Heart failure is associated with decreased heart function. The heart muscle cannot produce the energy needed to pump the required amount of blood throughout the body.
In Russia alone, about 7 million people suffer from heart failure. In people over 70, one in four people are affected, with men typically affected at a much younger age than women. The risk for men is approximately one and a half times higher than for women. In Russia, diseases of the circulatory system are the most common cause of death.
- What is heart failure?
- What causes heart failure?
- What are the types of heart failure and what are their symptoms? Left-sided heart failure
- Right-sided heart failure
- Global heart failure
- Systolic heart failure
- Diastolic heart failure
- Chronic heart failure
- Acute heart failure
The heart works, the heart does not sleep
Heart... An organ surrounded by a romantic halo, awarded the attention of writers, musicians, poets... The heart is a unique symbol of love; we associate our feelings and emotions with it. If you descend from heaven to the “sinful” earth and briefly and prosaically define what a heart is, you will get something like this: “the heart is a strong muscular pump capable of pumping blood throughout the body to provide tissues with oxygen.” It would seem like just a pump, but what a pump! Able to work without sleep or rest for years, decades; capable, if necessary, of instantly changing the operating mode. And all this thanks to its amazing structure - muscle, valves, its own circulatory system, innervation and many ingenious mechanisms of regulation and compensation both inside and outside the heart.
The heart is a “fiery motor”!
Normally, the heart is a strong muscular pump capable of pumping blood throughout the body to provide oxygen and nutrients to all organs and tissues of the body, as well as remove their waste products. Depending on whether we are resting or actively working, the body requires different amounts of nutrients. To meet the needs of the body, the frequency and strength of heart contractions, as well as the size of the lumen of blood vessels, can vary significantly. What happens when the heart stops sufficiently supplying tissues and organs with oxygen and nutrients? In this case, doctors diagnose heart failure (HF). The disease is usually chronic and the patient may live with it for many years before being diagnosed.
What classes is heart failure divided into?
There are several classifications of heart failure:
- Classification according to V. Kh. Vasilenko, N. D. Strazhesko, G. F. Lang;
- Classification of acute heart failure according to the Killip scale;
- And the most common is the New York Heart Association classification.
According to the New York Heart Association (NYHA) functional classification, heart failure is classified into classes I-IV depending on the severity of symptoms and limitation of physical activity.
Heart failure is divided into four classes depending on the severity of symptoms:
- NYHA I: heart disease without any restrictions on physical activity. Normal activity does not cause increased fatigue, palpitations, or difficulty breathing.
- NYHA II: Heart disease causing moderate limitation in daily activities. No symptoms at rest.
- NYHA III: Heart disease causing marked limitation in daily activities. Simple activities such as brushing your teeth, eating, or talking cause fatigue, palpitations, or difficulty breathing. There are no symptoms at rest.
- NYHA IV: Heart disease that causes symptoms at rest (and with any degree of light physical activity).
Heart failure significantly reduces quality of life. Patients often experience great frustration with physical limitations and tend to withdraw from social life. For this reason, psychological disorders such as depression are often present in addition to the expected physical symptoms.
“Glitches”, “coughs”, “sneezes”... Who is to blame?
There are many reasons for the development of heart failure. Among them, the most important place is occupied by coronary heart disease or insufficient blood supply to the heart muscle. Ischemia, in turn, is caused by blockage of the heart vessels with fat-like substances. A heart attack can also cause heart failure because some of the heart tissue dies and becomes scarred. Arterial hypertension is another common cause of insufficiency. The heart requires much more effort to move blood through the spasmodic vessels, which results in an increase in its size, in particular the left ventricle. Later, weakness of the heart muscle or heart failure develops. Causes that influence the development of heart failure include cardiac arrhythmias (irregular contractions). A number of beats of more than 140 per minute is considered dangerous for the development of the disease, because At the same time, the processes of filling and ejection of blood by the heart are disrupted. Changes in the heart valves lead to disturbances in the filling of the heart with blood and can also cause the development of heart failure. The problem is usually caused by an internal infection (endocarditis) or a rheumatic disease. Risk factors for the development of diseases of the cardiovascular system, and, ultimately, heart failure, can also include excess weight, a sedentary lifestyle, alcohol and drug addiction, and hormonal disorders.
Consequences
After a certain amount of time, the heart weakens until it can no longer contract strongly enough. This causes the volume of blood released into the systemic circulation to decrease.
The heart muscle tissue slowly dies and is replaced by scar tissue. Decreased blood output in the long term can lead to several consequences. Initially, patients notice swelling in their legs and experience shortness of breath. The supply of nutrients and oxygen to the body decreases, and then this is observed at rest.
