Classification of chronic heart failure - signs, degrees and functional classes. Approximate formulations of diagnoses of arterial hypertension

Depending on the severity of symptoms, three degrees of severity of chronic heart failure are distinguished:

• 1 degree - compensated (mild);
• 2 degree - subcompensated (moderate), it, in turn, is divided into degrees 2a and 2b;
• Grade 3 - decompensated irreversible (severe).

First degree chronic heart failure

The main symptoms of chronic heart failure of the first degree are fatigue, irritability, and poor sleep. With significant physical exertion, prolonged conversation, shortness of breath appears (especially often after a heavy meal). Pulse quickened, especially after exercise. On examination, auscultation, the doctor detects symptoms characteristic of a heart disease that led to the development of heart failure, but often they are not pronounced.

After competent treatment, the patient's condition quickly normalizes, the symptoms of heart failure disappear.

Second degree

The second degree of chronic heart failure is divided into degrees 2a and 2b.

At grade 2a, shortness of breath occurs even with little physical exertion. Patients complain of insomnia, loss of appetite, rather strong heartbeat, heaviness in the right hypochondrium. Data objective examination similar to those in the first stage, but all pathological abnormalities are expressed to a much greater extent.

As in the first stage, after treatment, the patient's condition returns to normal, almost complete compensation occurs.

At grade 2b, the patient's condition is much more severe. Shortness of breath periodically occurs at rest, the abdomen is swollen, the liver is enlarged and painful, disturbs strong pain in the right hypochondrium, regular sleep disturbances. There are swelling on the legs, cyanosis of the skin. The pulse reaches 100 beats per minute even at rest. Sometimes there are pains in the chest, hemoptysis. However, it is still possible to achieve full compensation, in some cases even for many months.

Third degree of chronic heart failure

At this stage of the disease, the patient's condition is severe, shortness of breath constantly torments, edema spreads to the whole body, accompanied by cyanosis of the skin and mucous membranes, sometimes with a yellowish tinge. Coughing often produces bloody sputum. Moist rales are well heard in the lungs. pulse is frequent and weak. Often there are arrhythmias.

Heart failure of the third degree, unlike the second, is irreversible. Improving the condition with proper treatment is possible, but it is short-lived. At this stage, both in the heart and in other organs, severe irreversible disorders develop, affecting the nervous system. Drowsiness and depression alternate with periods of insomnia, mental agitation and confusion. Joining at this stage bacterial infection almost always leads to a sad outcome.

Thus, in the treatment of chronic heart failure, it is very important to prevent the development of the pathological process to the third degree, at which modern medicine unable to cope with the growth of irreversible changes in the body.

Mitral valve insufficiency 1, 2, 3 degrees: causes, diagnosis and treatment

Causes

All causes of mitral valve insufficiency are divided into those that appeared during the laying of organs (congenital) and acquired. The latter include:

Congenital changes include:

The causes of the defect may be associated with congenital changes, hereditary pathology, or be the result of acquired diseases.

Classification

The leading factor in the pathogenesis of mitral valve insufficiency is reverse blood flow, or regurgitation. Given the volume of the countercurrent, there are several degrees of mitral insufficiency:

According to the clinical course, mitral valve insufficiency can be acute or chronic. The first type of pathology is usually associated with sudden changes, for example, rupture or ischemia of the papillary muscles in an inferior myocardial infarction. The chronic course is characterized by a gradual increase in insufficiency against the background of a sluggish process, for example, with a gradual transformation of the heart in dilated cardiomyopathy or in rheumatic disease.

Symptoms

Symptoms of mitral valve insufficiency in a compensated state may be absent or appear only with intense exercise. In the future, in the chronic course of the disease, the transformation of the left ventricle gradually occurs, since it has a large load. This condition leads to the expansion of its cavity and thickening of the walls (hypertrophy). First, there is a lack of blood flow in a small circle, and then in a large one. With secondary right ventricular failure, it is possible to identify:

At acute development mitral insufficiency, the heart chambers do not have time to adapt to new hemodynamic conditions, so the symptoms of left ventricular failure come first.

Heart failure classification and clinical manifestations.

In practical medicine, heart failure has several classifications. Distinguish according to the form of the course of the process, the localization of the pathology and the degree of development of the disease. In any case, heart failure is a clinical syndrome that develops as a result of insufficient "pumping" function of the myocardium, which leads to the inability of the heart to fully meet the energy needs of the body.

Along the course, chronic and acute forms of heart failure are distinguished.

Chronic heart failure.

This form of heart failure is most often a complication and a consequence of some kind of cardiovascular disease. It is the most common and often asymptomatic. long time. Any disease of the heart eventually leads to a decrease in its contractile function. Usually, chronic heart failure develops against the background of myocardial infarction, coronary artery disease, cardiomyopathy, arterial hypertension, or valvular heart disease.

As statistics show, it is heart failure that is not treated in time that most often causes death in patients with heart disease.

Acute heart failure.

Under acute heart failure, it is customary to consider suddenly rapidly sharply evolving process- from several days to several hours. Typically, this condition appears against the background of the underlying disease, and it will not always be heart disease or exacerbation of chronic heart failure, as well as poisoning the body with cardiotropic poisons (organophosphorus insecticides, quinine, cardiac glycoside, and so on).

Acute heart failure is the most dangerous form of the syndrome, which is characterized by sharp decline contractile function of the myocardium or with stagnation of blood in various bodies.

According to localization, right ventricular and left ventricular heart failure is distinguished.

With right ventricular failure, there is stagnation of blood in the systemic circulation due to damage and / or excessive load on the right side of the heart. This type syndrome is usually typical for constrictive pericarditis, malformations of the tricuspid or mitral valves, myocarditis various etiologies, severe coronary artery disease, congestive cardiomyopathy, and also as a complication of left ventricular failure.

Right ventricular heart failure is manifested by the following symptoms:

- swelling of the neck veins,

- acrocyanosis (cyanosis of the fingers, chin, ears, tip of the nose)

- increased venous pressure,

- swelling of varying degrees, ranging from evening edema of the legs to ascites, hydrothorax and hydropericarditis.

- Enlargement of the liver, sometimes with pain in the right hypochondrium.

Left ventricular heart failure characterized by stagnation of blood in the pulmonary circulation, which leads to impaired cerebral and / or coronary circulation. Occurs when overload and / or damage to the right heart. This form of the syndrome is usually a complication of myocardial infarction. hypertension. myocarditis. aortic heart disease, left ventricular aneurysm and other lesions of the left calving of the cardiovascular system.

Typical symptoms of left ventricular heart failure:

- in violation of cerebral circulation, dizziness, fainting, darkening in the eyes are characteristic;

- in case of violation of the coronary circulation, angina pectoris develops with all its symptoms;

- a severe form of left ventricular heart failure is manifested by pulmonary edema or cardiac asthma;

- in some cases, violations of the coronary and cerebral circulation and, accordingly, symptoms can also be combined.

Dystrophic form of heart failure.

This is the final stage of right ventricular failure. It is manifested by the appearance of cachexia, that is, depletion of the whole organism and dystrophic changes in the skin, which manifest themselves in an unnatural luster of the skin, thinning, smoothing of the pattern and excessive flabbiness. In severe cases, the process reaches anasarca, that is, total edema of the body cavities and skin. There is a violation in the body of water-salt balance. A blood test shows a decrease in albumin levels.

In some cases, there is both left and right ventricular failure. This usually occurs with myocarditis, when right ventricular failure becomes a complication of untreated left ventricular failure. Or in case of poisoning with cardiotropic poisons.

According to the stages of development, heart failure is divided according to the classification of V.Kh. Vasilenko and N.D. Strazhesko into the following groups:

preclinical stage. At this stage, patients do not feel any special changes in their condition and is detected only when testing with certain devices in a load state.

I the initial stage is manifested by tachycardia, shortness of breath and fatigue, but all this is only under a certain load.

II stage is characterized by stagnation in tissues and organs, which are accompanied by the development of reversible dysfunctions in them. Here are the sub-stages:

IIA stage - not pronounced signs of stagnation, occurring only in a large or only in a small circle of blood circulation.

IIB stadia is a pronounced edema in two circles of blood circulation and obvious hemodynamic disturbances.

III stage - The symptoms of IIB heart failure are accompanied by signs of morphological irreversible changes in various organs due to prolonged hypoxia and protein degeneration, as well as the development of sclerosis in their tissues (cirrhosis of the liver, hemosiderosis of the lungs, and so on).

There is also a classification of the New York Heart Association (NYHA), which divides the degree of development of heart failure based solely on the principle functional evaluation the severity of the patient's condition. At the same time, hemodynamic and morphological changes in both circles of blood circulation are not specified. In practical cardiology, this classification is the most convenient.

I FC- No limit physical activity of a person, shortness of breath manifests itself when rising above the third floor.

II FC- a slight limitation of activity, palpitations, shortness of breath, fatigue and other manifestations occur exclusively during physical activity of the usual type and more.

III FC- Symptoms appear with the slightest physical activity, which leads to a significant decrease in activity. At rest, clinical manifestations are not observed.

IV FC- Symptoms of HF appear even in the while state and increase with the slightest physical exertion.

