Today, in the age of technology, the development of cardiovascular diseases causes quite serious concerns not only among employees of medical organizations, but also in the upper levels of government. That is why, more and more, new strategies are being developed to reduce the diseases under consideration, and scientific developments are being actively funded that will help achieve these goals in the future.
One of the directions in the treatment of patients with cardiovascular diseases is the prevention and treatment of cardiac pathology. If in this area some of the diseases can be successfully treated, others still remain "difficult to cure" due to the lack of methods and other necessary components of proper treatment. This article discusses the concepts of cardiac output, its norms and methods of treatment, the fraction of cardiac output (normal in children and adults).
Current situation
Due to the increase in life expectancy among the elderly, the prevalence of cardiac pathology in this group increases, especially with a disturbed ejection fraction. In recent years, proven methods of drug treatment have been developed and the use of resynchronization devices, a cardioverter-defibrillator that prolong life, improve its quality in patients with this pathology.
However, methods for treating heart pathology with a normal fraction have not been determined; treatment of this pathology remains empirical. There are also no proven treatments for acute forms of cardiac decompensation (pulmonary edema). Until now, the main drugs in the treatment of this condition are diuretics, oxygen and nitro drugs. The ejection fraction, the norm, its pathology, require a serious approach to the problem.
Visualize the heart muscle and determine the work of the chambers of the heart (atria, ventricles) using Doppler cardiography. To understand how the heart works, examine its ability to contract (systolic function) and relaxation (diastolic function) of the myocardium.
Fraction Values
The ejection fraction, the norm of which is discussed below, is the main instrumental indicator that characterizes the strength of the heart muscle.
The values of the ejection fraction obtained by Doppler cardiography:
- Normal rates are greater than or equal to 55%.
- Slight deviation - 45-54%.
- Moderate deviation - 30-44%.
- The expressed deviation is less than 30%.
If this indicator is less than 40% - "heart strength" is reduced. Normal values are above 50%, "heart strength" is good. Allocate the "gray zone" from 40-50%.
Heart failure - a combination of clinical manifestations, biochemical markers, research data (electrocardiography, dopplerography of the heart, radiography of the lungs) that occur with a decrease in the strength of heart contraction.
Distinguish between symptomatic and asymptomatic, systolic and diastolic heart failure.
Relevance of the problem
In the past 20 years, the incidence of heart failure among Europeans has been decreasing. But the number of cases in the middle and senior groups of the population is increasing due to increased life expectancy.
According to European studies (echocardiography), a decrease in ejection fraction was found in half of patients with symptomatic heart failure and in half of asymptomatic patients.
Patients with heart failure are less able to work, their quality of life and its duration are reduced.
The treatment of these patients is the most expensive for them and for the state. Therefore, the search for ways to prevent the occurrence, early diagnosis and effective treatment of heart diseases remains relevant.
Studies conducted in recent decades have proven the effectiveness of a number of groups of drugs to improve prognosis and reduce mortality in patients with low heart fraction:
- adenosine converting enzyme inhibitors (Enalapril);
- angiotensin P antagonists (Valsartan);
- beta blockers (Carvedilol);
- aldosterone blockers ("Spironolactone");
- diuretics ("Torasemide");
- "Digoxin".
Causes of Heart Failure
Heart failure is a syndrome that is formed due to a violation of the structure or functioning of the myocardium. Pathology of conduction or heart rhythm, inflammatory, immune, endocrine, metabolic, genetic, neoplastic processes, pregnancy can cause cardiac weakness with or without impaired ejection fraction.
Causes of heart failure:
- Coronary heart disease (more often after a heart attack);
- hypertension;
- a combination of ischemic heart disease and hypertension;
- idiopathic cardiopathy;
- atrial fibrillation;
- Valvular defects (rheumatic, sclerotic).
Heart failure:
- systolic (ejection fraction of the heart - the norm is less than 40%);
- diastolic (ejection fraction of 45-50%).
Diagnosis of systolic heart failure
Diagnosis of systolic heart failure involves:
1. ejection fraction of the heart - the norm is less than 40%;
2. stagnation in the circles of blood circulation;
3. changes in the structure of the heart (scars, foci of fibrosis, etc.).
Signs of blood stasis:
- increased fatigue;
- dyspnea (shortness of breath), including orthopnea, nocturnal paroxysmal shortness of breath - cardiac asthma;
- swelling;
- hepatomegaly;
- expansion of the jugular veins;
- crepitus in the lungs or pleural effusion;
- Noises during auscultation of the heart, cardiomegaly.
The combination of several of the above symptoms, the availability of information about heart disease helps to establish heart failure, but it is crucial to conduct Dopplerography of the heart with the determination of structural changes and assessment of the ejection fraction of the myocardium. In this case, the cardiac ejection fraction will be decisive, the norm after which myocardial infarction will be definitely different.
Diagnostic criteria
Diagnostic criteria for heart failure with a normal fraction:
- ejection fraction of the heart - the norm is 45-50%;
- congestion in a small circle (shortness of breath, crepitus in the lungs, cardiac asthma);
- impaired relaxation or increased stiffness of the myocardium.
To exclude heart failure, biological markers have been determined in recent years: atrial natriuretic peptide (acute heart failure - more than 300 pg / ml, with chronic more than 125 pg / ml). The level of the peptide will help in determining the prognosis of the disease, the choice of the optimal treatment.
Patients with a preserved cardiac fraction are usually older, and more often women. They have many concomitant pathologies, including arterial hypertension. In these patients, the level of type B natriuretic peptide in blood plasma is lower than in patients with a low fraction, but higher than in healthy ones.
Tasks for doctors to treat patients
The goals of treating patients with heart failure when the ejection fraction of the heart is above normal:
- relief of symptoms of the disease;
- reduction of cases of repeated hospitalizations;
- Prevention of premature death.
The first step in correcting heart failure is non-drug treatment:
- restriction of physical activity;
- restriction of salt intake;
- fluid restriction;
- weight loss.
Treatment of patients with reduced EF
Step 1: diuretic (“Torasemide”) + angiotensin converting enzyme inhibitor (“Enalapril”) or angiotensin P receptor blocker (“Valsartan”) with a gradual increase in dose to a stable state + beta-blocker (“Carvedilol”).
If symptoms persist, step 2: add an aldosterone antagonist (Veroshpiron) or angiotensin P.
If symptoms persist, it is possible to add “Digoxin”, “Hydralazine”, nitrorepates (“Cardiket”) to the treatment and / or carry out invasive interventions (installation of resynchronization devices, implantation of a cardioverter-defibrillator, heart transplantation), after conducting an ultrasound of the heart. The ejection fraction, the norm of which is described above, in this case is determined by ultrasound.
Modern tactics for treating heart failure with angiotensin-converting enzyme inhibitors, angiotensin P receptor blockers, beta-blockers, aldosterone blockers, diuretics, nitrates, hydralazine, digoxin, omacor, if necessary, the installation of resynchronization devices and cardioverter defibrillators has significantly increased the last two decades patients with terminal forms of this disease. This poses new challenges for doctors and researchers.
The search for methods to replace myocardial scar tissue remains relevant.
Conclusion
Thus, from the presented article, one can see the practical value of the methods undertaken by doctors. The ejection fraction (norm and pathology) has not yet been fully studied. And although medicine is currently not yet perfect for combating the pathologies under consideration, we need to hope and invest a sufficient amount of investment in the development and development of scientific research in this area. Indeed, the development of the medical industry mainly depends on scientists. Therefore, public authorities should support all scientific medical institutions trying to move the issue under consideration.