Heart failure: symptoms and treatment in the elderly

Heart failure - a pathological condition in which there is a weakening of the myocardial contractility, and as a result, blood circulation is disturbed.

It is never an independent disease, but is a result of conditions such as coronary heart disease, hypertension, heart disease and others. Especially prevalent heart failure in the elderly, but can be diagnosed in children. In order to recognize the pathology, it is necessary to know its characteristics.

What it is?

Heart failure - a clinical syndrome associated with acute or chronic disorders of the heart and, therefore, insufficient blood supply to organs and tissues. The root cause is the deterioration of the heart's ability to filling or emptying due to myocardial damage.

Depending on how rapidly developing heart failure, it is divided into acute and chronic. Acute heart failure may be associated with trauma, the effect of toxins, heart disease and without treatment can lead quickly to death.

Chronic heart failure develops for a long time and manifests characteristic symptoms complex (dyspnea, fatigue and reduced physical activity, edema etc.) that are associated with inadequate perfusion of organs and tissues at rest or with exercise and often fluid retention body.

Causes of

Development of cardiovascular disease can be caused by a number of different causes and factors, however, most cases its origin is a natural outcome of existing and progressing in the human heart diseases.

The main causes of heart failure include:

• overload of the heart muscle (often caused by pulmonary hypertension, hypertension, Pulmonary stenosis or aortic insufficiency and heart valve apparatus);
• disorders associated with blood cardiac filling process (can be caused by heart pericarditis, amyloidosis, fibroelastosis);
• heart failure (may be due to angina, cardiomyopathy, myocardial infarction, myocarditis, Kardiosklerosis, as well as some system in the form of disease erythematosus, rubella, Rheumatism);
• heart rhythm disturbances (it appears on the background of progressive arrhythmia).

Physicians have noted that sometimes the emergence of this disease may also contribute fevers, anemia, thyroid diseases, pregnancy, metabolic malfunction and alcoholism.

Classification

Classes of chronic heart failure:

• I class. Symptomatology weakly expressed, the load corresponding to overcome a flight of stairs to the floor level III, causes shortness of breath.
• Class II. Somewhat reduced level of physical activity, vigorous walking and lifting on I floor cause the manifestation of symptoms.
• Class III. Man gets tired quickly from insignificant physical activity, normal walking, but after resting symptoms disappear.
• Class IV. Severe fatigue, shortness of breath intense concerned even without a load, any physical activity provokes cardiovascular failure.

Localization of pathology released:

1. Left ventricular failure. With this type of pathology of the blood stagnates in the pulmonary circulation, and in the great circle is ejected insufficient.
2. Right ventricular failure. The process is reversed, the blood stagnates in the systemic circulation while reducing its volume in a small circle.
3. Biventricular failure. Characterized by simultaneous pathology of both ventricles of the heart.

By type of hemodynamics are distinguished:

1. Hypokinetic heart failure - heart throws out enough blood, it causes arrhythmic, reflex or true cardiogenic shock.
2. Congestive heart failure - venous blood lingers in the systemic circulation, manifested swelling of limbs, lung, cardiac asthma.

By provoking factors:

1. Overload - occurs due to excessive load on the heart, interfering with the natural flow of blood.
2. Myocardial - caused by lesions of the heart wall violates systolic and diastolic function of the heart.
3. Mixed - combines multiple different factors.

The development of heart failure

Dates of the onset overt cardiac failure unique to each patient and cardiovascular disease. Depending on what kind of ventricle of the heart suffers more due to illness, distinguish right and left ventricular heart failure.

In cases of right heart failure excessive volume of fluid retained in the vessels systemic circulation, thereby causing swelling, first - in the feet and ankles. In addition to these basic attributes for right heart failure characterized by a fast fatigue, due to low blood oxygen saturation, as well as a feeling of fullness and pulsation neck.

Left ventricular heart failure is characterized by fluid retention in the pulmonary circulation, whereby the amount of oxygen entering the blood decreases. As a result, there dyspnea, aggravated by exertion, weakness, and fatigue.