When formulating a diagnosis, it is best to use the last two classifications, as they complement each other. Moreover, it is better to indicate first according to V.Kh. Vasilenko and N.D. Strazhesko, and next in brackets according to NYHA.

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Causes of CHF development, risk factors

The main cause of this pathology is a noticeable decrease in the filling of the heart with blood, as a result of which the ejection of fluid from the artery will also be reduced.

Because of this violation, there is a decrease in EF (that is, cardiac output fraction). In a healthy adult, calm state EF should be 4.5-5 l / min. This amount of blood is sufficient for normal provision body with oxygen.

Sometimes heart failure occurs as a result of damage to the myocardium or other structures of this organ.

Often the cause of the pathology is cardiac causes or an increased need for oxygen in the tissues of the body.

The main cardiac factors are:

1. Serious violations. For example, heart attack, coronary artery disease and inflammation of the heart muscle. Due to necrosis or tissue damage, the muscle loses its elasticity and is not able to contract at full strength.
2. Heart disease or injury. As a result of these changes, the heart is unable to provide a normal blood supply.
3. Dilated, as well as hypertrophic cardiomyopathy, leading to a decrease in muscle elasticity.

Heart failure occurs due to stress, bad habits or due to hard physical labor.

Often chronic view diseases can be triggered by improper medication.

This reaction occurs in antiarrhythmic drugs or NSAIDs.

Classification of pathology and symptoms of CHF 2 degrees

Heart failure is conditionally divided into several stages, each of which has its own characteristics:

Depending on the severity of CHF, it is customary to classify into 4 FCs (functional class):

1. If a person has FC I, he is able to normally tolerate physical activity, the result of a strong load will be shortness of breath and fatigue.
2. In FC II, the patient's activity will be moderately limited.
3. In FC III, habitual activity is noticeably limited due to pronounced symptoms.
4. With IV FC, it will no longer be possible to carry out the necessary load without pain, and the signs of pathology appear even at rest.

Features of the second degree of CHF

At grade 1A, the symptoms are mild, mainly due to increased stress. The result of this is left ventricular failure (the left heart is affected). The patient will have a displaced left heart border, asthma attacks appear, the liver changes size (increases).

If the right heart sections are affected, signs of circulatory stagnation are noticeable (in a large circle). The result of this is acrocyanosis, ascites and tachycardia. All boundaries of the heart expand. When CHF is in the second degree - 2B, significant disturbances are noticeable, because two circles (large and small) lack blood circulation.

The patient complains of shortness of breath, palpitations, weakness. The person cannot lie on their back and develops orthopnea. In addition, the boundaries of the heart expand, the liver enlarges, and sometimes extrasystole appears.

How to treat CHF

Heart failure must be treated in a timely manner to prevent further deterioration of the patient's condition. However, in addition to high-quality drug therapy, and sometimes surgical intervention diet is recommended. In addition, it is necessary to take care of rational physical activity, as well as psychological rehabilitation.

The most effective drugs for CHF are beta-blockers, special ACE inhibitors, cardiac glycosides, etc. In addition to the main funds, sometimes there is a need for additional (statins and anticoagulants) and auxiliary drugs.

Electrophysiological methods of treatment should be distinguished. It is required if drug therapy did not bring the desired result. The operation for the implantation of a pacemaker, the use of some types of cardiac stimulation, etc., has proven itself well.

In the most severe cases of heart failure, a heart transplant or implantation of artificial ventricles is required.

Comprehensive therapy for CHF must necessarily include proper nutrition. In order to prevent disability and get rid of pathology, it is important to limit the amount of salt consumed, and in case of severe swelling, do not drink a lot of fluids. It is preferable to focus on high-calorie foods that contain a lot of vitamins and protein.

In the treatment of CHF 2 FC 2 shows physical activity. However, it is necessary to correctly determine the most appropriate level of exercise for the patient. An assistant in this will be a special walking test.

Through daily brisk walking, the patient improves exercise tolerance and the effectiveness of therapy. After stopping treatment, it is recommended to make rational exercise part of everyday life.

Timely diagnosed CHF will help prevent its development to the terminal III stage. This pathology primarily affects the elderly, therefore, if unusual symptoms occur, it is recommended to seek qualified medical advice in a timely manner.

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Disease Definition

Millions of people around the world today suffer from heart failure. The number of such patients is increasing year by year. What is heart failure and how to deal with it?

From school course biology, we know that our body is directly dependent on the operation of a pump called the “heart”. Throughout our lives, it is constantly working to deliver oxygenated and nutrient-rich blood to every cell in the body. When the nutrition of the cells is sufficient, the body functions normally.

In heart failure, a weakened heart is unable to provide the cells with the necessary amount of blood. Fatigue and shortness of breath develop. Any manipulation, even as simple as climbing stairs, walking or carrying food, is difficult for the body.

On the initial stage development, heart failure leads to an increase in the chambers of the heart. So the heart throws out more blood. Increasing load leads to an increase in the heart muscle. This allows the heart to pump more blood. However, over time, these measures do not help - the heart "gets tired", its capabilities are depleted.

The body as a whole also tries to compensate for the lack of blood with all possible methods. blood vessels constrict to keep blood pressure to compensate for the weakness of the heart muscle. The body diverts blood away from less important organs and tissues to maintain circulation to the most vital organs, the heart and brain.

These temporary measures may mask the problem called "heart failure" for a while, but not solve it. Eventually, the heart will be unable to meet the needs of the body, and the person will feel tired, breathing problems, etc. anxiety symptoms- Tips for visiting a cardiologist.

The presence of compensatory mechanisms of the body explains why some people may not realize the deplorable state of their condition at a time when heart failure is already on the threshold. This, by the way, is an excellent argument in favor of regularly being examined by a doctor.

Causes

Now you need to figure out how heart failure occurs and what causes contribute to the progression of the disease. The most common cause of heart failure is various diseases of cardio-vascular system. The most common of these is the narrowing of the arteries that deliver oxygen to the heart muscle. Vascular diseases occur in youth, and often they are left without proper attention. With age, congestive heart failure may develop against their background.

Heart failure syndrome can aggravate the course of almost all diseases of the heart and blood vessels. But its main "partners" are arterial hypertension and coronary heart disease (or a combination of these diseases). Often, cardiologists in their practice note that cardiovascular insufficiency can occur with heart attacks and angina pectoris.

Among the reasons contributing to the development of such a formidable disease as heart failure, one should name: changes in the structure of the heart valves, thyroid diseases (hyperthyroidism), infectious lesions heart muscle (myocarditis).

Heart failure in children can manifest itself as a complication of many infectious diseases:

As you can see, there are no “non-serious” infections. Almost any, in the absence of qualified treatment, can lead to serious complications in the heart.

Chronic heart failure can be caused by alcohol and drug addiction, excessive physical activity, and even a sedentary lifestyle.

Recently, a study was conducted in the United States on the causes of sudden death of taxi drivers. It turned out that prolonged sitting in a car causes a slowdown in blood flow, the formation of blood clots and, as a result, heart failure.

During pregnancy in women with various pathologies blood vessels or the heart due to an increase in the load on the heart, severe heart failure can develop.

Heart failure often occurs in people with diabetes and diseases endocrine system generally. In short, everything that overloads the blood vessels and the heart can lead to a disease. To exacerbate the disease lead (in addition to physical overstrain): poor nutrition, lack of vitamins, poisoning, stress.

Varieties of heart failure

According to the duration of development, heart failure is divided into two forms:

Acute heart failure that develops at lightning speed (from several minutes to several hours). Its manifestations are pulmonary edema, cardiac asthma and cardiogenic shock. Acute cardiovascular failure occurs with myocardial infarction, rupture of the wall of the left ventricle, acute insufficiency of the mitral and aortic valves. Chronic heart failure (unlike acute heart failure) develops slowly and develops over weeks, months, or even years. Diseases such as heart disease, hypertension, chronic respiratory failure, and prolonged anemia can cause chronic heart failure.

In turn, chronic heart failure is divided into three degrees according to the severity of the course (classification by Vasilenko V.Kh. and Strazhesko N.D., proposed in 1935):

Heart failure of the 1st degree is the initial latent circulatory failure. It manifests itself in the form of shortness of breath, palpitations, excessive fatigue. At rest, these symptoms disappear. Heart failure of the 2nd degree is characterized by the appearance of cardiovascular disorders at rest. If the patient has severe circulatory disorders, persistent changes in metabolism and irreversible changes in the structure of organs and tissues, then there is a heart failure of the 3rd degree.

To date, a different classification has been adopted in the world (proposed by the New York Heart Association (NYHA)). In accordance with it, all patients who are diagnosed with heart failure belong to one of four categories, depending on the limitation of their physical activity:

Class 1. Physical activity is not limited and the patient's quality of life does not suffer. Class 2. Moderate limitation of physical activity and no discomfort during rest. Grade 3. Severe decrease in performance, however, symptoms disappear during rest. Class 4. Complete or partial loss of working capacity. Heart failure, accompanied by chest pain, manifests itself even at rest.

