Circulatory failure (NK) is a pathological condition in which blood is not delivered to the organs of the human body in the right amount. Due to a malfunction in the cardiovascular system, the human body can no longer fully function. This disease is quite common: every hundredth inhabitant of our country suffers from such a syndrome. Medical statistics indicate: an annual increase in the incidence rate is 3 cases per 1000 people. Every year, only 35% of those suffering from circulatory failure undergo treatment in stationary conditions.
Disease classification
There are heart failure syndrome associated with heart disease and a disease associated with circulatory disorders of the cardiovascular system. The classic clinical manifestations of vascular failure is the occurrence of collapse, orthostatic hypotension, and shock.
Types of circulatory failure
Classification of diseases according to their course is divided into acute and chronic form. The concept of acute failure applies to the designation of cardiac asthma and pulmonary edema. The acute form usually develops rapidly against the background of myocardial infarction, rupture of the walls of the left ventricle, myocarditis or acute insufficiency of the aortic and mitral valves, prolonged circulatory failure or other pathologies. With the development of the acute form, there are clinical signs of an unfavorable course of the disease, a prognosis of a fatal outcome is possible.
With the gradual development of insufficiency, a chronic form is isolated. It can form from several weeks to tens of years. The causes of its appearance may be the presence of heart defects, arterial hypertension, chronic respiratory failure or prolonged anemia. Today, there are two classifications of circulatory failure. The first of them was proposed about a century ago. It is based on a functional approach and a qualitative assessment of changes in the body.
Classification by N.D. Strazhesko and V.G. Vasilenko
Such a method of separation was proposed - the outstanding Soviet cardiologists-clinicians Strazhesko and Vasilenko. The classification of circulatory failure distinguishes three different stages of the course of the disease.
At the first, initial and, most often, latent stage (I), the patient at rest has no symptoms of any disturbances. Only with physical exertion can shortness of breath, a feeling of fatigue, or a rapid heartbeat occur. In this case, there may be signs of compensatory hypertrophy and / or tonogenic dilatation of one or another part of the heart.
The second stage (II) according to the classification of circulatory failure is divided into two subgroups in which the manifestations of the disease will have more pronounced symptoms.
The second stage of the first substage (II-A) is characterized by insufficiency of the right or left heart, stagnation phenomena, mildly expressed and quickly disappearing after appropriate treatment and compliance with the necessary regimen. Shortness of breath and weakness are observed at rest, with physical exertion they increase significantly, which is why full-fledged activity is impossible. There are metabolic disorders and disruptions in the activity of some organs. The liver may be slightly larger than normal and painful, but in moderation. By evening, the legs may swell; by morning, puffiness passes.
According to the proposed classification, the second stage of the second substage (II-B) is characterized by signs of stagnation of blood in the pulmonary circulation and large circulation, which are also expressed at rest. Even slight increases in physical activity lead to increased shortness of breath. Failure of both the right and left heart is observed. There are signs of ascites and diffuse cyanosis. The liver is enlarged and painful, impaired renal function, swelling.
In the third, final, dystrophic stage (III), irreversible disorders occur in organs and systems, while the liver and lungs are most affected.
The offer of American cardiologists
Nevertheless, today the proposal by the New York Association of Cardiology (NYHA) is considered to be the optimal classification of circulatory failure by severity. According to the American classification, heart failure can be divided into functional classes, and each of them depends on the physical load that the patient can withstand. It is based on the principle of the degree of pathology of hemodynamic disturbances in the large and small circle of blood circulation. Thus, the proposal of American cardiologists allows us to determine the patient's working capacity or the ability to carry out any activity without the appearance of complaints specific to heart failure.
Function classes
The classification of circulatory failure by functional classes does not have to correspond to certain stages of the manifestation of insufficiency. Depending on the therapeutic treatment and the degree of progression of the disease, the functional class may vary.
According to the level of performance and the degree of tolerance of physical exertion to patients, chronic heart failure (CHF) is divided into four classes:
- CHF of the first functional class. This includes physically active patients. On their part, there are no complaints of shortness of breath or heart palpitations with increased loads.