Listen to your heart
Thus, heart failure is not an independent disease, but a stage of heart disease. Its severity and speed of development can vary and depend on the severity of the primary heart disease, the patient’s lifestyle, his age, concomitant diseases and, finally, on the quality of treatment. Heart failure is manifested by such symptoms as increased fatigue, swelling of the legs, shortness of breath, asthma attacks, causeless weight loss, etc. Any of these symptoms, especially taken individually, can occur in a variety of diseases. Therefore, the correct diagnosis is made, unfortunately, rarely and most often in the later stages of the disease. Thus, significant weight loss, which is typical for severe degrees of heart failure, is often mistaken for a sign of cancer. Or, for example, harmless swelling of the legs caused by stagnation of lymph gives rise to a diagnosis of “heart failure.” In my practice, there was a case when a patient with a severe form of heart failure was treated for several months for... constipation.
Sad facts
Meanwhile, the prognosis for heart failure is unfavorable, if not fatal. When some primary symptoms of the disease (for example, pulmonary edema) appear, there is immediately a threat of death. These statistics are disappointing - within 3-5 years, 50% of patients die from heart failure, and after 9 years only 0.2% remain alive, of course, provided that the disease was not treated appropriately. Conventional drug treatment can only keep such patients alive in a state of severe disability with frequent hospitalizations. Of course, there is a radical way to help them - transplant a new heart. However, significant limitations for this intervention (age limit, high cost of surgery, lack of a sufficient number of donor hearts) make it unrealistic for the majority of heart failure sufferers. Now they have begun to talk about a new, promising method of restoring decrepit heart muscle, based on planting so-called “stem” cells. But, unfortunately, for practical use this is a matter of a rather distant future.
How to distinguish heart disease from others
Many people experience chest pain not necessarily due to any heart disease. Often this occurs due to another illness. If your heart hurts, it can be caused by diseases of the musculoskeletal system, respiratory, digestive and other diseases. However, only a doctor can make an accurate diagnosis after examining the patient.
But any person who has experienced such signs should understand if the heart hurts, what to do and how to recognize that it really is a heart disease. You need to know this in order to promptly consult a specialist in case of some serious pathologies. The signs of the disease may vary; you must learn to recognize them. The most important thing is to distinguish between cardiac and non-cardiac pain. For this purpose, you need to know the duration and intensity of the attack. In addition, it is advisable to have information about other diseases whose symptoms are similar to those of the heart.
The first symptoms of a heart attack
Discomfort in the chest can occur for various reasons. To understand that the heart hurts, it is advisable to know several characteristic symptoms. Seizures are not always accompanied by unpleasant sensations. At the same time, people with other ailments complain that they have difficulty breathing and pain in the left side of their chest. But all this is not a consequence of cardiac diseases.
The earliest signs that indicate that the functioning of the human body’s motor system is impaired most often appear several months, or even years, before the first attack. Therefore, everyone should know how and where the heart hurts. Early signs of the disease that should alert you are:
- Painful sensations behind the ribs. They hit the back, arm, neck, teeth. The left side is most often affected. At the same time, there is shortness of breath, nausea, and increased sweating.
- Discomfort after physical activity, stress, which disappears after rest or nitroglycerin tablets.
- Shortness of breath appears even with moderate exertion, simple work, while eating, and even in a lying position. Before the attack begins, the patient may sleep while sitting or suffer from insomnia.
- Severe fatigue from usual activities can begin long before the first attack.
- Representatives of the stronger sex sometimes develop erectile dysfunction several years before the diagnosis of coronary artery disease.
- Swelling. This symptom is considered the most basic evidence of cardiac dysfunction. At first, the swelling is almost invisible, but becomes larger over time. This is noticeable when a person removes shoes or rings from their fingers. If swelling is observed, you should consult a specialist and undergo an examination.
- Stopping breathing during night sleep, as well as snoring. These signs indicate a predisposition to an attack of heart disease.
Signs of coronary diseases
1. Myocardial infarction
Heart attacks can occur in different ways and how the heart hurts , symptoms in women and men in different situations can be different. In the case of myocardial infarction, everything happens approximately like this:
- There is a feeling of heaviness, pain in the central part of the chest, arm.
- Discomfort spreads to the left arm, neck, throat, and lower jaw.
- You feel dizzy, sweating, your skin becomes paler, and you feel nauseous.
- There is a feeling of heaviness in the stomach, a burning sensation in the chest.
- Anxiety, weakness.
- Rapid pulse.
The course of a heart attack may be different. Sometimes there are no signs at all. Sometimes the patient says that he experiences discomfort in the chest, sometimes there are no such symptoms and the process can be painless. Signs of a major heart attack: shortness of breath, blue lips, etc. very similar to symptoms of acute heart failure.
