1.What is heart failure?
Heart is a serious and, unfortunately, very common disease. This disease is one of the main reasons for hospitalization in people over 65 years of age.
Heart failure does not mean the heart stops working. Rather, it means that the heart becomes weaker than usual and pumps blood less well. In heart failure, blood moves through the heart and body at a slower rate. As a result, the heart cannot pump enough oxygen and nutrients
to meet the body's needs.
The heart responds to this by stretching the chambers
so more blood can pass through them, and this helps for a while.
But over time, the walls of the heart muscle weaken, unable to work at such a strenuous rhythm. This affects the kidneys, which cause the body to accumulate more fluid and salt. Fluid can accumulate in the arms, legs (ankles and feet), lungs and other organs, leading to edema. This condition is also called congestive heart failure .
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Causes of chronic heart failure
Heart failure Chronic heart failure is the final outcome of any heart disease.
A short list of nosologies that can lead to the development of CHF:
- hypertonic disease;
- coronary heart disease: previous myocardial infarction;
- cardiomyopathies (hereditary and acquired);
- myocarditis of various etiologies;
- acquired heart defects;
- pericardial disease (constrictive pericarditis);
- tachyarrhythmias (fibrillation, atrial flutter).
2.What causes the disease?
Heart failure can be caused by many factors and pathological processes occurring in the heart, including:
- Cardiac ischemia
. Coronary heart disease (CHD) is a disease of the arteries that supply blood and oxygen to the heart, in which blood flow to the heart muscle is reduced. As a result, the heart lacks oxygen and nutrients. - Heart attack
. A heart attack can occur when a coronary artery suddenly blocks and stops the flow of blood to the heart muscle. All or part of the heart muscle is no longer supplied with oxygen and may become damaged. A heart attack can cause an area in the heart that then does not function properly. - Cardiomyopathy
, or damage to the heart muscle. The causes of cardiomyopathy can range from problems with the arteries or circulation, infections, or alcohol or drug abuse. - Common factors leading to fatigue
. This may include high blood pressure, heart valve disease, thyroid disease, kidney disease, diabetes, or congenital heart defects. All this can lead to heart failure. In addition, heart failure can result from a combination of several of these conditions.
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Causes
The main cause of CHF is coronary heart disease, heart attack, rhythm disturbances and other acute diseases of the cardiovascular system. Their development is ultimately influenced by risk factors:
- smoking;
- aging;
- overweight;
- heredity;
- high cholesterol and sugar.
Hypertension can also cause the development of heart failure. According to statistics, 26% of people in Russia have this disease. Hypertension leads to hypertrophy of the heart muscle, and subsequently to CHF. Therefore, patients with this disease are recommended to undergo regular examinations by a doctor to prevent the development of heart failure.
Another root cause may be: smoking, excess body weight and diabetes. Research shows that smoking affects the development of cancer and cardiovascular diseases. And diabetes is potentially dangerous to health, as it contributes to the development of many pathological changes in the cardiovascular system. In any case, the same measures are applied to a diabetic to protect against heart attacks and strokes as to a patient with already proven angina. First of all, this is correction of nutrition and lifestyle and, of course, adequate treatment. The resort cardiology clinic "Chernaya Rechka" has a special program for the treatment of diabetes.
3.What are the types and stages of heart failure?
What are the types of heart failure?
Systolytic dysfunction
, or
systolic heart failure , occurs when the heart muscle does not contract strongly enough to allow normal flow of oxygenated blood throughout the body.
Diastolic dysfunction , or diastolic heart failure, occurs when the heart beats normally, but the ventricle—the main chamber responsible for pumping blood—does not relax, reducing the amount of blood that can enter the heart and increasing blood pressure in the lungs.
Stages of heart failure
In 2001, the American Heart Association and the American College of Cardiology developed stages of heart failure. For each stage, characteristic signs were identified and treatment recommendations were developed. Doctors also noted that heart failure can progress, and the process can move from one stage to another.
The stages of heart failure according to this classification are as follows:
Stage A.
This includes people at high risk of developing heart failure, including those with high blood pressure, diabetes, coronary heart disease, alcohol abuse, or a family history of heart failure. In addition to drug therapy, regular exercise, quitting smoking and alcohol, and therapy aimed at treating high blood pressure and lipid metabolism disorders are recommended for this group.
Stage B.
This includes patients diagnosed with left ventricular systolic dysfunction, but only those without symptoms of heart failure. The diagnosis in this case was usually made based on the results of an ejection fraction less than 40% and echocardiogram results. Treatment methods for this group of patients are similar to the previous ones, however, in some cases it may be necessary to surgically treat the coronary artery and heart valves.
Stage C.
This group includes patients with systolic heart failure who exhibit symptoms of the disease. The most characteristic symptoms of heart failure are shortness of breath, rapid fatigue, and decreased physical activity. Additional treatment at this stage may include taking diuretics, a salt-free diet, limiting fluid intake, and in especially severe cases, surgical treatment using pacemakers and implantable cardiac defibrillators.
Stage D
This is the most serious stage, when patients continue to have systolic heart failure and characteristic symptoms even after complex treatment. In addition to the therapy used in the previous stages, the patient may need a heart transplant, surgical treatment, and special drug therapy, including those associated with the continuous administration of intravenous narcotic drugs.