Depending on the affected area, there are:

Left ventricular heart failure - develops as a result of an overload of the left ventricle. For example, due to narrowing of the aorta. Also, this type of insufficiency can occur due to a decrease in the contractile function of the heart muscle. This can occur with myocardial infarction. Right ventricular heart failure - develops when the right ventricle is overloaded (for example, with pulmonary hypertension). In the case when there is a simultaneous overload of the right and left ventricles, mixed heart failure develops.

Symptoms of the disease

How does heart failure manifest itself? The symptoms of the disease depend not only on the stage of heart failure, but also on which part of the heart does not cope with its work.

People who experience any of the symptoms associated with heart failure, even if they are mild, should see a doctor as soon as possible. When making a diagnosis, it is important to monitor symptoms and report any sudden changes. The main signs of heart failure:

Shortness of breath or difficulty breathing is one of the most common symptoms. When the heart begins to fail, it ceases to cope with the blood entering it. In this case, stagnation and overflow of the vessels of the lungs occur, which interferes with normal breathing. In the early stages, shortness of breath in heart failure occurs with exercise or other activity. When the condition worsens, shortness of breath can bother even at rest or sleep. Chronic cough in heart failure is also not uncommon. The accumulation of fluid in the lungs causes persistent cough and noisy wheezing. In this case, viscous sputum can be released, sometimes with an admixture of blood. Fatigue and increased fatigue. As heart failure progresses, the heart is unable to pump enough blood to meet all of the body's needs. To compensate, blood is diverted from less important areas, including the limbs, in favor of the heart and brain. As a result, people with heart failure often feel weak (especially weak in the arms and legs), tired, and have difficulty performing normal daily activities. Heart palpitations. By increasing the frequency of contractions, the heart tries to compensate for its weakness and inability to adequately pump blood throughout the body. Edema in heart failure usually appears in the later stages of the disease. congestion in the vessels and a decrease in blood flow to the kidneys leads to the retention of salt and water in the body. As a result, edema develops. Edema is located mainly on the ankles and legs, symmetrically. Swelling of the legs in heart failure increases slowly, over weeks or months. Edema is dense, leaving a hole when pressed. Abdominal edema or ascites in heart failure is accompanied by an increase in the liver and indicates a further deterioration in blood circulation.

Diagnostics

Heart failure refers to such diseases, in the diagnosis of which it is important not just one proven method, but a combination of diagnostic methods.

The significance of symptoms and clinical manifestations is extremely high. It is they who help the cardiologist to suspect the patient has a syndrome of heart failure. Remember: heart failure detected in time is a prognosis for a long life.

In addition to the complaints described above, the sounds emitted by the chest can tell a lot about the presence and degree of heart failure to an experienced doctor. Since in patients with progressive heart failure, along with increased respiration, its character may also change.

With the help of a stethoscope, the doctor can hear various wheezing in the lungs, determine whether the fluid is only in lung tissue or has already accumulated in the pleural cavity.

Characteristic noises in violation of the heart valves, increased heart rate may also indicate heart failure of one degree or another.

X-ray examination of organs chest allows you to identify stagnation of fluid in the lungs and an increase in the shadow of the heart (signs of left-sided heart failure).

Modern instrumental diagnostics heart failure allows you to finally establish concomitant changes in the heart and determine the degree of damage to it. In this case, well-known electrocardiography and echocardiography are used, as well as new methods of diagnostic imaging: radioisotope angiocardiography and coronary cardiography.

Treatment and emergency care

Once diagnosed, the question arises of how to treat heart failure? Therapeutic measures depend on the cause of heart failure, its type, severity of the course and how well your body can compensate for it.

Acute heart failure

Emergency care for heart failure can save a life. Remember: acute heart failure develops very quickly. With a lightning-fast course, death can occur within two to three minutes. Acute heart failure is an extremely severe pathology, the patient should be hospitalized in the intensive care unit without delay.

The symptoms of a disease such as heart failure should be known to both the patients themselves and their relatives in order to provide timely assistance even at the pre-medical stage. Acute heart failure is manifested by a rapid increase in shortness of breath, wheezing rapid breathing appears, the skin turns blue, and blood pressure rises. In the future, frothy, sometimes pinkish sputum appears on the patient's lips, which indicates an increase in pulmonary edema.

First aid for heart failure: Call immediately ambulance. Try to calm the patient - anxiety can aggravate his condition. Provide unhindered access to oxygen (open windows). Before the arrival of doctors, bring the patient to a half-sitting position. This will ensure the outflow of blood from the lungs to the lower extremities. After 10 minutes, apply tourniquets to the thigh area to reduce the volume of circulating blood.

Give the patient 1-2 nitroglycerin tablets under the tongue. The drug must be given every ten minutes, with the obligatory measurement of blood pressure.

In case of cardiac arrest, be sure to start artificial heart massage without waiting for the arrival of an ambulance. All further medical measures should only be carried out by qualified medical personnel in a cardiac intensive care setting.

Chronic heart failure

Treatment of chronic heart failure is long and requires the patient to constantly monitor the state of the body.

Medications for heart failure are selected individually, taking into account the stage of the disease and the state of the body as a whole. Self-medication with this pathology is unacceptable.

How and what to take in heart failure, only a qualified cardiologist should decide. What does the medical treatment of heart failure include?

ACE inhibitors. The first priority is to lower blood pressure. For these purposes, ACE inhibitors (enalapril, lisinopril and captopril) are most often used. These drugs dilate blood vessels, thereby lowering blood pressure in heart failure, improving blood circulation and reducing the load on the heart. Another group of drugs are beta-blockers (carvedilol, metoprolol and bisoprolol). This class of drugs not only slows the heart rate and lowers blood pressure, but also normalizes the heart rhythm. Diuretics. Treatment of edema in heart failure is an equally important task. With the progression of the disease, congestion in the lungs can develop extremely quickly. Pulmonary edema in heart failure is one of the formidable complications, often leading to death. However, we should not forget that diuretics in heart failure, along with water, remove potassium and magnesium from the body. The lack of these trace elements can seriously worsen the patient's condition. Therefore, when taking diuretics, it is necessary to make up for the lack of these substances in the body. In order to quickly remove fluid from the body and reduce the load on the heart, diuretics (lasix, indapamide, bumetanide) are used. In severe cases, to enhance the effect, the doctor may prescribe several drugs at once. Glycosides. In the treatment of patients with heart failure, it is extremely important to restore myocardial contractility. For these purposes, drugs called cardiac glycosides (digoxin, corglicon, strophanthin) are used. Once in the body, they increase the force of contractions of the heart muscle and slow down the heartbeat. Cardiac glycosides are highly effective drugs for the treatment of heart failure. However, they should be used with great caution, under the supervision of a physician.

If medical treatment for heart failure does not work, or if the patient has heart defects that are interfering with the course of the disease, the doctor may suggest surgery.

Diet for heart failure

Treatment and prevention of heart failure begins with diet. Nutrition for heart failure should be high-calorie, easily digestible and adjusted in relation to the daily intake of fluid and salt. Most suitable mode nutrition - fractional (5-6 times a day). Strong tea, coffee, chocolate must be excluded from the diet. It is strongly recommended not to eat spicy dishes, smoked meats. Alcohol in heart failure is strictly contraindicated!

The amount of salt is usually no more than 3-4 grams. per day. If the patient's condition worsens and edema increases, cardiologists may recommend a salt-free diet to the patient.

The diet for heart failure also includes a reasonable restriction of fluid intake. Usually daily water intake is limited to 1200-1500 ml. per day, including all liquid dishes (soups, teas, jelly, etc.).

Potassium is especially necessary for patients taking diuretics and cardiac glycosides.

With mild heart failure, especially at an early stage, it is enough to change lifestyle and nutrition. In many cases, this helps to completely get rid of swelling, shortness of breath, normalize weight and, thereby, remove unnecessary stress from the heart.

Folk remedies

Folk remedies for heart failure are widely used; even many eminent cardiologists use them in their practice.

long-term development and chronic course disease makes it possible to use natural and herbal medicines. Here are some of the most popular folk recipes for the treatment of this disease.