The sequence of occurrence and severity of heart failure symptoms are unique to each patient. In cases involving the right ventricle lesion, heart failure symptoms appear faster than in cases of left ventricular failure. This is due to the fact that the left ventricle of the heart is the most powerful department. It usually takes a lot of time before the left ventricle "surrender" their position. But if it does occur, the heart failure develops with catastrophic speed.

Acute heart failure

Acute heart failure often develops as a complication of severe arrhythmia (Paroxysmal tachycardia, ventricular fibrillation), acute myocarditis or myocardial infarction. The ability of the myocardium to effectively reduce drastically reduced, which leads to a drop in cardiac output and arterial system receives significantly less than normal blood volume.

Acute heart failure may be due to a decrease of the pumping function of the right ventricle, the left ventricle or the left atrium. Acute left ventricular failure develops as a complication of myocardial infarction, aortic defect, hypertensive crisis. Reduced contractile activity of the left ventricle leads to increased pressure in the veins, capillaries and arterioles of the lung, increase the permeability of the walls. This causes propotevanie blood plasma and the development of lung tissue edema.

Acute heart failure occur in different embodiments:

1. Acute decompensated heart failure. Manifestation of acute heart failure symptoms mild.
2. Hypertensive crisis. Right ventricular function stored, increased pressure causes pulmonary edema.
3. Pulmonary edema. Due hindered venous outflow occurs fluid effusion alveoli.
4. Cardiogenic shock. Low or critically low systolic pressure leads to a dramatic reduction in cardiac output. patient response inhibited, skin cold.
5. AHF with high cardiac output. Accompanied by tachycardia, pulmonary congestion, may increase blood pressure. The patient's skin is warm to the touch.

Left ventricular heart failure leads to a delay in the circulating blood of a small circle. At the same time develop acute pulmonary edema which manifests itself by the following features:

1. Increasing shortness of breath, even suffocation.
2. Stimulated posture while sitting, as occurs in the horizontal position lung ventilation deterioration.
3. Cough with frothy sputum character.
4. Remote crackles in the lungs during breathing.
5. Heart palpitations.
6. Cyanosis of the skin and mucous membranes.

Right ventricular failure of the heart is manifested by stagnation of blood circulating in the systemic circulation, which can be determined by the appearance of the following symptoms:

• jugular venous distention;
• pain in the right subcostal area because of portal hypertension, venous stasis and liver enlargement, which is accompanied by stretching of the capsule;
• in the case of acute liver parenchymal necrosis may cause jaundice;
• development of ascites (fluid accumulation in the abdomen).

Symptoms of chronic heart failure

Left ventricular weakness leads to changes in a big circle:

• First it pastoznost feet and legs and hidden edema elicited during weighing.
• Impaired blood flow in the kidney become a cause of reducing the number of separated urine until anuria.
• Increasing liver appears continuous congestive heart failure. Symptoms of it - it's the severity and pain in the right upper quadrant of his tension edematous liver capsule.
• Problems with cerebral circulation leads to sleep disorders, memory disorders, and even thinking and mentality.
• Patients disturb heartbeat (paroxysmal tachycardia, atrial fibrillation, arrhythmia), weakness, and fatigue.
• It appears edematous syndrome. Gradually swelling in heart failure is increasing, spreading to his feet, the anterior abdominal wall, lower back and genitals. Massive swelling are called hydrops.

Insufficiency of right heart chambers leads to disturbances in the pulmonary circulation and pulmonary symptoms manifest.

On the first place among the complaints of patients playing:

• Shortness of breath, which progresses and reduces the quality of life
• By choking episodes may occur with progression of heart failure.
• Gradually, shortness of breath cough joined with the Department of a small amount of clear sputum.
• There is a need to sleep with the head elevated, periodically hold position orthopnea (sit with reliance on hand).
• For patients characterized by a grayish-bluish skin color, cyanosis in the nasolabial triangle, the hands and feet. The fingers take the form of drum sticks. Nails become too convex and thickened.

