting is caused by an acute drainage of blood from the brain. Persons with emotional instability, a tendency to hypotension, and prolonged forced horizontal position are more predisposed to it. In pathology, the reaction speed of the human vasomotor system is important.

Symptoms:

sudden paleness;
short-term loss of consciousness;
constriction of the pupils;
slow heart rate;
a drop in blood pressure is determined.

Consciousness quickly returns on its own if the patient is placed with the head level lowered.

Collapse

Collapse - the patient’s condition is more severe, since the main vasomotor centers do not suffer from functional changes, but from intoxication during infections or from the pronounced toxic effect of poisons directly on the blood vessels and adrenal glands. In internal organs paresis of small capillaries with accumulation of a large volume of blood is observed.

Often the patient falls when trying to stand up

Symptoms:

complaints of weakness;
the patient is inhibited;
pallor;
blood pressure is low;
the skin is covered with sticky cold sweat.

Shock

Shock is caused by more serious pathological reasons:

extensive burns;
peritonitis;
acute blood loss;
massive trauma;
irritation of pain receptors (pneumothorax, stretching of organ capsules).

In the origin of the shock state, the addition of heart failure plays an important role, and when it comes to first place.

Symptoms:

the patient is often unconscious;
pale;
covered with sticky sweat;
lips are cyanotic;
shallow breathing;
tachycardia;
blood pressure is sharply reduced or not determined;
The pulse on the radial artery cannot be palpated, on the carotid artery it is difficult.

Features

To determine the correct treatment, it is necessary to distinguish Clinical signs heart and vascular failure.

In the clinic of acute heart failure, attention is drawn to:

forced position of the patient;
suffocation while sitting in bed;
moving to a lying position only increases shortness of breath;
typical bluish tint skin;
the expanded boundaries of the heart are determined;
on auscultation - rhythm disturbance;
when measuring venous pressure, its increase is determined;
Possible pulsating veins in the neck;
there are clinical signs of blood stagnation in the liver and lungs.

For vascular insufficiency:

the patient feels better lying down, since this increases the blood supply to the brain;
the skin is pale or has a grayish tint;
increased sweating;
the borders of the heart are normal;
no arrhythmia;
venous pressure drops, veins collapse;
there are no signs of congestion in the liver or lungs.

Emergency measures and therapy for acute cardiovascular failure are based on the prevailing symptoms and response body for treatment. It is important to determine the underlying cause of the severity of the condition. In all cases, the patient is supplied with oxygen through nasal catheters, cardiac glycosides and agents that affect vascular tone are administered.

Provide the necessary amount of assistance yourself or folk remedies impossible. It is necessary to call an ambulance as soon as possible.

Heart failure is a disease characterized by a number of symptoms associated with disturbances in the processes of filling and emptying human heart, as a result of which hemodynamic disorders subsequently form in the body.

Cough can be called symptoms of heart failure; the signs of this disease are quite characteristic, and at the first warning signs, the patient should not hesitate to contact a specialist. There are chronic and acute form such a disease.

Characteristic properties of acute heart failure

If a person has acute heart failure, then it is necessary to take into account that similar pathology is quite serious condition posing an immediate danger to life. The clinical development of the disease occurs very quickly and is determined by sharp decline contractile myocardial functions and a decrease in normal cardiac output.

With this form of heart failure, there is a delay in blood circulation in the pulmonary circle. In this regard, a sharp pulmonary edema forms, which is characterized by increasing shortness of breath, actually reaching suffocation. It must be taken into account that the treatment of shortness of breath in heart failure requires the use of special drugs, and in particular severe cases Surgical treatment is also used, when an electrical pacemaker is installed in a sick person.

Acute heart failure is characterized by rapid, irregular heartbeat, a bluish tint or cyanosis of the skin, and remote rales are observed in the lungs during breathing. The presence of shortness of breath in heart failure leads to the fact that the patient is forced to remain in a sitting position for a long time; ventilation of the lungs sharply worsens if the person lies down.

There are other standard symptoms of this disease. You can usually observe a cough in heart failure, which produces foamy sputum. With a significant increase in pressure in the pulmonary vessels, cardiopulmonary failure may occur due to pulmonary embolism. The unexpected appearance of shortness of breath should cause alarm, if before this the person was in a state of complete rest, blue lips, acute pain in the chest, in a situation pulmonary infarction coughing up blood may also be present.