If you or your family has been diagnosed with heart failure, elecampane will help. Dig up elecampane roots in early spring or late fall. Rinse, cut and dry in the oven. To prepare the medicine, you will need a decoction of oats. To do this, fill half a glass of unpeeled grains with 0.5 liters. water and bring to a boil over low heat. Then take a third of a glass of elecampane roots and pour the resulting decoction. Bring this composition back to a boil and insist for two hours. Then strain and add two tablespoons of honey. The resulting remedy must be taken in half a glass before meals, three times a day, for two weeks. Heart failure can be cured if you use next recipe: 2 tbsp. l. chop green or dry bean pods and pour 750 ml. water. Bring to a boil and cook for five minutes. Then take 1 tsp. chopped leaves of motherwort, leaves or flowers of hawthorn, lemon balm, mint, leaves or flowers of lily of the valley. Pour into boiling water with bean pods. Boil for another three minutes. Infuse for four hours, then strain. Store the resulting decoction in the refrigerator. A single dose of the drug is 4 tbsp. l. To the composition each time before taking it is necessary to add 20 drops of Zelenin. Take 3 times a day 20 minutes before meals. With pain in the heart, the following helps well folk method: take 0.5 kg. ripe hawthorn fruits, rinse and pour 1 liter. water. Boil on low heat for 20 minutes. Strain, add 2/3 cup sugar and the same amount of honey. Mix thoroughly. Take daily for a month, 2 tbsp. before eating. Store the composition in the refrigerator. Use healing properties viburnum and heart failure will leave you. Therapeutic effect Viburnum berries were known to our ancestors even in ancient times. Kalina is eaten both fresh and frozen. You can make a tincture of viburnum. To do this, take a tablespoon of viburnum, mash it so that the berries release juice. Add a tablespoon of honey and pour a glass of boiling water over it. Then insist for an hour. Take half a glass of medicine twice a day for a month. Take a break. Carry out such treatment 4 times a year. You can make jam (or jam) from viburnum and fill pies with it. This delicacy is an excellent means of preventing heart failure. Take 3 parts of yarrow herb and one each of lemon balm leaves and valerian root. Pour a tablespoon of the resulting collection into 0.5 liters. cold water and insist 3 hours. Then boil and after cooling strain. Infusion take a glass daily. If swelling occurs, rub 0.5 kg. pulp raw pumpkin and eat this amount daily. Can I drink pumpkin juice- 0.5 l. in a day. Get rid of edema and grated potatoes, which must first be peeled. It is used in the form of compresses on the edematous area. Secure the potatoes with a cloth. Hold the compress for twenty minutes. 2 tbsp. l. needles of spruce and birch leaves, pre-chopped, pour 2 glasses of water. Bring the composition to a boil and cook for 20 minutes over low heat. When the broth has cooled, strain. Take 4 times a day 30 minutes before meals, one fourth of a glass. The course of treatment is two months. Here is another proven recipe for heart failure: crushed harrow roots, birch leaves, flaxseed in a ratio of 3:3:4. Pour the resulting collection with a glass of boiling water. Let it brew for half an hour. Take 25 gr. three times a day, half an hour before meals. The course of treatment is not limited. For the treatment of myocardial dystrophy, chronic heart failure, arrhythmias can be used next remedy. Take 10 ml. the following alcohol tinctures: May lily of the valley, foxglove, arnica, mix with tinctures of hawthorn leaves and flowers (20 ml each). Take the composition 3 times a day before meals, 30 drops. Since this remedy is potent, it is necessary to consult a doctor before treatment.

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Why does the heart weaken?

With a variety of cardiac pathologies, too much blood may flow to the heart, it may be weak or difficult to pump blood against increased pressure in the vessels (see also causes of pain in the heart). In any of these cases, the underlying disease can be complicated by heart failure, the main causes of which are worth talking about.

Myocardial causes

They are associated with direct weakness of the heart muscle as a result of:

• inflammation (myocarditis)
• necrosis ( acute infarction myocardium)
• expansion of the cavities of the heart (dilated myocardiopathy)
• muscle wasting (myocardial dystrophy)
• myocardial malnutrition (ischemic disease, atherosclerosis of the coronary vessels, diabetes mellitus).

Among the reasons:

• compression of the heart by an inflammatory effusion in the heart sac (pericarditis)
• blood (with injuries or ruptures of the heart)
• fibrillation due to electric shock
• atrial fibrillation
• paroxysmal tachycardia
• ventricular fibrillation
• overdose of cardiac glycosides, calcium antagonists, adrenoblockers
• alcoholic myocardiopathy

Volume overload also leads to symptoms of heart failure.

It is based on the deterioration of blood flow conditions with an increase in venous return to the heart with heart valve insufficiency, defects in the septa of the heart, hypervolemia, polycythemia, or resistance to blood flow to cardiac output in arterial hypertension, congenital and acquired (rheumatic) heart defects with stenosis of valves and large vessels, constrictive myocardiopathy. Another overload can be with pulmonary embolism, pneumonia, obstructive pulmonary disease and bronchial asthma.

Combined variants develop with weakness of the heart muscle and an increase in the load on the heart, for example, with complex heart defects (Tetralogy of Fallot)

How fast the problem develops

Depending on how quickly the symptoms of heart failure increase, they speak of its acute or chronic variants.

• Acute heart failure develops over several hours or even minutes. It is preceded by various cardiac catastrophes: acute myocardial infarction, pulmonary embolism. In this case, the left or right ventricle of the heart may be involved in the pathological process.
• Chronic heart failure is the result of long-term illnesses. It progresses gradually and worsens from minimal manifestations to severe multiple organ failure. It can develop along one of the circles of blood circulation.

Acute left ventricular failure

Acute deficiency left ventricle is a situation that can develop in two ways (cardiac asthma or pulmonary edema). Both of them are characterized by congestion in the vessels of the small (pulmonary) circle.

Their basis is disturbed coronary blood flow, which remains more or less adequate only at the moment of relaxation of the heart muscle (diastole).

At the time of contraction (systole), blood does not completely enter the aorta, stagnating in the left ventricle. Pressure builds up in the left side of the heart, and the right side overflows with blood, causing pulmonary congestion.

cardiac asthma

Cardiac asthma is essentially cardiopulmonary insufficiency. Its symptoms may gradually increase:

• Pathology is manifested in the early stages of shortness of breath. Occurs initially with physical activity, tolerance to which gradually decreases. Shortness of breath is inspiratory in nature and, unlike bronchial asthma, it is difficult to inhale. At further development process, shortness of breath appears at rest, forcing patients to sleep on higher pillows.
• Then shortness of breath is replaced by episodes of suffocation, which often accompany night sleep. In this case, the patient has to sit up in bed, take a forced position with his legs lowered from the bed and leaning on his hands to enable the auxiliary respiratory muscles to work.
• Often attacks are combined with fear of death, palpitations and sweating.
• Cough in heart failure - with scanty, difficult to separate sputum. If you look at a person's face at the time of the attack, you can see the blue of the nasolabial triangle against the background of pale or grayish skin. There are also frequent respiratory movements chest, cyanosis of the fingers. The bullet is often irregular and weak, blood pressure is reduced.

Comparative characteristics of suffocation in cardiac and bronchial asthma

Pulmonary edema

Pulmonary edema is a significant effusion of the liquid part of the blood in lung tissue. Depending on where this fluid enters, pulmonary edema is divided into interstitial and alveolar. With the first, the effusion occupies the entire lung tissue, with the second, it is mainly the alveoli, which are clogged with bloody sputum. Pulmonary edema develops at any time of the day or night, as an attack of sudden suffocation. The patient's condition rapidly progressively worsens:

• increasing shortness of breath, shortness of breath,
• cyanosis of the extremities and face,
• palpitations, cold sweat
• disturbances of consciousness from motor and speech excitement up to fainting.
• hoarse, gurgling breathing can be heard in the distance.
• secreted in alveolar edema a large number of pink foam.
• if edema develops against the background of a decrease in cardiac output (with myocardial infarction, myocarditis), then there is a risk of developing cardiogenic shock.

Acute right ventricular failure

It's spicy cor pulmonale, which leads to congestion in the systemic circulation. Most probable causes its occurrence:

• thromboembolism of a large branch of the pulmonary artery
• pneumothorax
• lung atelectasis
• asthmatic status

It can also aggravate myocardial infarction or acute myocarditis. High blood pressure in the pulmonary circulation increases the load on the right ventricle and reduces blood flow to the left heart, which reduces cardiac output. As a result, coronary blood flow suffers and pulmonary ventilation decreases.

With such acute heart failure, the symptoms are as follows:

• The patient begins to be disturbed by shortness of breath and a feeling of lack of air.
• His neck veins swell, which is more noticeable on inspiration.
• The face and fingers become blue.
• Further, a pulsation in the epigastrium joins, an increase in the liver and heaviness in the right hypochondrium.
• Pastosity develops, and then swelling of the legs, face and anterior abdominal wall.

How is chronic heart failure classified?

In all cases, when heart failure (symptoms and organ disorders) develops slowly, they speak of its chronic form. As symptoms increase, this option is divided into stages. So, according to Vasilenko-Strazhesko there are three of them.

• initial stage
  • I - at rest there are no manifestations of pathology.
  • IA - preclinical stage, detected only by functional tests.
  • IB - symptoms of heart failure manifest themselves with physical exertion and completely resolve at rest.

• Stage two
  • II is characterized by the presence of signs of pathology at rest.
  • IIA - stagnation in a large or small circle with moderate manifestations at rest.
  • IIB- violations are detected in both circles of blood circulation.

• Stage three
  • III - dystrophic changes in organs and tissues against the background of circulatory disorders in both circles.
  • IIIA - Organ disorders are treatable.
  • IIIB- Dystrophic changes are irreversible.

The modern classification of chronic heart failure takes into account exercise tolerance and the prospects of therapy. For this, functional classes are used, which can change with successful therapy.

• Class I - this is the absence of restrictions with the usual physical activity. 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 at rest, and habitual exercise may be accompanied by shortness of breath or palpitations.
• Class III is the onset of symptoms at minimal exertion and their absence at rest.
• IV functional class does not allow to withstand even a minimal load, there are symptoms at rest.

