Modern medicine pays a lot of attention to the issue of heart pathologies, and among others, the study of acute and chronic heart failure is traditionally considered especially important. The stages of the disease, its signs, diagnostic features and treatment options - all this is considered by the brightest minds of our world in order to find effective methods for the prevention and timely detection and treatment of a disease associated with an increased risk to the patient's life.
general information
Before understanding what the progressive and initial stages of heart failure are, it is worth paying attention to the general terminology, to consider the condition described by this term. HF is a pathology in which contractile cardiac ability is at odds with the needs of the body, which leads to a metabolic failure. The disease is widespread. Especially often, pathology is found in elderly people. People of all genders are affected by heart failure in different forms.
Causes and consequences
Perhaps a person will have to understand from his own experience what the stages of heart failure are according to Strazhesko, which means a diagnosis made by a doctor if he had a heart or vascular disease - such pathologies often entail heart failure as a complication. Particular risks are associated with a heart attack, atherosclerosis, localized in the vascular system that feeds the heart directly. There is a high probability of developing heart failure if a person suffers from heart defects - inherited from birth or acquired over time. Risks are associated with high blood pressure, cardiac tamponade, myopathy of the heart, arrhythmia.
If the doctor has established any stage of heart failure (2b, 2a, first or third) in relation to the ventricle on the left, it may be caused by a disease of the respiratory system - COPD, hypertension, and other lesions.
Risks and Dangers
It is noted that it is especially important to know how to detect heart failure at an early stage, to people suffering from chronic increased pressure in the arteries, since such a condition is associated with significant risks of heart failure. More often a compensated form of a pathological condition develops. Lack of functioning of the kidneys, brady-, tachycardia can lead to similar consequences. A compensated variant of the pathology is often formed against the background of a coronary syndrome, proceeding acutely, with pulmonary embolism.
Certain risks of the formation of heart failure are associated with the drug course if the patient takes drugs that negatively affect the heart. Another source of the problem is also possible: if the doctor prescribed medications for heart failure, but the patient violates the prescribed regimen, the symptoms of the condition may disturb him.
Manifestations pointing to heart failure often accompany fever, fever, and anemia. Severe infection, hyperthyroidism can lead to similar consequences. Risks are associated with heavy consumption of water, salt, and alcohol. More often, symptoms of heart failure are observed in smokers, pregnant. It is possible to identify heart failure stage 1 (and other levels of development) against a background of impaired ability of the heart muscle to contract.
How to notice?
It is possible to assume any stage of chronic heart failure or acute if orthopnea appears, in which a person takes a stable unnatural posture, due to which it becomes somewhat easier for him physically. Exercise provokes shortness of breath, in some breathing problems accompany being at rest. Choking comes in bouts of coughing at night.
You can notice heart failure by a weak state and confused consciousness, a tendency to get tired at the slightest exertion. In the daytime, diuresis is reduced, the head is often dizzy, under the ribs on the right, a feeling of discomfort is born, especially strong if there is a failure of the right ventricle. In addition, there is swelling, especially pronounced in the evenings. Some at different stages of heart failure (2, 1, 3) develop ascites, that is, a condition in which the peritoneum becomes a localized area of accumulation of fluid secretions. HF can provoke acrocyanosis.
Diagnosis
Only a qualified doctor can tell at what stage heart failure (3, 2, 1) is observed. Before making a diagnosis, the doctor will conduct a series of examinations and tests to determine exactly what you had to deal with. Blood tests are considered basic - general and biochemistry. The patient is referred to an x-ray of the sternum. As a rule, ECG, echocardiography are shown. A patient who is suspected of HF is recommended to undergo a ventriculography, coronary angiography.
Types and Forms
In medicine, the stages, functional classes of heart failure are considered. All cases are divided into acute, chronicles. For the second type, the selection of several steps of the state progress is accepted. The most light is considered to be when intense exercise provokes breathing, the heart beats more often than normal, sensations become strong. If earlier, with a load, such manifestations were not, but with time they appeared, they speak of the first stage of heart failure.
With the allocation of functional classes, stages of heart failure, they speak of a state where moderate activity already provokes breathing difficulties. At the same time, there is a lack of blood flow, expressed by coughing and cardiac malfunctions, sonorous pulmonary wheezing and blood croaking. This condition relates to stage 2a. Gradually, manifestations of blood flow insufficiency appear in a large circle. This reveals itself as swelling of the legs, especially strong in the evenings.