The duration of such an attack is approximately thirty minutes. Nitroglycerin doesn't help at all.
2. Ischemia
The main manifestation of IHD is angina attacks. In this case, pain occurs in the heart; the symptoms are the same in women and men. Among them:
- cardiopalmus;
- dyspnea;
- cardiac dysfunction;
- inconsistent pulse;
- dizzy, nauseous;
- weakness, sweating.
With coronary artery disease, patients report that they have a burning sensation and pressure in their chest. There is a feeling of being overwhelmed. Often unpleasant sensations are transmitted to the arm, neck, and throat. Most often observed during physical activity, stress and stop when the person remains alone.
With angina at rest, pain in the heart, the causes of which are different, appears at any time, even at night. This form is considered unfavorable.
Inflammatory heart diseases
1. Pericarditis
Pericarditis is an inflammation of the outer lining of the heart, the main symptom of which is a dull pain in the heart area. The pain is usually in the center of the chest, in some cases it radiates to the arm, back, and neck. When swallowing, coughing, etc. discomfort intensifies. Lying down makes it worse, sitting up makes it better. Although the nature of the soreness is usually dull and aching, in some cases it can be acute. Pericarditis is also characterized by rapid heartbeat.
2. Myocarditis
Inflammation of the myocardium is one of the reasons why the heart hurts; approximately 90 percent of people complain about it. Its form can be different, it appears regardless of physical activity, but after some time it can become stronger. Nitroglycerin doesn't help.
Heart valve diseases
If valve disease is present, its severity cannot be judged by symptoms. The patient may not complain about anything and still be in serious condition. Main symptoms:
- Shortness of breath, which is observed not only during high loads, but even during the most usual activities and in a supine position;
- Discomfort in the chest during exercise, breathing in cold air;
- Weakness, dizziness;
- Heart rhythm disturbance. These are, in particular, an uneven pulse, rapid heartbeat, and disturbances in the functioning of the heart.
This pathology often leads to heart failure. Then the following symptoms appear: the legs swell, the stomach bloats, and body weight increases.
Cardiomyopathy
Almost all people who have this pathology complain of pain. As the disease progresses, the way the heart hurts and the symptoms change. At first, the pain is long-lasting, does not depend on physical activity, and nitroglycerin does not help. Feels in different places. Then it is spontaneous or paroxysmal in nature after exercise and most often goes away after taking a nitroglycerin tablet. Its character can be different, its localization is precise, but sometimes it spreads over a large area. Nitroglycerin does not always help.
Arrhythmia
There are several types of arrhythmias. They are characterized by changes in heart rhythm. There are several types of ailments that cause heart pain radiating to the left arm.
Heart defects
These diseases can be acquired or inherited. For a long time they may not talk about themselves. Sometimes your heart hurts; your doctor should tell you what to do. This pain is usually aching, cutting or stabbing in nature. Accompanied by high blood pressure.
Mitral valve prolapse
Aching or pressing pain that appears on the left side is not caused by physical activity. They do not stop after taking nitroglycerin. In addition, dizziness, rapid heartbeat, and headaches may occur in the morning and evening. Possible shortness of breath, lightheadedness.
Aortic stenosis
With this disease, there is a pressing sensation in the chest. There is a strong heartbeat, weakness, fatigue, shortness of breath during physical activity. Over time, shortness of breath and dizziness occur during night sleep. If you suddenly change your body position, you may faint. Attacks of asthma and angina pectoris are possible.
Thromboembolism of the pulmonary artery
This is a very serious condition that requires immediate attention. The first sign of the disease is a stabbing pain in the heart area, which becomes stronger when inhaling and does not radiate to other places. The patient's skin turns blue, blood pressure decreases, shortness of breath and rapid heartbeat appear. Nitroglycerin has no effect.
Aortic pathologies
Sudden, very strong painful bursting sensations in the chest are a consequence of aortic dissection. They are sometimes so painful that a person can lose consciousness. The patient needs emergency medical care.
If there is an aortic aneurysm, there is aching or throbbing pain in the heart, a specialist must decide what to do. If an aneurysm ruptures, the pain becomes unbearable. If measures are not taken, death may occur.
Non-cardiac diseases
1). Intercostal neuralgia. Many people who feel such pain in the heart area mistake it for heart pain. However, in reality they are different. With neuralgia, the pain is sharp and stabbing in nature. They intensify when coughing, deep breathing, sudden turns of the body, etc. This can go away quite quickly, sometimes the pain lasts for several hours. The patient can accurately determine the location of the discomfort; it is located between the right ribs. In the case of angina pectoris, a person experiences a burning, aching feeling that does not go away when the position of the body changes. It is impossible to determine the exact location.