- CHF of the second functional class. These are patients who are characterized by moderate physical activity limitations. The patient feels great at rest, however, even the usual physical activities cause fatigue, shortness of breath or an attack of tachycardia.
- CHF of the third functional class. In patients, the pronounced nature of the course of the disease. Even when at rest, the patient feels weakness, shortness of breath and palpitations.
- CHF of the third functional class. Discomfort can occur even with the slightest physical exertion. Without even moving, the patient experiences symptoms of insufficiency. The activity of such patients is minimized.
Classification of chronic circulatory failure according to the American system is quite simple and convenient. That is why it is generally accepted in international and European communities of cardiologists.
What causes chronic circulatory failure?
Heart failure most often occurs due to damage to the heart muscle or loss of ability to pump the right amount of blood through the vascular system. The main causes of this disease are:
- High blood pressure.
- Coronary heart disease, myocardial infarction, myocarditis, the formation of cardiomyopathy or atrial fibrillation, heart block.
- Changes in muscle structure occurring as a result of taking certain medications.
- Diabetes mellitus, impaired renal or liver function.
- Congenital malformations.
- The presence of bad habits, such as smoking, drinking alcohol or drugs.
Classic symptoms
Depending on the degree and type of violation, different symptoms may appear. If a failure occurred in the left ventricle of the heart, then the pulmonary circulation and the pulmonary system are susceptible to blood stasis. In this case, the patient experiences shortness of breath, signs of cyanosis (fingers and hands turn blue lips), dry rales are present, possibly hemoptysis.
If the right ventricle is affected, then a large circle of blood circulation is susceptible to stagnation of blood. In this case, characteristic: swelling of the extremities and pain in the right hypochondrium (stagnation of blood in the liver).
In any case, the patient experiences rapid fatigue and a rapid heartbeat. When classifying circulatory failure in children or adults, the symptoms of the disease will be more intense if the course of the disease has become more severe.
Diagnosis of the disease
Heart failure is determined on the basis of an examination by a cardiologist and the use of additional tools and examination methods. The state of cardiac activity is assessed by monitoring the ECG during the day and using treadmill tests. An echocardiogram allows you to establish the level of contractility and the size of various parts of the heart. To determine the degree and level of blockage of blood vessels, as well as to investigate the level of pressure in the heart chambers, such manipulation as cardiac catheterization allows.
Medication treatment
As the main means of treating circulatory failure, the classification of which was given above, are:
- Beta-blockers (inhibitors). These drugs help lower your blood pressure and lower your heart rate.
- Glycosides. These drugs are effective in eliminating the main symptoms. In addition, they help strengthen the heart muscle. Small amounts are effective in the treatment of atrial fibrillation. May have a quick and short-term or long-lasting effect.
- To eliminate the consequences of the disease, various diuretics are used, with the help of which excess fluid is removed from the body.
- The appointment of the use of polyunsaturated fatty amino acids helps to improve metabolism in the body. These substances protect against the occurrence of heart attacks.
Additional funds
In the treatment of heart failure, it is additionally prescribed:
- Statins The use of these drugs provokes a decrease in blood cholesterol. They contribute to the normalization of blood circulation. These drugs are used to combat ischemic disease.
- Anticoagulants. Drugs that disrupt platelet synthesis.
With special symptoms complicating the course of the disease, they can prescribe:
- Preparations containing nitrite compounds and salts of nitric acid. These components contribute to the expansion of blood vessels and improve blood circulation in heart disease.
- Calcium antagonists - are used to prevent the ingress of calcium into the cells of the cardiovascular system. Appointed with stable angina pectoris, stable high blood pressure and pronounced symptoms of circulatory failure. Often they are prescribed for arrhythmias.
- Disaggregants - means that exclude the process of thrombosis. Such drugs significantly reduce the risk of heart attacks. They are recommended for the treatment and prevention of atherosclerosis.
Special diets
Circulatory failure is a disease in which a strict diet is necessary. It minimizes the use of salt and liquid. A balanced diet should be easily digestible and include the necessary amount of vital nutrients, polyunsaturated fatty amino acids, fiber, and other equally important components.