Symptoms of chronic heart failure

This variant of heart failure is often the outcome of many chronic heart diseases. It proceeds according to the right or left ventricular type, and may be total. The mechanisms of its development are similar to acute forms, but extended in time, due to which oxygen starvation and degeneration of organs and tissues come first.

Insufficiency of the right heart chambers

leads to disturbances in the pulmonary circulation and is manifested by pulmonary symptoms. In the first place among the complaints of patients is:

• shortness of breath that progresses and reduces quality of life
• there is a need to sleep with a raised head, periodically occupy the position of orthopnea (sit with support on hands).
• gradually coughing joins the shortness of breath with the separation of a small amount of clear sputum.
• as heart failure progresses, episodes of suffocation may occur.
• patients are characterized by a grayish-cyanotic skin color, cyanosis in the area of ​​the nasolabial triangle, hands and feet. Fingers take shape drumsticks. Nails become excessively convex and thickened.

Left ventricular weakness leads to changes in the great circle

• Patients are concerned about palpitations (paroxysmal tachycardia, atrial fibrillation, extrasystoles), weakness and fatigue.
• There is an edematous syndrome. Gradually, edema in heart failure increases, spreading to the legs, anterior abdominal wall, lower back and genitals. Massive edema is called anasarca.
• First, it is the pastosity of the feet and legs and hidden edema, which is detected during weighing.
• Violations of blood flow in the kidneys cause a decrease in the amount of urine separated up to anuria.
• An increase in the liver manifests prolonged congestive heart failure. Its 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 disturbances in sleep, memory, and even mental and mental disorders.

Comparative features of cardiac and renal edema

Treatment for heart failure

Therapy of heart failure is carried out in two directions. Sharp forms require emergency care. Chronic variants undergo planned treatment with correction of decompensations and long-term maintenance doses of drugs (see new research by scientists on the effect of physical activity on the heart).

First aid

Emergency care includes prehospital stage carried out by an ambulance or a doctor on an outpatient appointment and inpatient treatment.

• Relief of acute left ventricular failure in the form pulmonary edema begins with giving the patient a position with a raised headboard. Oxygen inhalations with alcohol vapors are carried out. Lasix and isosorbide dinitrate on 5% glucose are administered intravenously. In case of oxygen starvation of the patient's tissues, they are transferred to artificial ventilation of the lungs (the trachea is intubated, after introducing atropine sulfate, dormicum, relanium and ketamine).
• Symptoms of acute right ventricular failure on the background of pulmonary embolism include oxygen therapy, the introduction of rheopolyglucin and heparin (with stable blood pressure). In case of hypotension, dopamine or adrenaline is administered. If it comes clinical death perform cardiopulmonary resuscitation.

Treatment of chronic heart failure

Chronic heart failure requires integrated approach. Treatment includes not only drugs, but involves a diet with a decrease in fluid (up to 2.5 liters per day) and salt (up to 1 g per day). Therapy is carried out using the following groups of drugs.

• Diuretic

They reduce venous return to the heart and allow you to cope with edema. Preference is given to saluretics (furosemide, lasix, torasemide, indapamide) and potassium-sparing (triampur, spironolactone, veroshpiron). Aldosterone antagonists (veroshpiron) are the drug of choice in the treatment of refractory edema.

• ACE inhibitors

They reduce pulmonary preload and congestion, improve renal blood flow, and remodel the heart muscle to increase cardiac output:

- Captopril (Capoten), enalapril (Enap), perindopril (Prestarium), lisinopril (Diroton), fosinopril (Monopril), ramipril (Tritace) are used. This is the main group to which chronic heart failure lends itself. Treatment is carried out with minimal maintenance dosages.

– Cardiac glycosides of medium and long-acting: digoxin (cedoxin) and digitoxin (digofton). The most preferred cardiac glycosides when against the background atrial fibrillation have heart failure. Treatment III and IV functional classes also require their assignment. The drugs increase the force of contractions of the mytocardium, reduce the frequency of contractions, and reduce the size of the enlarged heart.

• Beta-blocker tori

reduce tachycardia and myocardial oxygen demand. After two weeks of drug adaptation, cardiac output increases. Metoprolol succinate (betaloc ZOK), bisoprolol (concor), nebivolol (nebilet).

Treatment of heart failure is carried out for a long time under the supervision of a cardiologist and a therapist. If all the recommendations of specialists are followed, it is possible to compensate for the pathology, maintain the quality of life and prevent the development of decompensations.

Chronic heart failure (CHF) is a pathophysiological syndrome in which, as a result of cardiovascular diseases, there is a decrease in the pumping function of the heart, which leads to an imbalance between the hemodynamic demand of the body and the capabilities of the heart.

CHF is a disease with a complex characteristic symptoms(shortness of breath, fatigue and decreased physical activity, edema, etc.), which are associated with inadequate perfusion of organs and tissues at rest or during exercise and often with fluid retention in the body.

Epidemiology

In the Russian Federation, CHF suffers - 5.6%

50% of patients with CHF die within 4 years from the moment of manifestation of decompensation.

In severe CHF - 50% of patients die within 1 year.

The risk of VS in CHF is 5 times higher than in the general population

The average life expectancy for men is 1.66 years, for women - 3 years.

The maximum prevalence of CHF is at the age of 60-70 years.

Etiology

IHD, including myocardial infarction (67%)

Arterial hypertension (80%)

Acquired and congenital heart defects

Cardiomyopathy

Myocardial lesions of established etiology (alcoholic, etc.)

Effusive and constrictive pericarditis

Factors provoking the progression of CHF:

arterial hypertension

Cardiomyopathy, myocardial dystrophy

Diseases of the endocrine system (DM, thyroid disease, acromegaly)

Malnutrition (deficiency of thiamine, selenium, obesity)

Infiltrative diseases (sarcoidosis, amyloidosis, collagenosis)

Tachy and bradyarrhythmias

Heart defects

Side effects medicinal substances(β-blockers, antiarrhythmic, cytotoxic)

Pathogenesis

Etiological factors lead to a decrease in stroke volume, a decrease in cardiac output, which reduces the blood supply to organs and tissues (kidneys, brain, etc.). Compensatory mechanisms are included:

The activity of the sympathoadrenal system increases to maintain an optimal level of blood pressure.

The renin-aldosterone system is activated

Increased production of antidiuretic hormone (ADH).

The level of venous return to the heart, BCC,

Hypertrophy and dilatation of the myocardium

The production of vasodilators is impaired.

As a result, with the progression of the disease, the BCC increases and increases, a large volume of blood accumulates in the vascular bed, the permeability of the walls of the vessels is disturbed, and the liquid part blood oozes into the tissue. The accumulated carbon dioxide in the blood, when slowing down the movement of blood, irritates the receptors and reflexively causes an increase in breathing.

Schematic representation various types heart failure:

a - normal, b - left ventricular, c - right ventricular, d - total insufficiency

Classification of chronic heart failure according to Strazhesko and Vasilenko (1935, with additions)

Diseases of the heart and blood vessels occupy the first place among the causes of death in most countries. This is because the heart and circulatory system ensure the life of a person without interruption throughout life, performing a huge load. However, what exactly fails and leads to irreversible consequences? What do doctors understand by the term "insufficiency" and how can this be avoided?

Speaking of heart failure, doctors mean a discrepancy between the capabilities of the heart and the needs of the human body in providing tissues with oxygen and performing the contractile function of the heart. Many are familiar with the state of acute heart failure, which appears with excessive stress, for example, playing sports. It causes sudden changes in heart rate, shortness of breath, swelling. Acute deficiency may also result from injury or exposure to toxins.

The chronic form of heart failure (CHF) is formed over the years, and the symptoms accompany a person constantly, even during the period of lack of physical activity. The chronic form indicates a deterioration in the performance of the heart, poor circulation and can progress in the absence of proper treatment.

Important: regular preventive medical examinations can detect any disease at the initial stage, which will greatly facilitate treatment and improve the prognosis. Monitor your health and pay attention to any non-standard manifestations.

The mechanism of heart failure

The work of the heart is provided by the main heart muscle - the myocardium. Myocardial contraction occurs due to special protein fibers and nerve impulses. For high-quality work, the muscle needs energy and structural material. If the nutrients that enter the human body are not enough, then the main heart muscle becomes weak, its performance decreases, contractions become slower and less intense, which leads to incomplete emptying of the heart and the appearance of congestion. The conduction of nerve impulses is also impaired, which further worsens myocardial contractility.

Important: it is at this stage that the heart can go from healthy to diseased. At the initial stage, a person is unaware of the ongoing violations and does not feel discomfort. This explains the importance of maintaining a healthy lifestyle and good nutrition every day.

The weakness of the heart muscle stimulates the inclusion of a compensatory mechanism so that the myocardium can cope with the necessary load. As a result, the muscle begins to thicken. However, the lack of structural material leads to flabbiness of the myocardium and the inability to perform the required amount of work. Stagnation in the chambers of the heart provokes stagnation of blood in all circles of blood circulation. This causes fluid retention, venous and respiratory failure.

