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Heart failure – the sharp or chronic state caused by easing of sokratitelny ability of a myocardium and developments of stagnation in a small or big circle of blood circulation. It is shown by short wind at rest or at insignificant loading, fatigue, hypostases, cyanosis (cyanosis) of nails and a nasolabial triangle. The acute heart failure is dangerous by development of hypostasis of lungs and cardiogenic shock, chronic heart failure leads to development of a hypoxia of bodies. Heart failure – one of the most frequent causes of death of the person.

Heart failure

Heart failure – the sharp or chronic state caused by easing of sokratitelny ability of a myocardium and developments of stagnation in a small or big circle of blood circulation. It is shown by short wind at rest or at insignificant loading, fatigue, hypostases, cyanosis (cyanosis) of nails and a nasolabial triangle. The acute heart failure is dangerous by development of hypostasis of lungs and cardiogenic shock, chronic heart failure leads to development of a hypoxia of bodies. Heart failure – one of the most frequent causes of death of the person.

Decrease in sokratitelny (pump) function of heart at heart failure leads to development of an imbalance between the haemo dynamic needs of an organism and a possibility of heart for their implementation. This imbalance is shown by excess of venous inflow to heart and resistance which the myocardium needs to overcome for exile of blood to the vascular course, over ability of heart to move blood to system of arteries.

Without being an independent disease, heart failure develops as a complication of various pathologies of vessels and heart: valvate heart diseases, ischemic disease, cardiomyopathy, arterial hypertension, etc.

At some diseases (for example, an arterial hypertension) increase of the phenomena of heart failure happens gradually, for years, whereas at others (a sharp myocardial infarction), the functional cages which are followed by death of a part, this time is reduced to days and hours. At sharp progressing of heart failure (within minutes, hours, days), speak about its sharp form. In other cases heart failure is considered as chronic.

Chronic heart failure suffer from 0,5 to 2% of the population, and after 75 years its prevalence makes about 10%. The importance of a problem of incidence of heart failure is defined by steady increase in number of the patients suffering from it, a high rate of mortality and disability of patients.

Reasons and risk factors of development of heart failure

Among the most frequent reasons of heart failure which are found at 60-70% of patients call a myocardial infarction and IBS. They are followed by rheumatic heart diseases (14%) and a dilatatsionny cardiomyopathy (11%). In age group 60 years, except IBS are more senior, heart failure is caused also by a hypertension (4%). At elderly patients as the frequent reason of heart failure serves diabetes of the 2nd type and its combination to an arterial hypertension.

The factors provoking development of heart failure cause its manifestation at decrease in compensatory mechanisms of heart. Unlike the reasons, risk factors are potentially reversible, and their reduction or elimination can detain aggravation of heart failure and even to save the patient's life. Enter their number: overstrain of physical and psychoemotional capacities; arrhythmias, TELA, gipertenzivny crises, progressing of IBS; pneumonia, SARS, anemias, renal failure, ; reception of the cardiotoxic medicines, the drugs promoting a liquid delay (NPVP, estrogen, corticosteroids) raising HELL (an izadrin, ephedrine, adrenaline).; the expressed and quickly progressing increase in body weight, alcoholism; sharp increase in OTsK at massive infusional therapy; myocardites, rheumatism, infectious endocarditis; non-compliance with recommendations about treatment of chronic heart failure.

Mechanisms of development of heart failure

Development of an acute heart failure is often observed against the background of a myocardial infarction, sharp myocarditis, heavy arrhythmias (fibrillation of ventricles, paroksizmalny tachycardia, etc.). At the same time there is a sharp falling of minute emission and intake of blood in arterial system. The acute heart failure is clinically similar to sharp vascular insufficiency and is sometimes designated as a sharp cardiac collapse.

At chronic heart failure of change, developing in heart, a long time are compensated by its hard work and adaptive mechanisms of vascular system: increase of force of reductions of heart, increase of a rhythm, pressure decrease in a diastola due to expansion of capillaries and , the heart facilitating depletion during a systole, increase in perfusion of fabrics.

Further increase of the phenomena of heart failure is characterized by reduction of volume of warm emission, increase in residual amount of blood in ventricles, their overflow during a diastola and restretching of muscle fibers of a myocardium. The constant overstrain of the myocardium trying to push out blood to the vascular course and to support blood circulation causes its compensatory hypertrophy. However at some point there comes the decompensation stage caused by weakening of a myocardium, development of processes of dystrophy in it and a sklerozirovaniye. The myocardium itself begins to lack for blood supply and power supply.