Features of chronic heart failure

The most common chronic form of this disease occurs most often in people. To the maximum extent, chronic heart failure is characteristic of those who have reached a fairly advanced age of more than 60 years. The occurrence of such a disease is provoked various factors, among which we can mention the presence of arterial hypertension, myocarditis, chronic coronary heart disease, lung diseases, and diabetes mellitus.

Someone who constantly suffers from heart failure experiences increased fatigue, regular shortness of breath, and rapid heartbeat. You also need to know how to treat swelling of the legs in case of heart failure, since such an unpleasant symptom is also a characteristic sign of a disturbance in the functioning of the heart.

Most patients complain that they get tired very quickly and that they are simply unable to do any, even minimal, physical activity. Such problems are caused by insignificant cardiac output, insufficient peripheral blood outflow, increasing muscle weakness, and tissue hypoxia. If a person notices that, with the same load on the body as before, he begins to get tired faster and feel worse, he should not ignore such alarming signs; he should consult a doctor about this as soon as possible.

In the case of heart failure, shortness of breath increases gradually, at first it can only be observed with genuine physical effort, but then it occurs with the most basic movements and even in a situation of absolute rest. Decompensation of normal cardiac activity can provoke cardiac asthma in a person, in which attacks of suffocation appear at night, causing a feeling of deep panic.

Treatment options for diagnosing heart failure

Any person should be aware of the symptoms and treatment of heart failure in order to take emergency measures and provide first aid if necessary. Indicators for hospitalization of a patient may include characteristic features the presence of acute heart failure, the first manifestations of such a disease in a healthy person who is able to work age category. In case of ineffectiveness of the therapeutic treatment painful symptoms and lack of compensation for the chronic form of the disease, the patient may also be sent to a hospital.

If there are no symptoms of acute deficiency and the permanent illness is in the compensation stage, then treatment is carried out on an outpatient basis. When a person exhibits symptoms of cardiovascular failure, a specialist prescribes a certain set of measures that the sufferer similar disease must strictly comply.

The nutritional regimen is of great importance; the diet must contain foods with high percentage potassium, if a patient is diagnosed with heart failure, salt intake is strictly limited; it is also necessary to monitor the amount of fluid absorbed and not exceed permissible limits.

You cannot give up physical activity; some effort is necessary, but it should be clearly dosed depending on the individual condition of a particular patient. The patient is also prescribed special medications of a medicinal nature, positive influence which have already been proven to increase life expectancy and its quality. In case of significant edema, diuretics are recommended; the patient can drink herbs that have diuretic properties. It is also possible to use surgical methods to help those suffering from heart failure; often a pacemaker is inserted into a person or operations are performed to perform myocardial revascularization.

Both sexes are susceptible to heart failure. Signs of heart failure may be detected differently in women, but women are usually diagnosed with chronic form diseases. Symptoms can be observed for quite a long time, but do not bother the woman too much, so the woman may not immediately seek advice from a professional, which reduces her chances of completely getting rid of the disease. Often the diagnosis is made only when there is already an undoubted clinical picture disease, but recovering from such a health disorder in such cases turns out to be much more difficult. In men, more obvious problems in cardiac activity and acute failure are more often observed, so the disease is diagnosed faster.

And chronic heart failure. Thus, chronic is a condition when the heart muscle partially loses its ability to ensure normal blood flow. CHF can affect people of all ages, and as it develops it can cause complications up to sudden death. That is why it is important to diagnose and begin to treat the disease in time.

Features of the disease

Most often, CHF occurs in women, especially older women. Age characteristics affect treatment: older people are prescribed different groups of medications than children.

In women, heart failure occurs due to, and in men, due to coronary artery disease.
The most common cause of chronic heart failure in children is congenital pathologies of the heart muscle.

The following visual video will tell you how a person develops chronic heart failure:

Degrees

The main classification of degrees divides chronic heart failure into stages:

Initial. It can only be detected by echocardiography.
Expressed. The movement of blood is disrupted in one of the blood circulation circles.
Heavy. Blood flow is disrupted in both circles.
The final one. Blood flow is heavy, and the heart muscle and target organs like the brain undergo major changes.

