Scientific editor: Strokina OA, therapist, doctor of functional diagnostics. Practical experience since 2015.
November, 2018.
Heart failure - the inability of the heart to a normal filling and emptying, which leads to disruption of the blood supply to organs in accordance with the body's needs.
Symptoms of heart failure
By the manifestations of heart failure include:
- dyspnea on mild exertion or weak, or even at rest,
- heart palpitations,
- bluish fingernails or nasolabial triangle (not the cold, but at normal temperatures)
- symptoms of fluid retention in the body - edema (more swollen feet, preferably in the evening), ascites (fluid in the abdominal cavity);
- weakness;
- fatigue.
For heart failure are almost all heart diseases. The most common causes are arterial hypertension (95,5%), coronary heart disease (69,7%). Less often lead to organ failure:
- myocarditis;
- cardiomyopathy;
- heart defects;
- chronic obstructive pulmonary disease;
- atrial fibrillation (atrial fibrillation);
- anemia;
- transferred acute cerebrovascular accidents and others.
types
First of all disease is divided into
- acute
- chronic heart failure.
The first comes on suddenly and is characterized by severe symptoms, which should be removed only in a hospital. The second - slow, sluggish form which periodically especially aggravated by inappropriate treatment.
There are many gradations of disease. Some depend on the degree of reduction of the contractility of the heart, the other will determine the length of the flow.
For patients the most comprehensible is the classification of the severity of the current:
class |
Description |
I |
There are heart disease, but it does not limit the physical activity. Normal physical activity does not cause severe fatigue, palpitations and shortness of breath. |
I I |
Heart disease results in slight limitation of physical activity. The rest do not have symptoms. Normal physical activity causes fatigue, palpitation, or dyspnea. |
I I I |
Heart disease leads to a significant limitation of physical activity. The rest do not have symptoms. Activity Less common causes fatigue, palpitation, or dyspnea. |
I V |
Heart disease leads to severe restriction of any physical activity. Symptoms of heart failure and angina pectoris come alone. symptoms are worse in any activity. |
Diagnostics
Basically, doctors treat the symptoms, not specific to cardiac insufficiency:
- palpitations,
- swelling,
- an increase or decrease in weight,
- fainting
- and others.
Much less come to accept patients with specific symptoms:
- orthopnea - severe shortness of breath with a forced (bringing relief) position the patient sitting or half-sitting;
- nightly attacks of cardiac asthma (attacks of shortness of breath or choking that emerge from the stagnation of blood in the lungs).
laboratory methods
- Complete blood count - may be revealed anemia (symptoms similar to heart failure).
- Blood chemistry- sodium, potassium, calcium, urea content in urine and blood, liver enzymes and bilirubin, ferritin, total iron and calculation capacity of the blood, blood creatinine.
instrumental methods
- Electrocardiography - identify signs of cardiac disease (hypertrophy, myocardial infarction, heart rhythm disturbance, palpitations).
- Echocardiogram (ultrasound heart) - evaluation structure contractility (ejection fraction) and diastolic (ability to relax muscles) organ function.
These are the main methods that in most cases the diagnosis of heart failure. Others, more, are used when the echocardiogram EKGi did not give a clear understanding of the causes of the disease. These surveys include:
- a blood test for natriuretic hormones (at lower values exclude the diagnosis of heart failure, is also used to assess the prognosis of the disease);
- chest X-ray (detection of lung diseases with similar symptoms);
- coronary angiography (detection of coronary arteries);
- Cardiac MRI is used when there is insufficient information obtained by echocardiogram.
Treatment of heart failure
The primary goals of therapy for heart failure are:
- elimination of symptoms;
- slowing the progression of the disease;
- improving quality of life;
- reduction in the number of hospitalizations;
- improved prognosis.
Particular attention should be paid to body weight.
Therapy involves medication, correction of diet and lifestyle as necessary.
Most often appointed ACE inhibitors (e.g., kaptropil or analogs). In some cases, it is effective combination of bisoprolol (beta-blocker) and digoxin. Equally distributed assignment mineralocorticoid receptor antagonist (eplerenone). In the presence of edema is recommended to take diuretics.
