Update: October 2018
Heart failure is considered to be heart failure.
a condition that is associated with a weakening of force, frequency, or
heart rate regularity.
Such disorders of the heart lead to inadequate
blood flow in tissues and organs, their oxygen starvation and
manifest a certain set of symptoms, indicating
about stagnation in circulatory circles. Heart symptoms
deficiencies in women are as common as
Why heart is weakening
With a variety of cardiac pathologies to the heart can flow
too much blood, it may be weak or difficult to pump
кровь против повышенного давления в сосудах (см. также the reasons боли
in heart). In any of these cases, the underlying disease can
complicated by heart failure, the main reasons
which is worth telling.
Миокардиальные the reasons
They are associated with the immediate weakness of the heart muscle in
- inflammation (myocarditis)
- necrosis (acute myocardial infarction)
- expansion of the cavities of the heart (dilated myocardiopathy)
- muscle wasting (myocardial dystrophy)
- myocardial eating disorders (ischemic disease, atherosclerosis
coronary vessels, diabetes mellitus).
Among the reasons are:
- compression of the heart with inflammatory effusion in the heart bag
- blood (wounds or rupture of the heart)
- atrial fibrillation
- atrial fibrillation
- paroxysmal tachycardia
- ventricular fibrillation
- overdose of cardiac glycosides, calcium antagonists,
- alcoholic myocardiopathy
Volume overload also leads to deficiency symptoms.
It is based on the deterioration of the blood flow conditions at
venous return to the heart in case of insufficiency of the heart valves,
дефектах перегородок hearts, гиперволемии, полицитемии или
blood flow resistance to cardiac output during arterial
hypertension, congenital and acquired (rheumatic) defects
hearts со стенозом клапанов и крупных сосудов, констриктивной
myocardiopathy. Another overload can be with pulmonary thromboembolism
arteries, pneumonia, obstructive pulmonary diseases and bronchial
Combined options develop with weak heart
muscle and increasing the load on the heart, for example, with complex
пороках hearts (тетраде Фалло)
How fast the problem develops
Depending on how quickly the symptoms of the heart
deficiencies, they talk about acute or chronic her
- Acute heart failure builds up over several
hours or even minutes. It is preceded by various heart
catastrophes: acute myocardial infarction, pulmonary thrombus embolism.
At the same time, the left or
правый желудочек hearts.
- Хроническая недостаточность hearts – это результат длительных
diseases. It progresses gradually and becomes heavier from
minimal manifestations to severe multiple organ failure. She is
may develop in one of the circles of blood circulation.
Acute left ventricular failure
left ventricular – a situation that can develop in two
options (cardiac asthma or pulmonary edema). Both of them
characterized by stagnation in the small vessels (pulmonary)
Their basis is impaired coronary blood flow, which is less
only remains adequate at the time of relaxation of the heart muscle
At the time of contraction (systole), the blood does not fully flow into
aorta, stagnating in the left ventricle. Increases pressure in the left
отделах hearts, а правые переполняются кровью, провоцируя легочный
Cardiac asthma это, по сути, сердечно-легочная failure.
Symptoms of it may gradually increase:
- Pathology manifests itself in the early stages of shortness of breath. Arises
initially with physical exertion, tolerance to which gradually
going down. Dyspnea is inspiratory in nature and with it, in contrast
from asthma, breathing is difficult. With further development
process, shortness of breath appears alone, forcing patients to sleep on
- Then dyspnea is replaced by episodes of suffocation, which are often
accompany night sleep. In this case, the patient has to sit in
beds, forced position with a bed
kicking and resting on your arms to give you the opportunity to work
auxiliary respiratory muscles.
- Seizures are often combined with fear of death, palpitations and
- Cough for heart failure – with poor, difficult
discharge of sputum. If you look at the face of a person at the moment
attack, you can see the blue of the nasolabial triangle on
against the background of pale grayish skin. Also noted and frequent
respiratory movements of the chest, cyanosis of the fingers. Bullets more often
Irregular and weak, low blood pressure.