Chronic heart failure syndrome is also divided into functional classes:

First. The main symptoms are shortness of breath and decreased endurance.
Second. Physical activity is poorly limited, and fatigue and shortness of breath occur with exertion.
Third. During physical activity, the patient clearly manifests symptoms of CHF.
Fourth. The patient cannot perform any exercises without unpleasant symptoms, which also appear at rest, but weakly.

There are also several types of chronic heart failure depending on the location of blood stagnation:

right ventricular - stagnation in the small circle;
left ventricular - stagnation in the large circle;
biventricular - stagnation in both circles;

Read on to learn about the causes of chronic cardiovascular failure of degrees 1, 2, 3.

Chronic heart failure (schematic representation)

Causes

The mechanism of occurrence of CHF is associated with damage to the heart muscle or the inability to perform it normal work, that is, pumping blood through vessels.

This may occur due to:
Coronary heart disease.
History of myocardial infarction.
Arterial hypertension.
Cardiomyopathies, including postpartum.
Excessive intake of medications, especially antitumor drugs.
Diabetes mellitus.
Diseases of the thyroid gland.
Diseases of the adrenal glands.
Obesity.
Cachexia (depletion of the body).
Major deficiency of vitamins and other essential elements like selenium.
Sarcoidosis (dense nodules that compress normal areas of organs).
Kidney failure.
Atrial fibrillation.
Heart blocks.
Dry, effusion, constrictive or adhesive pericarditis.

Also common causes, especially in infants, are congenital and acquired heart defects.

Even relatively healthy man may get CHF. Doctors identify risk factors such as:

disorders of fat metabolism;
diabetes;
obesity;
bad habits ( , );

People who are inactive and unhealthy image life are also at risk.

Read on to learn more about the signs of chronic heart failure.

Symptoms

The symptoms of chronic heart failure depend on the specific part of the heart that cannot cope with its work. Most often, CHF manifests itself:

shortness of breath;
increased fatigue;
rapid heartbeat;
peripheral edema: begins with swelling of the legs, which gradually rises to the hips, lower back and above;
orthopnea.

Patients often have a cough, dry or with little sputum. As the disease progresses, blood may appear in the sputum.

The following video will tell you in more detail about the symptoms, diagnosis and treatment of chronic heart failure:

Diagnostics

Since the symptoms of chronic heart failure are pronounced, early diagnosis is not difficult. As with other diseases, diagnosis begins with collecting a history of complaints and life. If the doctor identifies signs of CHF and possible causes, he will conduct a physical examination of the skin for swelling, and also listen to the heart to detect murmurs.

To confirm the diagnosis, the patient is prescribed:

Biochemical and clinical tests of blood and urine. Help to identify associated disorders and complications of CHF.
Analysis of thyroid hormones to determine organ pathologies.
Coagulogram. Reveals increased clotting blood.
Blood test for BNP and proBNP, identifying CHF and its causes.
ECG to assess the rhythm of the heartbeat and detect heart rhythm disturbances.
Phonocardiogram. Helps detect systolic and diastolic heart murmurs.
Breast X-ray. Evaluates the structures and sizes of the heart and lungs, the presence of fluid in the pleural cavity.
Echocardiography. Evaluates the size of the heart muscle, wall thickness and other characteristics.
MRI to obtain an accurate image of the heart.
Endomyocardial biopsy. Appointed to as a last resort to clarify the cause of CHF.

Often patients are prescribed consultations with other specialists, for example, a physician and a cardiac surgeon.

Treatment

Chronic heart failure requires a complete overhaul of your lifestyle. The patient is shown:

Diet food with low content salts and liquids. You need to make sure that your food contains enough calories, protein and vitamins, and it should not be fatty.
Body weight control.
Physical activity according to doctor's recommendations.
Psychological assistance in case of stressful situations.

The patient should constantly consult with the attending physician about physical activity.

Medication

Typically, a patient is prescribed the following drugs for the treatment of chronic heart failure:

ACE inhibitors development of CHF, protecting the heart and target organs.
An angiotensin receptor antagonist if the patient does not tolerate ACE.
Diuretics for withdrawal extra salts and liquids.
Cardiac glycosides, if the patient has atrial fibrillation.
Statins if the patient has ischemic disease. Reduce the formation of lipids in the liver.
Anticoagulants if the patient has atrial fibrillation or is at risk of developing thromboembolism.
Nitrates to improve blood flow.
Calcium antagonists for the relief of hypertension.