Causes

It must be understood that heart failure is not an independent disease, but a complex of symptoms that arise as a result of pathologies and malfunctions. internal organs. Symptoms may be caused by:

1. Endocrine diseases.
2. arterial hypertension.
3. Exposure to toxic substances.
4. Heart defects.
5. inflammatory processes.
6. Ischemic disease.
7. Nervous diseases.

Important: when identifying any disease, consider the factor of heredity. The propensity to heart disease is often explained precisely by this.

Stages and severity of chronic heart failure

Heart failure is classified in two ways: according to domestic and foreign characteristics. The differences between these two methods are insignificant, and the stages largely correspond to functional classes, therefore, for a better understanding, the classification is presented in the form of a table. The stages presented below are characteristic only for the chronic form of heart failure.

Assessing the patient's condition, doctors use both classifications to more accurately characterize the patient's health. Below will be considered in more detail I functional class I degree of chronic heart failure.

How to identify the initial stage

Stage I class I is characterized by the absence of visible symptoms. Changes occur at the level of physiology and can be detected mainly by instrumental methods. At the initial stage, only the most vigilant patients or those who discovered the insufficiency by chance according to the results of any tests turn to doctors at the initial stage. Dysfunction of the heart can be detected by a cardiologist by:

1. Ultrasound, which reveals a change in the thickness of the walls of the left ventricle, a change in the shape of the heart.
2. Cardiac stress tests. Physical activity under the supervision of a doctor allows you to detect dyspnea of ​​tension, discomfort, tachycardia, heart murmurs.
3. Laboratory studies for the content of a special protein.
4. ECG, which will always show any changes in the work of the heart.
5. Echocardiography. Allows you to determine the stroke and minute volume of the heart, ejection fraction, changes in myocardial fibers and other important characteristics.
6. Stress echocardiography. Allows you to determine the reserve capacity of the heart, which is reduced when the heart is unable to perform its work in the required volume.

The transition from the first stage to the second is characterized by the appearance of symptoms that depend on which part of the heart cannot cope with the load. The patient may notice the following symptoms:

1. Shortness of breath or difficulty breathing.
2. Cough not associated with respiratory infections. In this case, it is explained by stagnant processes in the lungs.
3. Increased fatigue.
4. Rapid heartbeat, which compensates for the inability of the heart to perform the necessary amount of work.

Important: if you suspect a problem in the heart, contact only qualified specialists. It is fundamentally important to identify the symptoms described above in time and start the right treatment.

Prevention measures and treatment

Since stage I of class I CHF is the very beginning of the pathological process, it is worth paying attention to preventive and treatment measures that at this stage can return the heart to healthy state or significantly increase the patient's life expectancy:

1. Physical activity is not excluded and is recommended in moderation. The permissible load is calculated by the doctor, taking into account the cause of heart failure. Dynamic loads are recommended instead of force and static loads.
2. Weight normalization.
3. Medical treatment includes drugs that improve the nutrition of the heart muscle and energy metabolism. Popular antihypertensive agents may not be prescribed initially, or ACE inhibitors may be prescribed. If necessary, you should take funds from the group of statins (reduce the level of harmful lipids) and anticoagulants (thin the blood).
4. Refusal of tobacco and other toxic substances.
5. Control of blood pressure and cholesterol levels.
6. Fractional nutrition, reduced salt intake. Eating a diet rich in omega-3 acids and other heart-healthy nutrients (potassium, magnesium, calcium).
7. Correction of the daily routine. Patients need good rest, hiking, fresh air. It is necessary to abandon night shifts, overloads and stress at work.
8. It is imperative to eliminate the underlying cause that led to CHF. Given the high likelihood of progression of symptoms and subsequent poor prognosis, it is worth deciding to change jobs, visit a psychotherapist and other actions if they provoke heart problems.

Video - Symptoms of heart failure

Formulation of the diagnosis of arterial hypertension (AH).

With absence clear reason increase in blood pressure (BP) (with the exclusion of the secondary nature of hypertension), a diagnosis of hypertension is established with all the clarifications (risk factors, involvement of target organs, associated clinical conditions, degree of risk).

When identifying the exact cause of an increase in blood pressure (BP), the disease (for example, chronic glomerulonephritis) is put first, then symptomatic arterial hypertension or symptomatic arterial hypertension, indicating the degree of its severity and the involvement of target organs.

It should be emphasized that an increase in blood pressure (BP) in the elderly does not suggest a symptomatic nature of hypertension, unless an exact cause is identified (for example, atherosclerosis of the renal arteries). The diagnosis of atherosclerotic symptomatic hypertension is incorrect in the absence of proven facts (for more details, see the chapter Arterial hypertension in the elderly in the monograph by A.S. Galyavich Separate arterial hypertension. Kazan, 2002).

Approximate formulations of diagnoses of arterial hypertension:

- Hypertension stage II. Grade 3. Dyslipidemia. Left ventricular hypertrophy. Risk 3 (high).
– Hypertensive disease III stages. Grade 2. IHD: Angina pectoris II functional class. Risk 4 (very high).
- Hypertension stage II. Grade 2. Atherosclerosis of the carotid arteries. Risk 3 (high).
- Stage III hypertension. Degree 1. Obliterating atherosclerosis vessels of the lower extremities. Intermittent lameness. Risk 4 (very high).
- Hypertension stage I. Grade 1. Diabetes mellitus, type 2. Risk 3 (high).
- IHD: angina pectoris III FC. Postinfarction cardiosclerosis (myocardial infarction in 2002). Hypertension stage III. Grade 1. CHF stage 2, II FC. Risk 4 (very high).

Arterial hypertension of the 2nd degree, risk 4. CHF FC 1

§ IHD - on the basis of typical anginal pains in the region of the heart that occur during exercise in combination with risk factors for the development of coronary artery disease: hypertension, hypercholesterolemia, smoking, male sex, elderly age, abdominal obesity etc.

§ Angina pectoris FC 4- on the basis of typical stereotypical anginal pains in the region of the heart that occur with little physical exertion (walking less than 100 m or around the room, climbing to the 1st floor) and at rest.

§ Atherosclerotic cardiosclerosis– taking into account the presence of signs of myocardial damage in the form of CHF with intact or relatively intact heart geometry; deafness of heart tones.

§ Arterial hypertension -

§ 2 degrees- given the moderate nature of the increase in blood pressure: within 160-179 / 100-109 mm Hg. the need for effective control of blood pressure in combination therapy with two antihypertensive drugs from the main groups.

§ risk 4 - given the increase in blood pressure and the presence of multiple (more than 3) complications or lesions of target organs: LVH, and the presence of severe associated conditions: coronary artery disease, PIM, severe DEP.

§ Type I hypertensive crisis - on the basis of a typical clinical picture: a sudden onset, a violent clinic with tachycardia, an abundance of vegetative symptoms, a fairly rapid effect of antihypertensive drugs.

§ HSN FC 2- considering a moderate decrease in LV EF of 50% and the presence of signs of CHF at rest in the form of acrocyanosis.

§ DEP 3rd degree, mixed genesis- on the basis of severe encephalopathy against the background of cerebral atherosclerosis, hypertension, severe cardiopulmonary insufficiency.

§ COPD, mixed type - on the basis of a long-term irreversible broncho-obstructive syndrome with a cough with a small amount of viscous sputum, equally pronounced signs of broncho-inflammatory syndrome and emphysema.

§ severe course - given the severity of broncho-obstructive syndrome, the presence of severe DN, secondary pneumonia.

§ exacerbation phase - given the presence of clinical signs of exacerbation, signs of activity of laboratory parameters (leukocytosis, accelerated ESR).

§ DN 2-3 - on the basis of severe diffuse cyanosis, dyspnea at rest, signs of severe pulmonary heart failure, DEP.

§ HLS, decompensation - on the basis of characteristic clinical manifestations of chronic right ventricular failure against the background of a long-term pathology of the bronchopulmonary apparatus, complicated by diffuse pneumosclerosis, significant DN.

§ Secondary focal pneumonia with localization in the lower lobe on the right, of moderate severity - on the basis of clinical and radiographic data: inhomogeneous darkening of the lung tissue and moist small and medium bubbling rales in lower sections right lung, fever, characteristic inflammatory reaction in laboratory tests.

§ IHD - on the basis of typical anginal pains in the region of the heart that occur during exercise in combination with risk factors for the development of coronary artery disease: hypertension, hypercholesterolemia, advanced age, abdominal obesity, etc.

§ Angina pectoris FC 3- on the basis of typical stereotypical anginal pain in the region of the heart that occurs during moderate daily physical activity (walking from 100 to 500 m, climbing to the 2nd floor).

§ HSN FC 1- given the absence of signs of CHF at rest, LV EF 50%, the appearance of signs of CHF only during exercise.

§ Arterial hypertension - based on the lack of a clear relationship between the AH syndrome and the pathology of other organs and systems; typical slowly progressive labile course, systole-diastolic nature of hypertension, aggravated history of hypertension, onset of the disease in middle age;

§ 1st degree- given the mild nature of the increase in blood pressure: within 140-159 / 90-99 mm Hg. sufficiency for effective control of blood pressure monotherapy.