Comparative characteristics of asthma in cardiac and bronchial
|Cardiac asthma||Bronchial asthma|
|Breathing pattern||Noisy, bubbling||Dry wheezing|
|Nature of difficulties breathing||Trouble breathing||Exhale difficult|
|Detachable||Lean sputum, in transition to pulmonary edema – pinkish
|A lot of transparent “glass sputum”, which is bad
|Effect of diuretic||Reduce asthma symptoms||Worsen condition|
|The result of listening to the chest||Wet fine wheezing||Резкое ослабление breathing. Wheezing|
Pulmonary edema – это значительный выпот жидкой части крови в ткань
lung. Depending on where this fluid goes, swelling
the lung is divided into interstitial and alveolar. With the first effusion
occupies the entire lung tissue, with the second – mostly alveoli,
who are clogged up with bloody sputum. Pulmonary edema develops in
any time of day or night, like a bout of sudden choking. condition
patient rapidly progressively worsens:
- growing shortage of air, shortness of breath,
- the blueness of the limbs and face
- palpitations, cold sweats
- disturbances of consciousness from motor and speech arousal
down to fainting.
- hoarse bubbling breaths heard in the distance.
- with alveolar edema, a large amount of pink is secreted
- if edema develops on the background of a decrease in cardiac output (with
myocardial infarction, myocarditis), that is, the risk of cardiogenic
Acute deficiency правого желудочка
This is an acute pulmonary heart that leads to stagnant
phenomena in the systemic circulation. Наиболее вероятные the reasons
- thrombembolia large branch of the pulmonary artery
- lung atelectasis
- asthmatic status
It may also be complicated by myocardial infarction or acute
myocarditis. Increased pressure in the pulmonary circulation
increases the load on the right ventricle and decreases blood flow
к левым отделам hearts, что снижает сердечный выброс. As a result
coronary blood flow suffers and pulmonary ventilation falls.
With such acute heart failure, symptoms
- The patient begins to be disturbed by shortness of breath and a feeling of lack
- His neck veins are inflated, which is more noticeable while inhaling.
- The face and fingers become bluish.
- Then joins the ripple in the upper abdomen, the enlargement of the liver and
heaviness in the right hypochondrium.
- Pastoznost develops, and then swelling of the legs, face and
anterior abdominal wall.
How to share chronic heart failure
In all cases when heart failure (symptoms and
organ disorders) develop slowly, speak of its chronic
form. As the symptoms increase, this option is divided into
stage. So, according to Vasilenko-Strazhesko there are three of them.
- initial stage
- I – at rest there are no manifestations of pathology.
- IA – preclinical stage, emerging only functional
- IB – symptoms of heart failure manifest themselves when
physical exertion and fully pass away in peace.
- Stage Two
- II is characterized by the presence of signs of pathology at rest.
- IIA – stagnation in a large or small circle with moderate
- IIB-disorders are detected in both circles of blood circulation.
- Stage Three
- III – dystrophic changes in organs and tissues on the background
circulatory disorders in both circles.
- IIIA – Organ disorders are treatable.
- IIIB- Dystrophic changes are irreversible.
- III – dystrophic changes in organs and tissues on the background
Modern classification of chronic heart failure
takes into account exercise tolerance and perspectivity
therapy. For this purpose, functional classes are used, which
могут меняться при успешной therapy.
- Class I – is the lack of restrictions with the usual physical
load. Increased load may be accompanied by minimal
manifestations of shortness of breath.
- Class II implies a slight limitation of physical
activity: there are no symptoms alone, but the usual load can
accompanied by shortness of breath or palpitations.
- Grade III is the appearance of symptoms with a minimum load and
lack of them alone.
- IV functional class can not withstand even
the minimum load, the symptoms are and alone.
Symptoms of chronic heart failure
This type of heart failure is often the outcome.
многих хронических сердечных diseases. It proceeds under the law
or left ventricular type, and may be total. Its mechanisms
development similar to the acute forms, but stretched in time due to
bringing oxygen starvation and dystrophy to the first place
organs and tissues.
Insufficiency of the right heart chambers
leads to disturbances in the pulmonary circulation and manifests itself
pulmonary symptoms. First place among patient complaints
- dyspnea that progresses and reduces the quality of life
- there is a need to sleep with a raised head, to occupy
periodically position orthopnea (sit with support on the hands).
- gradually cough with separation separates from shortness of breath
small amount of transparent sputum.
- as heart failure progresses
episodes of choking occur.
- for patients characterized by a grayish-bluish color of the skin,
cyanosis of the nasolabial triangle, of the hands and feet.