Additional medications depending on the patient's condition.

A specialist will tell you more about medications and other methods of treating chronic heart failure in the following video:

Operation

The operation is indicated for severe arrhythmias that threaten the patient’s life. The most common operation is coronary artery bypass grafting. As a result of the operation, an additional path is created for the movement of blood from the aorta to the vessels. Mammary bypass surgery is also often performed - creating an additional path from thoracic artery to the vessels.

The patient may be prescribed:

Correction of valve defects surgically if there is severe stenosis or failure of the heart muscle.
Heart transplantation if it is not amenable to medical treatment.
Artificial ventricles of the heart that are inserted inside. The ventricles are connected to batteries located on the patient’s belt.

Others if available

Patients are often prescribed electrophysical therapy, which consists of:

Installation of pacemakers that create and transmit an electrical impulse to the heart.
Resynchronization therapy, that is, the installation of pacemakers that transmit an electrical impulse to the right atrium and ventricles.
In setting up a cardioverter-defibrillator, which not only transmits an electrical impulse, but also delivers a strong shock if a life-threatening arrhythmia occurs.

Disease prevention

Prevention of chronic heart failure can be primary and secondary. Primary treatment includes drugs aimed at preventing the disease in people at high risk. These include:

Moderate physical exercise and physical therapy.
Diets high in vitamins and fish, no fat.
Quitting bad habits like drinking alcohol or smoking.
Normalization of body weight.

Secondary preventive measures are carried out in cases where the patient already has diseases of the cardiovascular system or heart failure, which can become chronic. For this:

They take medications that normalize blood pressure.
They take medications that protect internal organs.
Improves blood flow in arteries.
Heart rhythm disturbances are treated.
Diseases are stopped.

Timely prevention helps not only prevent the onset of CHF, but also improve the quality of life of patients and reduce the number of hospitalizations. Now let's find out what complications of chronic heart failure are possible.

Complications

If CHF is not treated, the disease may become more complicated:

conduction disorders of the heart muscle;
an increase in the size of the heart muscle;
thromboembolism;
cardiac cachexia;
liver failure;
Complications of chronic heart failure;

The most terrible complication is sudden death.

It is noteworthy that heart failure spreads at a high rate. If 10 years ago only 4% of the population in Russia were sick, today the figure has increased to 8%.

Forecast

The prognosis largely depends on the severity of CHF:

With class 1 CHF, up to 80% of patients survive for 5 years;
with 2nd grade - 60%
with 3-4 grades - less than 29%.

Health to you and your families!

Cardiovascular failure (CVF) is pathological condition circulatory system, combining both of these types of failure, combined general etiology or pathogenesis.

They are varieties of one disorder - blood circulation (BC). This failure occurs when the pumping function of the heart fails, i.e. violation of its contractility. Against this background, an imbalance occurs between the capabilities of the heart and the body’s needs for oxygen and other useful components.

Vascular insufficiency manifests itself in that impaired blood flow in the periphery leads to sharp fall Blood pressure and fainting and collapse may occur. Almost always vascular insufficiency accompanies HF, so they are combined.

Vascular insufficiency may be associated with the poor condition of the arteries (if they are narrowed), then the supply of nutrition to the tissues is insufficient; venous insufficiency– waste blood flows slowly and insufficiently from the organs.

When the primary filling of the peripheral vessels suddenly decreases, collapse or syncope occurs. Heart failure (HF) is always the end of any cardiac and vascular disease, its natural outcome. The onset of the disease HF can only be with cardiomyopathy.

The prognosis for HF is also calculated at 5-year survival, as for oncology. The cause of heart failure is always associated with myocardial damage and a decrease in the heart's ability to fill and empty.

Based on the rate of development, heart failure is divided into acute and chronic. The speed depends on the type of pathology; for example, with hypertension, failure develops slowly, over years, and with MI, minutes and hours count (ACH). This type of failure is accompanied by pulmonary edema, cardiac asthma, cardiogenic shock.