Stage 2b indicates hepatic hypertrophy, swelling of the legs, ascites and cyanosis. Respiratory disturbances are observed even at rest, the heart is disturbed by pain and instability of functioning. The patient reveals oliguria, hydrothorax.
Status Progress
The third stage of heart failure manifests itself as a violation of blood flow in both circles. Examination of the respiratory system reveals irreversible pulmonary changes. There is pneumosclerosis, hepatic cirrhosis. The therapeutic course in most cases shows inefficiency. Based on the areas of lesions, they speak of heart failure in the left ventricle. In a large circle, the amount of moving blood decreases; in a small circle, stagnation occurs. HF in the right ventricle leads to stagnation in a large circle, while the small one becomes poorer.
A third stage of heart failure is possible, in which mixed symptoms are observed. As a rule, overload is localized in both ventricles.
Grouping System: US Version
A specialized NYHA classification developed by New York cardiologists has been developed. This method of dividing involves the breakdown of all patients into four large groups. The first class includes persons who, under normal physical activity, characteristic of everyday life, do not have shortness of breath. The second class is such a stage of heart failure, when the patient is faced with minor restrictions, it becomes more difficult to cope with physical activity. The third group includes people whose activity causes significant problems. The fourth category includes people who are worried about breathing problems, even when completely at rest.
How to fight: general information
If studies have indicated any stage of heart failure (compensated decompensation), it is necessary to proceed with the treatment of a pathological condition. The choice of therapy remains with the doctor, who is able to assess the nuances of the case and take into account the characteristics of the patient's body, the allergic reactions inherent in it. First of all, they identify what provoked the failure of the organ, and form a program to eliminate the root cause.
The patient is shown to take funds that effectively fight stagnation in the circulatory system. To do this, at different stages of heart failure will have to drink diuretics, Asparkam, Veroshpiron. The Panangin drug has proven itself well. The patient will benefit from means that optimize cardiac output, normalize the circulatory system, supply oxygen and nutrients to tissues. If the therapeutic course does not give the desired result, the patient can be referred for surgery.
Effects
If the last stage of heart failure is detected, the patient neglects the advice of a doctor and does not apply in detail to treatment, a high probability of various complications. In particular, sudden death of the heart threatens. There is a high probability of thromboembolism, thrombosis. A person is faced with an increased risk of liver failure, conduction malfunctions, and rhythmic contractions of the heart muscle.
Is it possible to warn?
In order not to learn from experience what the terminal stage of heart failure is, it is reasonable to lead a healthy lifestyle. Primary prevention of the disease includes the early detection of any diseases that adversely affect the heart, and the responsible treatment of these pathologies. If a person is affected by factors with a high degree of probability that can cause HF, it is necessary to exclude or change them if possible.
Secondary prevention involves eliminating manifestations of organ failure and preventing deterioration.
Compensated and non-such blood flow insufficiency
NK - circulatory failure - such a pathological condition in which organs, tissues do not receive the necessary nutrition through the circulatory system. This affects the ability of the cells to work, affects the course of plastic processes. It is customary to speak of a compensated and uncompensated form. In the first case, the symptoms are revealed after the load, the second option is the presence of signs in a resting, relaxed person.
Since there are acute forms of HF and the chronicle, therefore, we can talk about a combination of signs in determining the characteristics of the case. For example, a doctor may identify a patient with chronic heart failure in the stage of decompensation. This will be called the condition in which the symptoms appear only after certain loads, while the case develops slowly, and the likelihood of death at the time of the attack is small.
Terminology and Features
HF is usually called a condition in which circulatory hypoxia is formed . The quality of the blood flow is impaired, which leads to a lack of oxygen. Sometimes the condition is observed with increased pressure on the heart muscle due to the secretion of exudate, in some cases, damage to electricity, bruising, and injury can provoke heart failure. HF is possible with prolonged ischemia, an acute form of such a disease.
Chronic heart failure in the decompensation stage can develop if the heart is faced with too high loads. It is customary to divide all the causes leading to HF into two classes: initiating pre-, postloading above the norm. Preload is called blood flowing in the direction of the heart. It fills the ventricles, and the influx in excess of standard volumes can provoke a failure of the functioning of the valve system, hypervolemia, hemoconcentration, polycythemia.