§ risk 4 - given the increase in blood pressure and the presence of multiple (more than 3) complications or lesions of target organs: LVH, and the presence of associated conditions: coronary artery disease, DEP.

§ DEP 2nd degree, mixed genesis- on the basis of moderately severe encephalopathy against the background of cerebral atherosclerosis, arterial hypertension.

20.02.09 Substantiation of the clinical diagnosis:

Arterial hypertension 1, 2, 3, 4 degrees

Arterial hypertension (AH) of the 2nd degree implies vascular pathology, which is accompanied by increased blood pressure: systolic 160 #8212; 179 mm. rt. Art. diastolic 100-109 mm. rt. Art. Arterial hypertension of the 2nd degree is characterized by a fairly long increase in pressure, which up to normal indicators rarely goes down. This disorder is accompanied by symptoms of target organ damage (heart, kidneys, brain vessels, vision) and numerous complications. Patients usually complain of headaches in the parietal-occipital and parietal region, dizziness, nausea, palpitations, a feeling of vascular pulsation, muscle weakness, and swelling. Arterial hypertension of the 2nd degree requires mandatory medical treatment.

With hypertension of the 2nd degree, the risks of complications are quite significant. There are four degrees in total.

1st degree risk- 15% of patients experience cardiac disorders, which can be manifested by arrhythmia, cardiovascular insufficiency, any form of coronary artery disease, coronary syndrome, left ventricular hypertrophy and relative insufficiency of the mitral valve due to its dilatation.

Grade 2 risk– Patients have a 20% chance of cardiac complications. This form of hypertension of the 2nd degree is exposed to the patient in the absence of a violation of cardiac activity, diabetes or others endocrine pathologies, as well as heart attacks, that is, only arterial hypertension worries him. Wherein overweight is a risk factor.

Grade 3 risk- Patients have up to 30% chance of cardiac complications. This form of hypertension of the 2nd degree is diagnosed with diabetes mellitus, the presence of atherosclerotic plaques, impaired renal filtration.

Grade 4 risk- the course of existing pathologies is aggravated. This form of hypertension is exhibited with a combination of coronary artery disease, atherosclerosis and diabetes mellitus. and also, if the patient has suffered a myocardial infarction, regardless of the amount of damage and localization.

It should be noted that if patients understand what their health problem is, try to lead a healthy lifestyle, eat a more or less balanced diet, take therapeutic measures, the risk level is significantly reduced.

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How is the abbreviation of the disease CHF 2 FC 2 deciphered

CHF 2 FC 2 is commonly referred to as one of the degrees of chronic heart failure.

This disease is characterized by the inability of the heart and blood vessels to properly supply the body with blood.

The disease is included in dangerous pathologies therefore, without timely treatment, there is a risk of serious complications or even death of elderly patients.

Causes of CHF development, risk factors

The main cause of this pathology is a noticeable decrease in the filling of the heart with blood, as a result of which the ejection of fluid from the artery will also be reduced.

Because of this violation, there is a decrease in EF (that is, cardiac output fraction). A healthy adult at rest should have an EF of 4.5–5 L/min. This amount of blood is sufficient for the normal supply of oxygen to the body.

Sometimes heart failure occurs as a result of damage to the myocardium or other structures of this organ.

Often the cause of the pathology is cardiac causes or an increased need for oxygen in the tissues of the body.

The main cardiac factors are:

1. Serious violations. For example, heart attack, coronary artery disease and inflammation of the heart muscle. Due to necrosis or tissue damage, the muscle loses its elasticity and is not able to contract at full strength.
2. Heart disease or injury. As a result of these changes, the heart is unable to provide a normal blood supply.
3. Dilated, as well as hypertrophic cardiomyopathy, leading to a decrease in muscle elasticity.

Heart failure occurs due to stress, bad habits, or due to hard physical labor.

Often the chronic form of the disease can be triggered by improper medication.

Such a reaction occurs to antiarrhythmic drugs or NSAIDs.

Classification of pathology and symptoms of CHF 2 degrees

Heart failure is conditionally divided into several stages, each of which has its own characteristics:

Depending on the severity of CHF, it is customary to classify into 4 FCs (functional class):

1. If a person has FC I, he is able to normally tolerate physical activity, the result of a strong load will be shortness of breath and fatigue.
2. In FC II, the patient's activity will be moderately limited.
3. In FC III, habitual activity is noticeably limited due to pronounced symptoms.
4. With IV FC, it will no longer be possible to carry out the necessary load without pain, and the signs of pathology appear even at rest.

Features of the second degree of CHF

At grade 1A, the symptoms are mild, mainly due to increased stress. The result of this is left ventricular failure (the left heart is affected). The patient will have a displaced left heart border, asthma attacks appear, the liver changes size (increases).

If the right heart sections are affected, signs of circulatory stagnation are noticeable (in a large circle). The result of this is acrocyanosis, ascites and tachycardia. All boundaries of the heart expand. When CHF is in the second degree - 2B, significant disturbances are noticeable, because two circles (large and small) lack blood circulation.

The patient complains of shortness of breath, palpitations, weakness. The person cannot lie on their back and develops orthopnea. In addition, the boundaries of the heart expand, the liver enlarges, and sometimes extrasystole appears.

How to treat CHF

Heart failure must be treated in a timely manner to prevent further deterioration of the patient's condition. However, in addition to high-quality drug therapy, and sometimes surgery, it is recommended to follow a diet. In addition, it is necessary to take care of rational physical activity, as well as psychological rehabilitation.

The most effective drugs for CHF are beta-blockers, special ACE inhibitors, cardiac glycosides, etc. In addition to the main funds, sometimes there is a need for additional (statins and anticoagulants) and auxiliary drugs.

Electrophysiological methods of treatment should be distinguished. It is required if drug therapy has not brought the desired result. The operation for the implantation of a pacemaker, the use of some types of cardiac stimulation, etc., has proven itself well.

In the most severe cases of heart failure, a heart transplant or implantation of artificial ventricles is required.

Comprehensive therapy for CHF must necessarily include proper nutrition. In order to prevent disability and get rid of pathology, it is important to limit the amount of salt consumed, and in case of severe swelling, do not drink a lot of fluids. It is preferable to focus on high-calorie foods that contain a lot of vitamins and protein.

In the treatment of CHF 2 FC 2 shows physical activity. However, it is necessary to correctly determine the most appropriate level of exercise for the patient. An assistant in this will be a special walking test.

Through daily brisk walking, the patient improves exercise tolerance and the effectiveness of therapy. After stopping treatment, it is recommended to make rational exercise part of everyday life.

Timely diagnosed CHF will help prevent its development to the terminal III stage. This pathology primarily affects the elderly, therefore, if unusual symptoms occur, it is recommended to seek qualified medical advice in a timely manner.

Why develops and how is CHF treated?

Chronic heart failure (CHF) is a serious disease that is expressed by the inability of the heart and blood vessels to provide a normal supply of blood to the body. It often becomes the "terminus" of heart disease, but other diseases can also lead to it.

According to statistics, CHF most often causes hospitalization and sometimes death of the elderly. Without treatment, about half of those who get sick die within three years of being diagnosed. Men and women are equally prone to developing chronic heart failure, but women become ill later in menopause.

Causes and risk factors

The immediate cause of chronic heart failure is a decrease in the ability of the heart to fill it with blood and push it into the arteries, that is, to reduce the cardiac output fraction (EF). In a healthy adult, EF at rest is from 4.5 to 5 l / min. This is how much blood the body needs to be adequately supplied with oxygen.

The weakening of the functions of the heart most often develops due to damage to the heart muscle (myocardium) and other structures of the heart. But factors that violate its electrical activity can also influence the "motor" of the human body.

1. Cardiac causes include diseases and conditions that affect the myocardium, change the structure of the organ or prevent it from performing its function. The main ones are:

• myocardial infarction; ischemic heart disease (CHD); inflammation of the heart muscle and its membranes. Damage to heart tissue by necrosis; scars and scars make the heart muscle less elastic and unable to contract to its full potential.
• Rheumatic and other heart defects, injuries. A change in the "architecture" of the organ leads to the fact that normal blood circulation becomes impossible.
• Cardiomyopathy - dilated or hypertrophic. In the first case, the chambers of the heart stretch and lose their tone, which happens more often in older men and women, in the second, their walls become thicker and thicker. The heart muscle becomes less elastic and its contractility decreases.
• Arterial hypertension occurring in the elderly. Fluctuations in blood pressure prevent the heart from beating in a normal rhythm.

2. Secondarily, CHF develops against the background of conditions that increase the need for tissues in oxygen, and therefore require an increase in cardiac output. They are called non-cardiac risk factors for CHF. First of all, it is stress, hard physical work, alcoholism, smoking and drug addiction, as well as:

• complex bronchopulmonary infections (bronchitis, pneumonia), in which a person cannot breathe normally; embolism of the arteries of the lungs;
• thyroid disease, diabetes and obesity;
• chronic renal failure;
• anemia (anemia) that accompanies many diseases.