Fingers take the form of drum sticks. Nails become
overly convex and thickened.
Left ventricular weakness leads to changes in large
- Пациентов беспокоят сердцебиения (paroxysmal tachycardia,
atrial fibrillation, экстрасистолии), слабость и
- Edematous syndrome appears. Gradually swelling with heart
deficiencies are growing, spreading to the legs, front
abdominal wall, lower back and genitals. Massive swelling
are called anasarki.
- First, it is the pastos of the feet and legs and hidden edema,
detected during weighing.
- Нарушения кровотока в почках become причиной снижения
the amount of urine discharge up to anuria.
- An enlarged liver shows prolonged congestive heart failure.
failure. Her symptoms are heaviness and pain in the right
hypochondrium due to the tension of the edematous liver of its capsule.
- Problems with cerebral circulation lead to sleep disorders,
memory and even mental and mental disorders.
Comparative features of cardiac and renal edema
|Heart failure||Renal pathology|
|Early Stage Location||Feet, legs||Eyelids, face|
|Time of appearance||In the afternoon, in the evening||In the morning|
|Late stage localization||Legs up to hips, lower back, anterior abdominal wall, genital
|Face, loin, extensive as anasarki|
|Slew rate||Build up more slowly and get worse||They spread quickly and are easier to resolve.|
|Density||Tight swelling||Loose, “watery”|
|Enlarged liver||Characteristic||Not typical|
Heart Failure Treatment
Therapy of heart failure is carried out in two
directions. Acute forms require emergency care. Chronic
options undergo planned treatment with correction of decompensation
and long-term maintenance maintenance dosages of drugs (see new
research scientists on the effects of nat. stress on the heart).
Emergency treatment includes the prehospital phase
ambulance or doctor on an outpatient admission and inpatient
- Relief of acute left ventricular insufficiency in the form
pulmonary edema begins with giving the patient a position with
raised headboard. Oxygen inhalation with vapors
alcohol. Lasix and isosorbide dinitrate is injected intravenously at 5%
glucose. When oxygen starvation of the patient’s tissues is transferred to
mechanical ventilation (intubated trachea, previously
by introducing atropine sulfate, dormicum, relanium and ketamine).
- Symptoms of acute right ventricular failure on the background
pulmonary artery thromboembolism include oxygen therapy, the introduction of
reopoliglukina and heparin (with a stable blood pressure). AT
If hypotension is injected, dopamine or adrenaline is administered. If coming
clinical death, conduct cardiopulmonary resuscitation.
Chronic Heart Failure Treatment
Chronic heart failure requires comprehensive
approach. Treatment includes not only drugs, but involves
diet with a decrease in fluid (up to 2.5 liters per day) and salt (up to 1 g per
day). Therapy is conducted using the following groups of drugs.
They reduce venous return to the heart and allow you to cope with
swelling. Preference is given to saluretics (furosemide, lasix,
torasemide, indapamide) and potassium-sparing (triampur,
spironolactone, veroshpiron). Aldosterone antagonists (veroshpiron) –
drug of choice in the treatment of refractory edema.
- ACE inhibitors
They reduce preload and congestion in the lungs, improve renal
blood flow and remodeling the heart muscle, enriching the heart
– Captopril (kapoten), enalapril (Enap) are used,
perindopril (prestarium), lisinopril (diroton). Fozinopril
(monopril), ramipril (tritace). This is the main group that
поддается хроническая сердечная failure. Treatment is carried out
minimum maintenance dosages.
– Medium and long-acting cardiac glycosides: digoxin
(cedoxin) and digitoxin (digofton). Most preferred
cardiac glycosides when there are atrial fibrillation
сердечная failure. Treatment of III and IV functional classes
also requires their appointment. Drugs increase the strength of contractions.
mitocardium, reduce the frequency of contractions, reduce the size of the extended
reduce tachycardia and myocardial neediness in oxygen. After
two weeks of adaptation to drugs, cardiac output increases.
Metoprolol succinate (betalok ZOK), bisoprolol (Concor), nebivolol
Heart failure treatment is carried out for a long time under
observation by a cardiologist and a therapist. Subject to all recommendations
specialists can compensate for pathology, maintain quality
life and prevent the development of decompensation.