In this stage pathological process turns on neurohumoral mechanisms. Activation of mechanisms of simpatiko-adrenalovy system causes the narrowing of vessels on the periphery promoting maintenance stable HELL in line with a big circle of blood circulation at reduction of volume of warm emission. The kidney vazokonstriktion developing at the same time leads to the ischemia of kidneys promoting an interstitial delay of liquid.

Increase in secretion by a hypophysis of antidiuretichesky hormone increases processes of a reabsorption of water that involves increase of volume of the circulating blood, increase in capillary and venous pressure, the strengthened liquid transsudation in fabric.

Thus, the expressed heart failure leads to gross haemo dynamic violations in an organism:

  • to disorder of gas exchange

At delay of a blood-groove absorption by oxygen fabrics from capillaries from 30% normal increases up to 60-70%. The arteriovenozny difference of saturation of blood oxygen increases that leads to development of acidosis. Accumulation of nedookislenny metabolites in blood and strengthening of work of respiratory muscles cause activization of the main exchange. There is a vicious circle: the organism feels the increased need for oxygen, and the blood circulatory system is incapable it to satisfy. Development, so-called, oxygen debt leads to emergence of cyanosis and short wind. Cyanosis at heart failure can be central (at stagnation in a small circle of blood circulation and violation of oxygenation of blood) and peripheral (at delay of a blood-groove and the increased utilization of oxygen in fabrics). As insufficiency of blood circulation is more expressed on the periphery, at patients with heart failure is observed : cyanosis of extremities, ears, nose tip.

  • to hypostases

Hypostases develop as a result of a number of factors: an interstitial delay of liquid at increase in capillary pressure and delay of a blood-groove; delays of water and sodium at violation of water-salt exchange; violations of onkotichesky pressure of plasma of blood at disorder of proteinaceous exchange; reduction of an inactivation of an aldosteron and antidiuretichesky hormone at decrease in function of a liver. Hypostases at heart failure at first hidden, are expressed by bystry increase in body weight and reduction of amount of urine. Emergence of visible hypostases begins with the lower extremities if the patient goes, or from a sacrum if the patient lies. Further band dropsy develops: ascites (abdominal cavity), (pleura cavities), hydropericardium (pericardiac cavity).

  • to stagnant changes in bodies

Developments of stagnation in lungs are connected with violation of haemo dynamics of a small circle of blood circulation. Are characterized by a rigidnost of lungs, reduction of a respiratory excursion of a thorax, limited mobility of pulmonary edges. It is shown by stagnant bronchitis, a cardiogenic pneumosclerosis, a krovokharakanye. Developments of stagnation of a big circle of blood circulation cause the gepatomegaliya which is shown weight and pain in the right podreberye and then and cardiac fibrosis of a liver with development in it connecting fabric.

Expansion of cavities of ventricles and auricles at heart failure can result in relative insufficiency of predserdno-ventricular valves that is shown by swelling of veins of a neck, tachycardia, expansion of borders of heart. At development of stagnant gastritis nausea, appetite loss, vomiting, tendency to locks a meteorizm, loss of body weight develops. At the progressing heart failure heavy degree of exhaustion – a warm kakheksiya develops.

Stagnant processes in kidneys cause an oliguriya, increase in relative density of urine, a proteinuria, a gematuriya, a tsilindruriya. Violation of functions of the central nervous system at heart failure is characterized by bystry fatigue, decrease in the intellectual and physical activity increased by irritability, frustration of a dream, depressions.

Classification of heart failure

On the speed of increase of signs of a decompensation allocate sharp and chronic heart failure.

Development of an acute heart failure can happen on two types:

  • on the left type (sharp left ventricular or levopredserdny insufficiency)
  • sharp right ventricular insufficiency

In development of chronic heart failure in Vasilenko-Strazhesko's classification allocate three stages:

The I (initial) stage – the hidden signs of insufficiency of blood circulation which are shown only in the course of physical activity by short wind, heartbeat, excessive fatigue; at rest haemo dynamic violations are absent.

The II (expressed) stage – signs of long insufficiency of blood circulation and haemo dynamic violations (developments of stagnation of small and big circles of blood circulation) are expressed at rest; sharp restriction of working capacity:

  • The period of II And – moderate haemo dynamic violations in one department of heart (left-or right ventricular insufficiency). Short wind develops at usual physical activity, working capacity is sharply reduced. Objective signs – cyanosis, puffiness of shins, initial signs of a gepatomegaliya, rigid breath.
  • The period of the II B – deep haemo dynamic frustration with involvement of all cardiovascular system (a big and small circle). Objective signs – short wind at rest, the expressed hypostases, cyanosis, ascites; full disability.