3. Chronic heart failure can be provoked by taking certain medications prescribed for a long course. Their list is extensive, the most common are:

• Antiarrhythmic drugs (exception - Amiodarone).
• Non-steroidal anti-inflammatory drugs (NSAIDs), such as paracetamol; glucocorticoid hormones.
• Calcium antagonists (drugs that lower blood pressure); other antihypertensive drugs, for example, Reserpine.
• Tricyclic antidepressants.
• Vasodilator drugs for vasodilation - Diazoxide (Hyperstat), Hydralazine (Apressin). They are prescribed to elderly people with atherosclerosis.

Therefore, these medicines should not be taken longer than prescribed by the doctor. Long-term treatment is monitored by tests and other examinations and adjusted if necessary.

Classification and features of the flow

First of all, chronic heart failure is classified according to the ability of the heart to take in venous and give into vascular system oxygenated arterial blood. CHF can be systolic (type I) and diastolic (type II).

• Systolic CHF is such a violation of the function of the heart muscle when it cannot push out of itself during contraction required amount blood. At the same time, the function of the left ventricle can be preserved (EF > 40%) or impaired (EF 120 beats / minute, the patient is not allowed to sleep. Listening to the patient, the doctor can talk about the "gallop rhythm" - fast, clear heart beats characteristic of CHF.
• Edema. Bright diagnostic signs congestive heart failure - swelling on the ankles and legs, in bedridden patients - in the sacrum, in severe cases - on the hips, lower back. Over time, ascites develops.

The mucous membranes of the lips, the tip of the nose and the tips of the fingers become bluish due to poor circulation: these areas cease to be fully supplied with blood. The swelling of the jugular veins, noticeable when pressing on the abdomen on the right, is due to an increase in venous pressure with a violation of the outflow of blood from the heart. The liver and spleen increase against the background of stagnation in the systemic circulation, while the liver is sensitive, its tissues become denser.

Diagnostics

At the first appointment, the doctor will listen to the heart, measure the pulse, ask the patient about what he was ill with before and about his well-being, about what medications he takes. In the elderly, certain diseases and conditions may mimic heart failure, producing symptoms similar to heart failure, and require differential diagnosis.

• Amlodipine (a group of calcium antagonists used to lower blood pressure) sometimes provokes swelling of the legs, which disappear after its withdrawal.
• Symptoms of decompensated cirrhosis of the liver (ascites, enlargement of the organ, yellowness of the skin) are very similar to the signs of CHF.
• Shortness of breath accompanies lung diseases with bronchospasm. Its difference from rapid breathing in CHF is that breathing becomes hard, and wheezing is heard in the lungs.

The likelihood of chronic heart failure is higher if an elderly man or woman after 55 has a systematic increase in blood pressure, a history of myocardial infarction; in the presence of heart defects, angina pectoris, rheumatism. At the first appointment, the doctor prescribes clinical and biochemical blood tests, urinalysis and measurement of daily diuresis. Instrumental studies are also prescribed:

• Electrocardiography (ECG), if possible - Holter daily ECG monitoring; phonocardiography to determine heart sounds and murmurs.
• Ultrasound of the heart (EchoCG).
• Plain chest x-ray and / or coronary angiography, computed tomography (CT) - studies of the heart and blood vessels with contrast.
• Magnetic resonance imaging (MRI). This is the most accurate way to determine the state of myocardial tissues, the volume of the heart, the thickness of its walls and other parameters. However, MRI is an expensive research method, so it is used when other studies are insufficiently informative or for those for whom they are contraindicated.

The degree of chronic heart failure also helps to diagnose stress tests. The simplest of these is prescribed for older people - a six-minute walking test. You will be asked to walk for six minutes along a section of the hospital corridor at a fast pace, after which your pulse, blood pressure and cardiac parameters are measured. The doctor notes the distance you can walk without rest.

Treatment

Treatment of CHF consists in the normalization of myocardial contractility, heart rate and blood pressure; removal of excess fluid from the body. Drug treatment is always combined with moderate exercise and diet, limiting the calorie content of food, salt and liquid.

• ACE inhibitors. This group of drugs reduces the risk of sudden death, slows down the course of CHF, and alleviates the symptoms of the disease. These include Captopril, Enalapril, Quinapril, Lisinopril. The effect of the therapy can be manifested in the first 48 hours.
• Cardiac glycosides are the gold standard in the treatment of CHF. They increase the contractility of the heart muscle, improve blood circulation, reduce the load on the heart, have a moderate diuretic effect and slow down the pulse. The group includes Digoxin, Strofantin, Korglikon.
• Antiarrhythmic drugs such as Cordarone® (Amiodarone) lower blood pressure, slow the heart rate, prevent arrhythmias, and reduce the risk of sudden death in people diagnosed with CHF.
• Treatment of chronic heart failure necessarily includes diuretics. They relieve swelling, reducing the load on the heart and lowering blood pressure. These are Lasix® (Furosemide); Diacarb®; Veroshpiron® (Spironolactone); Diuver® (Torasemide), Triampur® (Triamteren) and others.
• Anticoagulants thin the blood and prevent blood clots. These include warfarin and medicines based on acetylsalicylic acid (aspirin).

Also, with the diagnosis of "chronic heart failure", vitamin therapy, prolonged exposure to fresh air, and spa treatment are prescribed.

Chronic heart failure Chronic heart failure (CHF)

Chronic heart failure (CHF) is a pathophysiological syndrome in which cardiovascular disease there is a decrease in the pumping function of the heart, which leads to an imbalance between the hemodynamic demand of the body and the capabilities of the heart.

CHF is a disease with a complex of characteristic symptoms (shortness of breath, fatigue and decreased physical activity, edema, etc.), which are associated with inadequate perfusion of organs and tissues at rest or during exercise and often with fluid retention in the body.

In the Russian Federation, CHF suffers - 5.6%

50% of patients with CHF die within 4 years from the moment of manifestation of decompensation.

In severe CHF - 50% of patients die within 1 year.

The risk of VS in CHF is 5 times higher than in the general population

The average life expectancy for men is 1.66 years, for women - 3 years.

The maximum prevalence of CHF is at the age of 60-70 years.

IHD, including myocardial infarction (67%)

Arterial hypertension (80%)

Acquired and congenital heart defects

Myocardial lesions of established etiology (alcoholic, etc.)

Effusive and constrictive pericarditis

Factors provoking the progression of CHF:

Diseases of the endocrine system (DM, thyroid disease, acromegaly)

Malnutrition (deficiency of thiamine, selenium, obesity)

Infiltrative diseases (sarcoidosis, amyloidosis, collagenosis)

Tachy and bradyarrhythmias

Side effects of drugs (β-blockers, antiarrhythmic, cytotoxic)

Etiological factors lead to a decrease in stroke volume, a decrease in cardiac output, which reduces the blood supply to organs and tissues (kidneys, brain, etc.). Compensatory mechanisms are included:

- the activity of the sympathoadrenal system increases to maintain an optimal level of blood pressure.

- activation of the renin-aldosterone system

- increased production of antidiuretic hormone (ADH).

- increases the level of venous return to the heart, BCC,

- hypertrophy and dilatation of the myocardium,

- the production of vasodilators is impaired.

As a result, with the progression of the disease, the BCC increases and increases, a large amount of blood accumulates in the vascular bed, the permeability of the walls of the vessels is disturbed, and the liquid part of the blood sweats into the tissues. The accumulated carbon dioxide in the blood, when slowing down the movement of blood, irritates the receptors and reflexively causes an increase in breathing.

Schematic representation of different types of heart failure:

a - normal, b - left ventricular, c - right ventricular, d - total insufficiency

In our country, two clinical classifications of chronic HF are used, which significantly complement each other. One of them, created by N.D. Strazhesko and V.Kh. Vasilenko with the participation of G.F. Lang and approved at the XII All-Union Congress of Therapists (1935), based on functional and morphological principles assessment of the dynamics of clinical manifestations of cardiac decompensation (table 1). The classification is given with modern additions recommended by N.M. Mukharlyamov, L.I. Olbinskaya and others.

Table 1

Classification of chronic heart failure, adopted at the XII All-Union Congress of Physicians in 1935 (with modern additions)

Although the classification of N.D. Strazhesko and V.Kh. Vasilenko is convenient for characterizing biventricular (total) chronic HF, it cannot be used to assess the severity of isolated right ventricular failure, for example, decompensated cor pulmonale.

Functional classification of chronic HF New York Heart Association (NYHA, 1964) is based on a purely functional principle of assessing the severity of the condition of patients with chronic HF without characteristics morphological changes and hemodynamic disorders in the systemic or pulmonary circulation. It is simple and convenient for use in clinical practice and is recommended for use by the International and European Societies of Cardiology.

According to this classification, 4 functional classes (FC) are distinguished depending on the patient's tolerance to physical activity (Table 2).

table 2

New York classification of the functional state of patients with chronic heart failure (modified), NYHA, 1964.

When formulating the diagnosis of chronic heart failure, it is advisable to use both classifications, which significantly complement each other. In this case, the stage of chronic HF according to N.D. should be indicated. Strazhesko and V.Kh. Vasilenko, and in parentheses - the functional class of CH according to NYHA, reflecting the functionality this patient. Both classifications are fairly easy to use because they are based on an assessment of the clinical signs of heart failure.