This type of heart failure - this is often the outcome of many chronic heart disease. It occurs on the right- or left ventricular type, and can be total. The mechanisms of its development are similar to acute forms, but stretched out over time, due to which in the first place serves anoxia and degeneration of organs and tissues.

Diagnostics

To establish a diagnosis of "heart failure" is sufficient inspection specialist. He drew attention to the signs and the patient's complaint, listen to his heart.

Additionally provided such research:

1. Echocardiography (echocardiography) with dopplerography. It allows you to identify the cause of the pathology.
2. Electrocardiography (ECG). It helps detect signs of hypertrophy, arrhythmia, signs of insufficient blood supply to the myocardium.
3. Radionuclide ventriculography. It helps to assess the contractility of the ventricles and their volumetric capacity.
4. X-ray examination. It helps to see the stagnation of blood in the pulmonary circulation, and also detect the increase in right heart.
5. Investigation of the level of hormones that produce myocardial cells - natriuretic peptides in plasma. A large deviation from normal values ​​indicates a severe stage of the disease.

Diagnosis of heart failure should be performed for the early detection of the disease even in the absence of the characteristic symptoms. This is due to the fact that the pathology develops against the background of certain diseases, and its early detection and treatment prolongs human life and improves its quality.

Effects

CH complications and consequences are nonspecific and depend on the stage of the disease. The most common:

1. Cardiac arrhythmias and death. Patients with heart failure die within the 44 per cent more likely than people without the syndrome of HF.
2. Pulmonary hemorrhage. Symptom accompanying CH pulmonary edema and cardiac asthma is one of the earliest complications of the disease.
3. Bronchopneumonia and infectious lesions. Due to the stagnation / extravasation of fluids and blood, as well as the low respiratory activity, there are very favorable conditions for the development of the respiratory tract and lung infections.
4. Pechenokletochnaya failure. Changes in the liver due to venous congestion and worsening perfusion.
5. Embolisms, heart attacks the lungs and other internal organs due to blood stasis.
6. Chronic renal / cardiocerebral insufficiency, decompensation of the alimentary canal system functions without occlusion of arteries - caused by low complication MOS.
7. Cardiac cachexia. It is a complication in end-stage heart failure, and disorders caused by metabolic processes, in particular the poor absorption of fats leading to generalized anorexia.

drug therapy

Conservative treatment of heart failure comprises receiving different groups of drugs:

drugs group	names tablets	produced the effect
cardiac glycosides	Digitoxin, digoxin, methyldigoxin, Strofantin K	Maintain and improve the contractile function of the heart muscle
ACE inhibitors	Captopril, lisinopril, fosinopril	Reduce pressure, dilates blood vessels, reduces the risk of heart failure
calcium antagonists	Verapamil, Cinnarizine, diltiazem, amlodipine, nitrendipine	Expanding the artery, the pressure reduced eliminate arrhythmias
diuretics	Spironol, Urakton, furosemide, aldactone	The withdrawal of excess fluid from the body, prevent the formation of edema, improve efficacy, reduce pressure
Beta-blockers	Metoprolol, atenolol	Reduce pressure, slow heart rate
nitrates	Nitroglycerine	Relieve pain in the chest, extend vein
other	ATP Riboksin, Carnitine	Stimulate metabolism in the myocardium

If the patient has heart failure 1 degree, which appeared on the background of excessive exercise, the doctor may decide that the patient is no need to make serious preparations. In this case, he will appoint only medicines that improve the metabolism of the heart muscle, as well as B vitamins to strengthen the heart and blood vessels.

Power and Mode

Nutrition in heart failure has its own characteristics. Patients recommended diet № 10, while the second and third degree circulatory disorders 10a.