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Types and symptoms
There are two types of CHF: systolic and diastolic with preserved blood ejection function. Even 20 years ago, the second type was difficult to diagnose, since the heart muscle did not weaken, and symptoms of CHF still occurred. Thanks to the advent of cardiac ultrasound and echocardiography, the diagnostic problem was solved.
A characteristic feature of the second type of CHF is increased pressure in the left ventricle. Because of it, the muscle thickens and becomes rigid - unable to relax. When circulation occurs, the heart must not only eject blood and contract, but also come to a state of rest so that the next portion can enter it. If this does not happen, blood stagnation occurs. And it turns out that the heart seems to pump blood well, but cannot relax.
There are four stages of chronic heart failure:
- The appearance of mild ailments during physical activity, but there are no structural changes in the heart yet.
- The occurrence of structural changes in the heart.
- Manifestation of the first symptoms.
- The manifestation of pronounced symptoms that are difficult to treat.
The first stage of the disease can appear decades before symptoms and therefore often goes undetected. Basically, it makes itself felt in the form of rapid fatigue and rapid heartbeat during vigorous activity. It does not appear in a calm state.
At the second stage of the disease, structural changes in the heart appear - the first signs of hemodynamic disturbances and blood stagnation, which lead to an enlargement of the chambers of the heart. Symptoms appear the same as in the first stage.
The first symptoms of the disease - shortness of breath and constant heart rhythm disturbances - appear only in the third stage. They are felt during physical activity and are long-lasting.
In older people, shortness of breath can also occur at rest due to stagnation of blood in the venous bed of the pulmonary circulation. Subsequently, shortness of breath begins to be accompanied by a cough, which appears at night or during physical activity. It appears due to stagnation of blood in the vessels of the lungs and gives rise to further swelling of the bronchial mucosa - at this moment the period of the last stages of CHF begins.
With severe circulatory failure, the patient has:
- constant shortness of breath;
- wheezing in the lungs;
- chronic fatigue;
- severe swelling of the limbs;
- enlarged heart;
- accumulation of fluid in the abdominal cavity.
Such symptoms indicate a severe case and, in some cases, require surgical intervention.
4.Diagnosis of the disease
A special test called ejection fraction (EF) . It helps determine how well the heart pumps blood with each beat and can be used to diagnose both systolic and diastolic dysfunction. Ejection fraction as a percentage measures the amount of blood pumped with each beat.
In patients with systolic heart failure, the ejection fraction is less than 40%. Other diagnostic tests such as an echocardiogram or cardiac ultrasound can show how the heart is dilating and not pumping out enough blood with each beat.
Patients with diastylic heart failure have a normal ejection fraction test and their heart is pumping well, but an echocardiogram will show that the heart is not filling sufficiently during the relaxation phase that occurs between beats.
For timely diagnosis of heart failure, it is recommended to consult a cardiologist and periodically undergo a comprehensive cardiac examination.
Symptoms of chronic heart failure
Main symptoms:
- shortness of breath at rest and on exertion,
- swelling of the legs, legs, feet, anterior abdominal wall.
- enlarged liver and pain in the right hypochondrium.
- decreased exercise tolerance.
Classes of CHF
According to the New York Heart Association methodology, there are 4 classes of CHF.
Class 1 – there are heart diseases, but they do not limit daily activity.
Class 2 – heart disease leads to a slight limitation of physical activity. There are no symptoms at rest; normal physical activity causes fatigue and shortness of breath.
Class 3 – significant limitation of physical activity.
Class 4 – restriction of any physical activity; symptoms appear at rest.
The class of heart failure can be determined using the SHOKS questionnaire (scale for assessing the clinical condition of the patient) as modified by Mareev V.Yu. A particular class of CHF is assigned depending on the number of points that are assigned based on the results of answers to questionnaire questions.
Methods for diagnosing chronic heart failure
The central place in the diagnosis of CHF is occupied by instrumental diagnostic methods: chest radiography, ECG and echocardiography.
Laboratory diagnostics for CHF, in addition to the standard examination (general blood count, blood biochemistry - lipid profile assessment), may include an indicator such as brain natriuretic peptide, or BNP (brain natriuretic peptide) - a peptide hormone that is produced by heart cells in response for excessive stretching. This analysis is prescribed only by a doctor if necessary and has interpretation features.
If necessary, to clarify the nature of CHF, an MRI of the heart with contrast can be performed - to exclude myocarditis - or coronary angiography (if coronary artery disease is suspected).
X-ray of the chest organs
X-ray of the chest organs shows the presence of congestion in the pulmonary circulation, fluid in the pleural cavities, which indicates the presence of heart failure (this is what causes shortness of breath in CHF).
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ECG
An ECG often reveals left bundle branch block or scar changes in the myocardium after a myocardial infarction, as well as cardiac arrhythmias, which can cause heart failure.
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Echocardiography
According to echocardiography (ultrasound of the heart), you can see the size of the heart chambers, zones of hypokinesis, aneurysms, and other reasons that lead to the appearance of heart failure. The main indicator that doctors focus on is the ejection fraction (a value expressed as a percentage), which reflects the capabilities of the heart and is an indicator of the efficiency of its work.
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