III (dystrophic, final) a stage – resistant insufficiency of blood circulation and a metabolism, morphologically irreversible violations of structure of bodies (a liver, lungs, kidneys), exhaustion.

Symptoms of heart failure

Acute heart failure

The acute heart failure is caused by weakening of function of one of departments of heart: left auricle or ventricle, right ventricle. Sharp left ventricular insufficiency develops at diseases with primary load of the left ventricle (a hypertension, aortal defect, a myocardial infarction). When weakening functions of the left ventricle pressure in pulmonary veins, arteriola and capillaries increases, their permeability increases that conducts to a propotevaniye of a liquid part of blood and development at first of interstitsialny, and then alveolar hypostasis.

As clinical manifestations of sharp insufficiency of the left ventricle serve cardiac asthma and alveolar hypostasis of lungs. The attack of cardiac asthma is usually provoked by physical or psychological tension. The attack of sharp suffocation arises at night more often, compelling the patient in fear to wake up. Cardiac asthma is shown by feeling of shortage of air, heartbeat, cough with difficult departing phlegm, the sharp weakness cold then. The patient adopts the provision – sitting with the lowered legs. At survey – skin pale with a grayish shade, cold sweat, , severe short wind. Arrhythmic pulse, expansion of borders of heart to the left, deafs warm tone, a gallop rhythm is defined weak, frequent filling; arterial pressure tends to decrease. In lungs rigid breath with single dry rattles.

Further increase of developments of stagnation of a small circle promotes development of hypostasis of lungs. Sharp suffocation is followed by cough with allocation of plentiful quantity of a foamy phlegm of pink color (because of blood impurity availability). At distance the bubbling breath with damp rattles (a symptom of "the boiling samovar") is heard. Position of the patient , the person tsianotichny, veins of a neck bulk up, skin is covered by cold sweat. Pulse is threadlike, arrhythmic, frequent, HELL it is lowered, in lungs – damp mixed rattles. Hypostasis of lungs is the medical emergency demanding measures of intensive therapy since can lead to a lethal outcome.

Sharp levopredserdny heart failure meets at a mitralny stenosis (the left predserdno-ventricular valve). Sharp insufficiency of the left ventricle is clinically shown by the same states, as. Sharp insufficiency of the right ventricle arises at tromboemboliya of large branches of a pulmonary artery more often. Stagnation in vascular system of a big circle of blood circulation develops that is shown by hypostases of legs, pain in the right podreberye, feeling of a raspiraniye, swelling and a pulsation of cervical veins, short wind, cyanosis, pains or pressure in heart. Peripheral pulse weak and frequent, HELL it is sharply lowered, TsVD is raised, heart is expanded to the right.

At the diseases causing a decompensation of the right ventricle, heart failure is shown earlier, than at left ventricular insufficiency. It is explained by great compensatory opportunities for the left ventricle - the most powerful department of heart. However at decrease in functions of the left ventricle heart failure progresses with a catastrophic speed.

Chronic heart failure

Initial stages of chronic heart failure can develop on left-and right ventricular, left-and pravopredserdny types. At aortal defect, insufficiency of the mitralny valve, arterial hypertension, coronary insufficiency stagnation in vessels of a small circle and chronic left ventricular insufficiency develops. It is characterized by vascular and gas changes in lungs. There is short wind, suffocation attacks (is more often at night), cyanosis, heartbeat attacks, cough (dry, sometimes with a blood spitting), increased fatigue.

Even more expressed developments of stagnation in a small circle of blood circulation develop at chronic levopredserdny insufficiency at patients with a stenosis of the mitralny valve. There are short wind, cyanosis, cough, a blood spitting. At long venous stagnation in vessels of a small circle there is a sklerozirovaniye of lungs and vessels. There is an additional, pulmonary obstacle for blood circulation in a small circle. Elevated pressure in system of a pulmonary artery causes the increased load of the right ventricle, causing its insufficiency.

At primary defeat of the right ventricle (right ventricular insufficiency) developments of stagnation develop in a big circle of blood circulation. Right ventricular insufficiency can accompany mitralny heart diseases, a pneumosclerosis, emphysema of lungs etc. There are complaints to pains and weight in the right podreberye, emergence of hypostases, decrease in a diuresis, a raspiraniye and increase in a stomach, short wind at the movements. Cyanosis, sometimes with an icteric tsianotichnym a shade, ascites develops, cervical and peripheral veins bulk up, the liver increases in sizes.

Functional insufficiency of one department of heart cannot long remain isolated, and total chronic heart failure with venous stagnation in line with small and big circles of blood circulation develops over time. Also development of chronic heart failure is noted at damage of a cardiac muscle: myocardites, cardiomyopathy, IBS, intoxications.