With CHF – the process is underway slowly, over years, accompanied by tissue hypoxia chronic. 2% of the population suffers from CHF, this figure grows in old age - after 75 years - already 10%. HF is currently the leading cause of death.

Etiology of the phenomenon

HF often develops in the elderly; those suffering from cardiac pathologies: hypertension, diabetes, coronary artery disease, atherosclerosis, myocardial infarction, acquired heart defects; genetic predisposition; infectious-allergic pathologies of the heart muscle.

Contributing factors: increased load with impaired hemodynamics; organic changes in the myocardium; vasoconstriction; high cholesterol; AG.

As well as psycho-emotional stress; TELA; arrhythmias; surge arrester; use of drugs with a negative effect on the heart muscle (cardiotoxic); endemic goiter; taking hypertensive drugs; alcoholism; speed dial weight; a sharp increase in blood volume during enhanced infusion therapy.

Vascular insufficiency can occur in asthenics at the moment of a sharp rise; with prolonged stuffiness in the room; taking and increasing the dose of antihypertensive drugs; with exhaustion; frightened

Provoking factors for fainting are anemia, bleeding, overwork; severe infections; starvation. Collapse can develop when severe pathologies: sepsis, peritonitis, pneumonia, sunstroke, intoxication, pancreatitis, etc.

What happens with heart failure

Against the background of myocarditis, pronounced arrhythmias, during heart attacks, the volume of blood entering the arteries drops sharply. In this case, the clinical picture of AHF becomes similar to vascular insufficiency, which is why it is also called cardiac collapse.

With CHF, everything happens slowly, since first compensatory mechanisms develop, with the help of which the body tries to compensate for the insufficient work of the myocardium. In this way, the circulatory system still tries to supply organs and tissues in sufficient quantity nutrition and oxygen. These mechanisms include increased heart function. It begins to contract more strongly and quickens its rhythm.

At first, the heart copes with its work, the left ventricle hypertrophies compensatoryly. The patient's symptoms do not bother him; only the blood pressure rises. But the growth of the myocardial wall in thickness begins to gradually compress the coronary vessels and now the heart muscle itself begins to suffer from hypoxia and ischemia.

The walls of the left ventricle can no longer increase their thickness and begin to stretch, dilatation occurs. Sclerotic foci (cardiosclerosis) appear on the LV wall.

Cardiac output decreases. At some point, the heart becomes so exhausted that diffuse heart failure begins to occur in it. dystrophic changes. The force of contraction drops again, irrevocably. Left ventricular heart failure and cardiac decompensation develop.

Neurohumoral mechanisms come into play. They activate the sympathetic-adrenal system. The result of this is a narrowing of peripheral vessels; blood pressure in the systemic circle stabilizes for some time even with a reduced MO.

But narrowing of peripheral vessels means renal ischemia. Their work is disrupted and fluid begins to be retained in the tissues of the body. Body weight begins to increase, urine output decreases—this is hidden edema. Then, under the influence of an increase in ADH, water reabsorption increases and edema becomes obvious.

They rise to the lower back and abdomen. Transudate accumulates in natural cavities - the pericardial sac, pleura, abdominal cavity. The speed of blood flow slows down. Tissue cells begin to intensively absorb oxygen - instead of 30-70%. The arteriovenous difference in oxygen saturation increases and acidosis develops.

Under-oxidized metabolic products begin to accumulate in the blood, and lung excursion increases. Oxygen debt in the circulatory system develops. This leads to dyspnea and cyanosis. Due to the weakness of the heart muscle, the parts of the heart expand and the functioning of the heart valves is disrupted. Subsequently, cardiac cachexia occurs.

Classification of CH according to Vasilenko-Strazhesko

There are acute and chronic forms of HF. According to the localization, AHF can be left- and right-ventricular, as well as total. AHF - most often develops during MI, quickly, over several hours or days. CHF increases gradually over a number of years.

