The first signs of heart failure are the topic of the article. With heart failure may be observed:
• increased fatigue - especially with severe form;
• shortness of breath - first appears only with physical exertion, but in later stages it can also occur at rest;
■ cough with white or pink foamy expectoration, associated with fluid retention and congestive pulmonary events;
• edema - accumulation of excess fluid in tissues; localized on the shins of walking patients and in the lumbosacral region and on the hips - in the recumbent;
• weight loss - the disease is often accompanied by a decrease in appetite, nausea and vomiting;
• abdominal pain - can occur due to stagnant phenomena in the liver.
Heart failure occurs when the heart is damaged or overloaded - for example, against one of the following diseases:
• Coronary heart disease - often associated with the lesion of the myocardium of the left ventricle of the heart;
• chronic pathology of the heart muscle - for example, due to viral infections or alcoholism;
• hypertension - leads to a decrease in the elasticity of the arterial wall, which complicates the work of the heart;
• Acute or chronic myocarditis (inflammation of the heart muscle) - may be a complication of viral and bacterial infections;
■ heart defects - changes in the heart valves of an innate, degenerative nature or due to damage;
• Constriction of the aorta - congenital pathology;
• discrepancy of the minute cardiac output to the body's needs - when the organ works with a high load to saturate tissues with oxygen;
• Infringement of a venous inflow - for example, the chronic thickening of a pericardium limits inflow of blood to heart, as a result for maintenance of a circulation it works with the raised loading.
Functions of the heart
The heart is a muscle pump that pumps blood to all organs, saturating them with oxygen and nutrients. The heart commits about 100,000 strokes per day, pumping 25-30 liters of blood per minute. The heart is divided into the left and right halves, each of which consists of the atrium and the ventricle. Poor oxygenated blood from the hollow veins enters the right atrium. From here it is pumped through the right ventricle into the vessels of the lungs. The left atrium receives oxygen-enriched blood from the pulmonary circulation, then ejects it into the left ventricle, from where it is pumped to the large circulation. Heart valves prevent the return of blood. The heart muscle has its own blood supply, provided by the coronary arteries. A two-layered shell covering the heart is called the pericardium. The diagnosis of heart failure is made on the basis of clinical data, however, additional studies can clarify its causes and choose the best treatment. To suspect heart failure are symptoms such as shortness of breath and swelling.
Examination
During the diagnostics the following investigations are carried out:
• blood tests - an extensive blood test, biochemical tests to evaluate the function of the liver, kidney and thyroid gland; determination of the level of cardiac enzymes (with myocardial infarction it is increased);
• Chest X-ray of chest organs - to detect an increase in the size of the heart, the presence of fluid in the lungs, sealing the walls of the arteries;
• electrocardiogram (ECG) - in patients with heart failure, abnormal ECG changes are usually observed;
• echocardiography is a key study that assesses the function of the left ventricle, cardiac valves and pericardium; color dopplerography - used to study the state of heart valves and intracardiac blood flow;
■ cardiac catheterization - allows you to measure the pressure in the heart chambers and the main vessels;
• Load tests - allow you to evaluate the reaction of the heart to the physical load.
Patients with decompensated heart failure are usually shown hospitalization. If possible, treat diseases underlying heart failure, such as anemia. Providing rest to the patient can reduce the burden on the heart, but stay in bed should be limited to avoid the formation of blood clots in the vessels of the lower limbs. All medical manipulations are best done in a sitting position, not lying down. The food should be small portions, with the restriction of salt. Alcohol and smoking are excluded. To treat heart failure, the following drugs are used: diuretics - increase the amount of urine output, lower blood pressure, reduce swelling and dyspnea; beta-blockers - normalize the heart, slowing the heart rate, but at the beginning of their admission, a doctor's control is necessary; angiotensin-converting enzyme (ACE inhibitors) - can prevent the progression of the disease, as well as reduce mortality from chronic heart failure and myocardial infarction. The initial dose selection should take place under the supervision of the doctor.
• angiotensin II receptor antagonists - similar in their effect to ACE inhibitors, but have less side effects;
• digoxin - often causes nausea, in addition, often there are difficulties with the selection of a dose. It is used mainly to normalize the heart rhythm with arrhythmias.
Many patients are shown combined therapy with several drugs. Heart failure can develop at any age, but it is observed mainly in the elderly. Chronic heart failure suffer from 0.4 to 2% of the adult population. With age, the risk of developing heart failure gradually increases. Among all patients who go to medical institutions in Russia, 38.6% have signs of chronic heart failure. Despite the development of treatment methods, the prognosis for patients with heart failure often remains unfavorable. The survival rates among them are worse than with some common types of cancer. About 50% of patients with severe heart failure die within two years from the date of diagnosis.