Afterload is the resistance of an organ to the movement of blood from its cavities into blood vessels. The growth of the SSPS leads to an increase in afterload. Often, the condition is observed with increased pressure, valvular stenosis, and hydropericardium. The cause may be a decrease in vascular aortic, arterial lumens.
Pathology mechanisms
It is customary to evaluate the primary mechanism for the formation of a pathological condition. They analyze the work of the veins through which blood moves to the heart, and the contractility of the muscular structures of the organ. The primary cardiogenic form is diagnosed when the ability of the tissues to contract decreases, while the volumes of blood coming from the veins are close to standard. Damage to the myocardium of a diverse nature can provoke this form of pathology. Sometimes the cause is the focus of inflammation, in other cases - ischemia, poisoning.
The secondary form is observed when the volume of blood flowing through the veins to the heart of the heart is reduced while maintaining the contractility of the organ. This condition is possible if there is a significant loss of blood or fluid secretions accumulate in the pericardial region. Muscles cannot relax at the time of diastole, as a result, full filling of the ventricles is impossible. Paroxysmal tachycardia can provoke a pathological condition.
Metabolism and overload as sources of HF
Metabolic heart failure is diagnosed when coronary blood flow is disturbed. The same is possible with the appearance in the heart of the focus of inflammation, metabolic failure, impaired functioning of the endocrine system. Arrhythmia can provoke metabolic HF. The basis of such a pathology is a malfunction of metabolism, which normally occurs in the heart muscle, due to a lack of oxygen and energy reserves. Enzyme structures are disturbed, the balance of electrolytes is lost, the regulation of the organ through impulses of the nervous system.
Overload HF is observed with vascular, cardiac defects, high blood pressure, an increase in the volume of fluid in the circulatory system. The pathological condition is explained by a prolonged increased load on the myocardium, associated with an excess of flowing blood or a weakening of the outflow. First, the condition develops into compensatory hyperfunction, then organ hypertrophy is observed. The third stage is cardiac decompensation, that is, insufficient functioning of the organ. A progressive lack of oxygen in myocytes of the heart leads to dystrophy, affecting protein, lipid structures. Myofibrils die, the lack of energy increases, the muscle tone of the heart decreases.
Drug therapy: features of drugs
With heart failure, they often resort to ACE inhibitors. In our country, studies were organized that showed the reliability and safety of the use (in accordance with the instructions) of the preparations Fosinopril, Trandolapril, Captopril. Ramipril and Enalapril medicines have a good reputation. ACE inhibitors are recommended to be taken with CHF at any stage of the development of pathology. The etiology of the disease, the features of its development and the functional class of the case do not play a role. The absence of this group of drugs in the therapeutic program is associated with an increased risk of death. The sooner the patient begins to take ACE inhibitors, the slower the progression of the chronic disease. It is recommended to use medicines of this group with blood pressure of 85 units or more. At low rates, the effectiveness of the funds is preserved, which means that the drug course should still include ACE inhibitors, however, in lower concentrations. On average, twice less than standard doses are prescribed.
It is noted that shortly after the start of the use of ACE inhibitors, hypotension may occur. This is due to the effect of the active compound on neurohormones in the circulatory system. The use of titrating dosage avoids this effect or reduce it to a minimum by the 14th day of drug use. The long course of ACE inhibitors is effective due to the blockade of neurohormones. To make the treatment as effective as possible, it is necessary to use ACE inhibitors without composing drugs with beta-blockers, nitrates or BKK. When hypotension is eliminated, begin a combined drug course.
Aldosterone antagonists in heart failure
Often with HF, medications are prescribed for spironolactone. This substance is widely used in medicine and has been used as an element of complex treatment since the middle of the last century. Belongs to the class of potassium-preserving diuretics in the body. The main indication for the use of the composition is CHF in a decompensated form.The drug is prescribed for excessive accumulation of fluid in the body. Spironolactone is usually combined with loop, thiazide diuretics.
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Diuretics
Diuretic drugs should be used in cases that indicate the accumulation of excess volumes of fluids in the body. When choosing drugs and the nuances of their administration, the negative effect of funds on the patient’s body, in particular, on the renin, angiotensin, aldosterone system, is taken into account . Drugs can cause electrolyte imbalance.
Diuretics are always prescribed in combination with ACE inhibitors, thereby reducing the effective dosage. You should use the weakest productive in a particular case of drugs. It is shown that it is necessary to have a backup type, dose used in case of decompensation of the condition.