There are 3 stages in its development:

Stage I (HI) – hidden, initial stage. She manifests herself with shortness of breath and palpitations when the load increases. After rest, everything goes away. It decreases somewhat, but the ability to work is still well maintained.
Stage II is already the time of noticeable hemodisorders. Shortness of breath appears even with small loads, and later spontaneously. This stage undergoes 2 periods: A and B.
H stage IIA - symptoms appear with moderate loads, but they are not yet pronounced. They manifest themselves as increased cardiac impulse and dyspnea. The cyanosis is not sharp, and at times there is a dry cough. Auscultation - non-voiced crepitating moist rales may be heard on inspiration. The patient feels irregularities in the heart and a feeling of fading, and swelling of the feet appears in the evenings. This already indicates hemodynamic problems in the aortic system. Here is the very beginning of development - small swelling disappears in the morning; at times there is a feeling of heaviness and discomfort in the right hypochondrium. The liver is slightly enlarged on palpation - along the edge of the costal arch. The patient gets tired noticeably faster, and his ability to work is reduced.
H IIB stage – there is already shortness of breath at rest. All symptoms become more severe. Cyanosis is pronounced, pulmonary rales are increased. Aching pains in the heart are added. The swelling in the legs does not go away; it rises upward, towards the body. The liver becomes denser, fibrosis and cirrhosis develop in it. Interstitial fluid begins to fill all cavities. It appears in the pleura and abdominal cavity. Little urine. The person is disabled.
Stage III (H III) - dystrophic, final stage. Hemodynamics are disturbed everywhere, connective tissue grows in the main organs (cardiosclerosis, pneumosclerosis, cirrhosis, stagnation in the kidneys). The patients are exhausted. Treatment does not improve.

Symptomatic manifestations

If a person has cardiovascular failure, symptoms and complaints may not always coincide with the severity of the clinical picture and morphological disorders.

Symptoms of CHF

CHF develops over a long period of time. Its symptoms and signs: shortness of breath, daytime sleepiness, weakness and decreased physical activity; one of the first signs is heaviness in the legs and rapid fatigue, blood pressure is reduced, dizziness is often felt, leg swelling appears, and gradually increases; their appearance in the abdominal cavity is called ascites. It is accompanied by pain in the liver; There is stagnation of blood in the portal vein system and in the liver itself. The pathology is called congestive heart failure.

The main symptom is shortness of breath (dyspnea). Orthopnea - shortness of breath occurs when the patient is lying down and the head end of the bed is low. In this position, the venous flow to the heart increases. Cough with heart failure usually goes away on its own after treatment and improvement of well-being. Nocturia - too early symptom, precedes oliguria. Symptoms of CHF also include a rapid, weak pulse.

Symptoms of AHF

Acute cardiovascular failure is usually associated with myocardial infarction, with left ventricular failure most often present. It all starts with the appearance acute pain behind the sternum, which are not relieved by analgesics. The pain can last more than 20 minutes, which forces a person to see a doctor.

The person begins to complain of heaviness behind the sternum and severe shortness of breath. This indicates left ventricular failure; increased heart rate and weakness are noted. There is pronounced blueness of the tip of the nose, nails, lips, ears and lip triangle.

The patient is tossing about, covered in cold sweat, and has a fear of death. A bad prognosis is the appearance of a cough. He talks about the onset of pulmonary edema. Acute cardiovascular failure is accompanied by cardiac asthma, cardiogenic shock, and acute renal failure.

Acute left ventricular failure occurs in those pathologies when there is an increased load on the LV (hypertension, myocardial infarction, aortic disease). Since venous pressure remains high against the backdrop of weakened myocardial function, blood plasma leaks into the interstitial spaces and reaches the alveoli. At the same time, the pulmonary circulation remains overflowing with blood, like the heart itself.

The LV is not doing its job. The skin becomes pale and the breathing rate increases. Cardiac asthma (“paroxysmal nocturnal dyspnea”) is added. which may bother you after physical overload or stress. It usually occurs at night, the patient experiences suffocation and wakes up in fear. He does not have enough air, he is suffocating, complaining of heart palpitations. The patient becomes covered in sweat and complains of severe weakness, a cough appears.

The sputum is scanty and viscous. If treatment is not carried out, this symptom develops into pulmonary edema. So the combination of these 2 severe symptoms occurs against the background of decreased myocardial contractility, increased central venous pressure, and stagnation in the pulmonary circulation.

Then the patient takes a forced position: sits down, lowering his legs and resting his hands. The skin of the face becomes gray, cyanosis is pronounced, the veins in the neck are swollen, shortness of breath does not stop, breathing is rapid, pulse is rapid, blood pressure is low.