Diet is aimed at the normalization of weight, regular physical activity of moderate activity should become a habit.
medication
Drugs are administered in any way. Their number depends on the stage of the symptoms of heart failure, as well as its causes.
In some cases, the doctor prescribes a drug, while in others need a combination thereof. Each person is different - it tests, medical history are not identical, so choose a treatment option only the attending doctor, because too many nuances on the interaction between medication, which simply do not understand the power of a person not familiar with the pharmacological action of various substances.
ACE inhibitors
They should be considered as first-line drugs (which necessarily prescribe the absence of contraindications) in the treatment of heart failure. They have proven effective in numerous clinical studies. The most common use are captopril, enalapril, lisinopril, perindopril.
Beta-blockers
Recommended for use in combination with digitalis, thus further reduced the risk of life-threatening arrhythmias, and coronary heart disease events (angina symptoms). Furthermore Beta-blockers decrease heart rate, reduced ventricular wall thickness, improve the prognosis of the disease. The most popular are bisoprolol, metoprolol succinate, nebivolol.
Mineralocorticoid receptor antagonists
This group of drugs by the right one of the three major groups for heart failure (along with ACE inhibitors and beta-blockers). Spironolactone and eplerenone should be administered only after a blood test for potassium and creatinine, as both are potassium-sparing. During treatment it is also necessary to monitor the levels of potassium and creatinine. If they are exceeded is high risk of cardiac arrhythmias, of life-threatening, and the deterioration of renal function.
glycosides
Digoxin - the most commonly used drug from the group of cardiac glycosides.
Taking the drug should be very carefully and only on the recommendation of the attending physician. Independent of his appointment is fraught with the appearance of life-threatening arrhythmias due to incorrectly selected dosage.
diuretics
Diuretics (diuretics) are necessary in the presence of excess fluid in the body, manifested by edema. Except for treatment is only one stage of the disease.
The primary drugs in this group include hydrochlorothiazide, indapamide, torasemide, furosemide.
Sartana
Second-line drugs - valsartan, losartan. Are assigned if the patient contraindications to ACE inhibitors (bilateral renal artery stenosis, ACE inhibitor intolerance, persistent dry cough associated with taking an ACE inhibitor, and so forth).
Non-recommended drugs
Caution should be exercised when using these drugs or to avoid their purpose in heart failure:
- non-steroidal anti-inflammatory drugs (NSAIDs), these include ortofen, ibuprofen, diclofenac, indomethacin, aspirin, and others;
- calcium channel blockers (verapamil, diltiazem);
- tricyclic antidepressants;
- corticosteroids (prednisolone, hydrocortisone, cortisone, etc.);
- lithium preparations.
Diet and lifestyle for heart failure
The diet is primarily aimed at combating obesity. Fluid intake should not be restricted. Only in severe cases, heart failure requiring intravenous diuretics). In other cases, the active diuretic therapy minimum fluid volume should be 1.5 liters per day.
Limiting salt intake to 5-6 g per day. This refers to the total intake of salt, that is, of all foods, not just salt. Therefore, the specialist should tell the patient the most salty foods that should be abandoned. Such as pickles, smoked meats, sausages, canned food.
It is strongly recommended to all patients to stop smoking.
Alcohol use should be prohibited in the suspected alcoholic cardiomyopathy.
In all other cases, alcohol consumption is possible in a limited number (1 glass of dry red wine a day).
It is necessary to give up sedentary lifestyle. It should encourage moderate activity aimed at strengthening the muscles (e.g., walking), while heavy loads are not recommended. Recommendations for physical activity should be given a doctor LFK.
Specific recommendations include dynamic load (walking) 3-5 times a week for 20-30 minutes or cycling for 20 minutes. 5 times per week.
sources:
- Clinical guidelines PRAs - CSC - RNMOT. Heart failure: chronic (CHF) and an acute asthma (ADHF). Diagnosis, prevention and treatment. - Cardiology. 2018; 58 (S6).