2). Osteochondrosis. This disease is quite easy to mistake for angina pectoris. The person is sure that his heart hurts, the symptoms are as follows: numbness occurs in the left hand, and it becomes more painful when moving. All this is especially similar to angina pectoris when an attack occurs during night sleep. The main difference is that nitroglycerin does not work.
3). Diseases of the central nervous system. In such a situation, patients often complain. However, symptoms vary. This can be regular, short-term, acute or aching pain in the heart area. Neuroses, as a rule, are characterized by a variety of vegetative disorders. A person may experience anxiety, insomnia or, on the contrary, increased sleepiness. Your hands get cold or cold, your head starts to hurt, and much more. Often patients suffering from neuroses complain, talking about numerous symptoms that they do not actually experience. And the “core people” are very reserved in sharing their feelings. Sometimes it is difficult to understand whether a patient has ischemic heart disease or cardioneurosis, since the cardiogram does not show any changes.
4). Disturbances in the functioning of the gastrointestinal tract. However, in this case, heart pain symptoms are somewhat different. They last longer, and the person feels nauseous, vomits, and develops heartburn. The intensity is determined by food intake. Often the symptoms of acute pancreatitis are similar to myocardial infarction. Sometimes exacerbations of gallbladder diseases radiate to the left half of the chest and it seems that the pain is in the heart. To understand what the problem is, you should take antispasmodics. If relief occurs, then the patient has gastrointestinal diseases.
5). Pulmonary diseases. Painful sensations similar to heart pain sometimes appear with pneumonia. This can also happen with pleurisy. But in this case, the pain is acute, intensifying with inhalation and coughing.
What to do?
Every person who feels pain in the chest thinks about what to do next. If there is any suggestion that your heart is hurting, you need to take immediate action. After all, the cause may be serious, in particular myocardial infarction or an attack of angina. Therefore you need to do the following:
- You should calm down and sit down. A stressful state will only worsen the situation.
- You need to try to take a different position. If after this there is relief, there is a possibility that the reason is different. If the pain increases, a pressing pain appears in the heart area, there is a risk that it is angina pectoris.
- It is recommended to allow access to fresh air and open a window.
- To prevent breathing from being constricted, you need to make your clothes looser, unbutton your collar
- If you suspect angina, take a nitroglycerin tablet and place it under your tongue. If relief does not come within a quarter of an hour, you need to take another tablet. You should call for emergency assistance. The medicine does not work for a heart attack.
Finally
Even if the pain in the heart area, the cause of which must be determined by a specialist, has gone away, you need to go to the hospital as soon as possible and get examined. Self-medication is unacceptable.
In Nizhny Novgorod, you can undergo a preventive examination at the Road Clinical Hospital, where professionals work.
... and the other side of the coin
At the same time, in recent years, the development of medical science and pharmacology, in a successful combination with medical experience, has made it possible to achieve amazing success in the treatment of even the most severe forms of heart failure. Patients manage not only to save life, but also to regain its quality, an active lifestyle, and regain weight (and this after losing 20-30 kg!). Moreover, all treatment takes place on an outpatient basis, without hospital stay. Having worked for decades in a cardiac surgery center where there was a heart transplant department, I, along with other doctors, was a powerless witness to the death of patients after many months of fruitless waiting for donor hearts. How many of them could be saved thanks to today's knowledge, capabilities and experience!
According to the feat and the reward...
Angioplasty and stenting of arteries
- Cost: 100,000 - 250,000 rubles.
- Duration: 40 minutes
- Hospitalization: 1-2 days in hospital
More details
I will not hide that the treatment of such patients, in addition to experience, requires considerable effort and time from the doctor and great pedantry in carrying out the patient’s prescriptions. However, it would be too arrogant to attribute all the successes in the treatment of heart failure only to yourself, as the attending physician. The ability to quickly and accurately diagnose the underlying disease that caused heart failure has a huge role. In 50% of cases, this is coronary heart disease, the identification and treatment of which with coronary angiography and angioplasty greatly facilitates the subsequent correction of myocardial weakness. Equally important for successful treatment is the identification of the earliest, so-called “preclinical” (i.e., before the onset of complaints) forms of heart failure, which is only possible with the use of instrumental research methods: echocardiography, Holter monitoring, stress tests. The Center for Endosurgery and Lithotripsy has not only the most modern equipment, but also highly qualified specialists, which is necessary for the detection and timely treatment of heart failure. All these conditions help to successfully achieve the task of long-term preservation of active life in one of the most severe categories of patients with heart disease - patients with heart failure. But the reward is high: over the past 5 years, there has not been a single death among my 187 patients with heart failure!
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.