Auscultation reveals dry wheezing in the lungs and muffled heart sounds. Pulmonary edema is possible. The cough becomes wet, with a large volume of foamy, pink sputum. Bubbling, rapid breathing is noticeable to everyone around (a symptom of a “boiling samovar”). The pulse becomes arrhythmic, barely palpable (thread-like).

Left ventricular failure does not manifest itself and grow as quickly as right ventricular failure. This phenomenon is explained by the fact that the left ventricle is the most powerful of all parts of the heart, and has a higher ability to compensate. May remain in a state of compensation for a long time. But when it decompensates, progression occurs at a catastrophic speed. Right ventricular decompensation occurs much earlier. It develops when the pulmonary artery and its branches are blocked by a blood clot (PE).

In right ventricular failure, the peripheral veins are filled with blood. The permeability of the vein walls increases and the blood plasma gradually begins to sweat outside the vessels. This is manifested by swelling in the limbs.

Also persistent symptoms with this type of deficiency, lack of strength and feeling constant fatigue. They are caused by the fact that the brain experiences a lack of oxygen and nutrition.

Stagnation increases in the systemic circulation. The swelling begins to rise higher, there is no outflow of fluid. The liver begins to suffer: it increases in size and the hepatocytes in it begin to be replaced by fibrous tissue, cirrhosis develops. Pain in the right hypochondrium and nausea appear.

Patients note a feeling of fullness in the neck veins. Shortness of breath, cardialgia and cyanosis become constant and increase. The pulse is increased, weakened, blood pressure is reduced. And all this against the background of increased venous pressure (CVP). The heart is enlarged on the right side.

Symptoms of total cardiovascular failure - here the symptoms are combined for both types of heart failure.

Diagnostic measures

For diagnosis, ECG, Echo-ECG, MRI, and radioisotope ventriculography are performed. Objectively: swelling in the legs, ascites, changes in the boundaries of the heart.

They also analyze the electrolyte composition of the blood, the level of CO2, determine the acid-rich acid, urea, creatinine, residual nitrogen, and determine cardio-specific enzymes.

In case of CHF, the reserve capabilities of the heart muscle are determined. For this purpose, bicycle ergometry and treadmill test (on a treadmill) are performed. An x-ray of the lungs determines hypertrophy of the heart size and reveals stagnation of blood circulation.

Principles of treatment

Treatment is always complex, but symptomatic. However, symptoms and treatment are not closely related because symptoms do not always determine the severity of the disease.

Surgical treatment

Surgical intervention according to indications when conservative intervention is ineffective, its goal is to prevent further damage to the heart:

Bypass surgery is the most common type of surgery. With this method, the blood is directed in a different way, past the blocked vessel.
Surgery – when the valves are deformed, blood begins to flow back; in such cases they are replaced or, in the case of stenosis, they are restored.
Operation Dora is possible after a left ventricular infarction. After such an MI, a scar remains on the cardiac tissues. During surgery, this aneurysm or dead section of the wall is removed.
Heart transplantation can be performed in cases of severe heart failure when all other methods have failed.

Myocardial revascularization is also performed.

When you need to see a doctor urgently

The patient may experience unusual symptoms:

causeless weight gain;
shortness of breath increases in the morning;
growth of swelling in the legs, moving to the stomach;
fast fatiguability;
pulse rises above one hundred;
chest pain;
the appearance and intensification of a cough against the background of the absence of signs of a cold;
daytime drowsiness and insomnia at night;
heart rhythm disturbances;
small volume of urine excreted;
difficulty breathing;
increased anxiety.

An ambulance should be called urgently if:

increased chest pain;
fear of death appeared;
shortness of breath increased;
sweating increased;
sweat sticky, cold;
bubbling breath;
nausea appeared;
pulse up to 150;
severe headache;
loss of consciousness;
paralysis.

What are the forecasts

Symptoms will appear throughout the entire period of the disease, from its very beginning. The drugs will not cure the patient, they only prolong life and alleviate symptoms. The only thing that can be completely cured is acquired heart defects in a state of compensation. They are treated surgically.

As a preventative measure, a work-rest regime must be observed. It is necessary to give up smoking and alcohol, eliminate stress and overwork.

Regular exercise and avoiding colds will help prevent the disease. All doctor's instructions should be followed clearly and carefully.