Basic principles of clinical nutrition in heart failure:

• Standards fluid receiving 600 ml - 1.5 l per day.
• Fats 50-70 grams per day (25% vegetable oil)
• Carbohydrates 300-400 g (80-90 g of sugar and other confectionery)
• The diet includes foods rich in potassium deficiency which leads to myocardial dystrophy: dried apricots, raisins, seaweed.
• Ingredients that have an alkaline reaction, as a metabolic disorder in heart failure leads to acidosis (acidification of the body). Recommended: milk, bread from wheat flour, cabbage, bananas, beets.
• The food should be high-calorie, legkousvaimoy rich in vitamins and proteins. Otherwise develops decompensation stage.
• In obesity and overweight (> 25 kg / m²) must restrict caloric intake 1900-2500 kcal. Eliminate fatty, fried foods and pastries with cream.
• Limiting the salt that causes the water retention in the body, increasing the load on the heart and the appearance of edemas. salts norm reduced to 1-3 g per day. the salt is completely shut down with severe heart failure.
• When a pathological loss of body weight due to fat mass and muscle (> 5 kg in 6 months) recommended calorie meals 5 times a day in small portions. Since the stomach overflow causes raising of the diaphragm and a violation of the heart.

In acute heart failure shows a rest. And if the patient will be in the supine position, the condition may worsen - intensified pulmonary edema. Therefore, it is desirable to be in a sitting position with the floor lowered down.

In chronic heart failure is contraindicated in peace. Lack of movement increases the congestion in the large and small circulation.

Folk remedies

Long term development and chronicity of the disease enables the use of natural ingredients. Here are some of the most popular folk recipes for the treatment of this disease.

1. The state of heart failure will improve, if we use the following recipe. 2 tbsp. l. green or dried green beans chop and pour 750 ml of water. Bring to the boil and cook for five minutes. Then take 1 hour. l. crushed leaves of Leonurus, leaves or flowers of hawthorn, lemon balm, mint, leaves or lily of the valley flowers. Pour into boiling water with bean pods. Boil for an additional three minutes. Insist four hours and then strain. The resulting broth in the refrigerator. A single application dose is 4 Art. l. Before going to sleep to the composition every time it is recommended to add 20 drops Zelenin. Drink 3 times a day 20 minutes before meals.
2. Take a tablespoon of fresh Viburnum, knead it until the juice and pour a glass of boiling water, add two teaspoons of honey. Give broth brew for an hour and then take two times a day ½ cup for the 1st month.
3. Soothing collection. The infusion helps to reduce the load on the heart muscle. Mix the crushed roots of Valeriana officinalis, grass, peppermint, lemon balm leaves (3: 3: 4). Spoon collection zaparivayut 300 ml boiling water in the teapot, insist 20 minutes, filtered, and taken in the morning and at bedtime for ½ cup.
4. When the pain in the heart of the well to the next national method. Take 0.5 kg of ripe fruits of hawthorn, rinse and fill with 1 liter of water. Boil for 20 minutes on low heat. Strain, add 2/3 cup of sugar and the same amount of honey. Mix thoroughly. Take every day for a month for 2 tablespoons. l. before eating. The composition of the store in the refrigerator.
5. Two tablespoons of chopped dried adonis pour a glass of boiled water, to move into a thermos and leave for two hours. Strain the infusion and drink 50 milliliters of liquid, three times a day for two weeks.
6. Sagebrush. The active substance in the composition of plants - tauremzin - has beneficial effects on the respiratory, cardiovascular and nervous system, improves blood circulation. Broth Artemisia dosage administered to the brain hemorrhage, angina pectoris, tachycardia, dyspnea: 30 g of dry raw pour two glasses of water and boiled at low heat for fifteen minutes. Receiving 150 ml three times a day before meals.

prevention

As a preventive measure to prevent the onset of this disease is necessary to prevent the development of diseases that lead to it. Among them, ischaemia, hypertension, heart defects. In addition, you need to prevent the emergence of possible factors that favor the emergence of.

If you have heart failure, the symptoms of which are already evident, it is necessary, first of all, to try to prevent its progression. To do this, do not exceed the recommended exercise, take all prescribed by a doctor, be screened regularly by a cardiologist.