Diagnosis of heart failure

As heart failure is the secondary syndrome developing at the known diseases, diagnostic actions have to be directed to its early identification, even in the absence of strong indications.

When collecting the clinical anamnesis it is necessary to pay attention to exhaustion and as the earliest symptoms of heart failure; presence at the patient of IBS, hypertensia postponed a myocardial infarction and the rheumatic attack, a cardiomyopathy. Detection of hypostases of shins, ascites, the speeded-up low-amplitude pulse, listening of the III tone of heart and shift of borders of heart are specific signs to heart failure.

At suspicion of heart failure carry out definition of electrolytic and gas composition of blood, acid-base balance, urea, creatinine, kardiospetsefichesky enzymes, indicators of proteinaceous and carbohydrate exchange.

The ECG on specific changes helps to reveal a hypertrophy and insufficiency of blood supply (ischemia) of a myocardium, and also arrhythmia. On the basis of an electrocardiography various load tests about use of the exercise bike (veloergometriya) and "the running path" are widely applied (tredmil-test). Such tests with gradually increasing level of loading allow to judge reserve opportunities of function of heart.

By means of an ultrasonic echocardiography it is possible to establish the reason which caused heart failure and also to estimate pump function of a myocardium. By means of MRT hearts are successfully diagnosed IBS, the congenital or acquired heart diseases, arterial hypertension, etc. diseases. The X-ray analysis of lungs and bodies of a thorax at heart failure defines stagnant processes in a small circle, a kardiomegaliya.

The radio isotope ventrikulografiya at patients heart failure allows to estimate sokratitelny ability of ventricles with a fine precision and to determine their volume capacity. At severe forms of heart failure for definition of damage of internals carry out ultrasonography of an abdominal cavity, a liver, a spleen, a pancreas.

Treatment of heart failure

At heart failure the treatment directed to elimination of primary reason is carried out (IBS, a hypertension, rheumatism, myocarditis, etc.). At the heart diseases, cardiac aneurism, a slipchivy perikardit creating a mechanical barrier in work of heart quite often resort to surgical intervention.

At sharp or heavy chronic heart failure the bed rest, absolute mental and physical rest is appointed. In other cases it is necessary to adhere to the moderate loadings which are not breaking health. Consumption of liquid is limited to 500-600 ml a day, salts – 1-2 g. The vitaminized, digestible dietary food is appointed.

The pharmacotherapy of heart failure allows to prolong and to considerably improve a condition of patients and quality of their life.

At heart failure the following groups of medicines are appointed:

  • warm glycosides (digoxin, , etc.) – raise a myocardium sokratimost, increase its pump function and a diuresis, promote satisfactory shipping of physical activities;
  • vazodilatator and APF inhibitors - angiotensin - the turning enzyme (enalaprit, captopril, lizinoprit, perindoprit, ramiprit) - lower a tone of vessels, expand veins and arteries, reducing thereby resistance of vessels during warm reductions and promoting increase in warm emission;
  • nitrates (nitroglycerine and its prolonged forms) – improve a krovenapolneniye of ventricles, increase warm emission, expand coronary arteries;
  • diuretics (furosemide, ) – reduce a delay of excess liquid in an organism;
  • Β-adrenoblokator () – reduce heart rate, improve krovenapolneny hearts, increase warm emission;
  • anticoagulants (acetilsalicylic to - that, ) – interfere with a tromboobrazovaniye in vessels;
  • the medicines improving metabolism of a myocardium (group B vitamins, ascorbic acid, inosine, potassium medicines).

At development of an attack of sharp left ventricular insufficiency (hypostasis of lungs) of the patient hospitalize and render urgent therapy: enter the diuretics, nitroglycerine, medicines increasing warm emission (, dopamine), carry out oxygen inhalations. At development of ascites punktsionny removal of liquid from an abdominal cavity is carried out, at emergence of a gidrotoraks - a pleural puncture. To patients with heart failure in view of the expressed hypoxia of fabrics oxygenotherapy is appointed.

Forecast and prevention of heart failure

The five-year threshold of survival of patients with heart failure makes 50%. The remote forecast is variable, severity of heart failure, the accompanying background, efficiency of therapy, a way of life etc. exert impact on it. Treatment of heart failure at early stages can compensate a condition of patients completely; the worst forecast is observed at the III stage of heart failure.

As measures of prevention of heart failure serves prevention of development of the diseases causing it (IBS, hypertensions, heart diseases, etc.), and also the factors promoting its emergence. In order to avoid progressing of already developed heart failure observance of the optimum mode of physical activity, reception of the appointed medicines, constant observation of the cardiologist is necessary.

Heart failure - treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!

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