CHF: classification. Symptoms of chronic heart failure, treatment

Chronic heart failure, the symptoms of which will be described later, is a pathology, the manifestations of which are associated with a violation of the blood supply. The condition is noted at rest and during exertion and is accompanied by a delay in the body fluid. The treatment of cardiovascular diseases in most is carried out medically and comprehensively. Timely access to a doctor contributes to a more rapid restoration of blood supply and the elimination of pathology. Next, we consider in detail what constitutes CHF. Classification of the ailment, symptoms and therapeutic measures will also be described in the article.

General information

CHF, the classification of which is quite extensive, is based on a decrease in the ability of an organ pumping blood to empty or fill. This condition is primarily due to muscle damage. Equally important is the imbalance of systems that affect cardiovascular activity.

Clinical picture

How does chronic heart failure manifest itself? Symptoms of the pathology are as follows:

• Shortness of breath - shallow and frequent breathing.
• Increased fatigue - reduced tolerance to normal physical exertion.
• Peripheral edema. As a rule, they appear on the legs and feet, and over time rise higher, extending to the hips, the anterior wall of the peritoneum, lower back, and so on.
• Cardiopalmus
• Cough. At the initial stages, it is dry, then scanty sputum begins to stand out. Subsequently, blood inclusions can be detected in it.
• Orthopnea position. The patient needs to lie with his head raised (on pillows, for example). In an even horizontal position, shortness of breath and cough begin to intensify.

Forms of pathology

Despite the implementation of therapeutic measures, the patient's condition may worsen. In this case, a more thorough diagnosis of the heart and circulatory system is necessary. In-depth studies will reveal hidden provoking factors. The following stages of heart failure are distinguished:

• The first (initial). At this stage of heart failure, there are no circulatory disorders. When conducting echocardiography, latent dysfunction in the left ventricle is detected.
• The second A (clinically expressed). The condition is characterized by hemodynamic disturbances (blood movement) of one of the circles.
• Second B (heavy). This stage is characterized by hemodynamic impairment in both circles. Damage to the structure of the organ and blood channels is also noted.
• The second (final). The condition is accompanied by severe hemodynamic disorders. Severe, often irreversible changes in the structure of target organs are also characteristic of this form of heart failure.

The classification of pathology can also be carried out in accordance with the functional type. There are four of them.

Functional types

As in the previous section, changes can be both in the direction of improvement, and deterioration even against the background of ongoing therapeutic measures with detected CHF. The classification according to functional types is as follows:

• The first type is characterized by the absence of restriction of physical activity. The patient can tolerate the physical load familiar to the body without the manifestation of signs of pathology. Slow recovery or shortness of breath may occur during overvoltage.
• The second type is characterized by a slight restriction of activity. Pathology does not manifest itself in any way at rest. Normal, familiar to the body physical activity is tolerated by patients with shortness of breath, increased fatigue, or increased rhythm. At this stage, heart diagnosis is highly recommended.
• With the third type, a more noticeable limitation of activity is observed. The patient has no unpleasant sensations at rest. Less intense than usual physical activity is accompanied by the manifestation of signs of pathology.
• With the fourth type, any activity of the patient is accompanied by the appearance of unpleasant sensations. Signs of pathology are observed in the patient at rest, intensifying with slight physical exertion.

Blood stagnation zones

Depending on the predominant localization of the violation, the patient can be identified:

• Right ventricular failure. In this case, congestion is noted in a small circle - pulmonary blood channels.
• Left ventricular failure. In this case, congestion is localized in a large circle - in the blood channels of all organs, excluding the lungs.
• Two ventricular (biventricular) insufficiency. Blood stasis in this case is observed in two circles at once.

Phases

The treatment of cardiovascular diseases is selected in accordance with the clinical picture. Manifestations of pathologies depend on the localization of disorders and provoking factors. Of no small importance in the selection of therapy is the medical history. CHF may be associated with a violation of diastole and / or systole. In accordance with this, several phases of pathology are distinguished. In particular, there are:

• Systolic heart failure. It is associated with a disorder of systole - the time of ventricular contraction.
• Diastolic insufficiency. This phase is caused by a violation of diastole - the relaxation time of the ventricles.
• Mixed form. In this case, there are violations of diastole and systole.

Causes

When choosing a therapeutic method for eliminating heart failure, degrees, phases and forms are of great importance. However, it is also important to identify the causes of the development of pathology. Chronic heart failure may result from:

• Myocardial infarction. In this condition, the death of part of the heart muscle occurs, which is associated with the cessation of blood flow to it.
• IHD in the absence of a heart attack.
• Arterial hypertension - a persistent increase in pressure.
• Taking drugs. In particular, pathology can develop due to the use of antitumor drugs and medications to restore rhythm.
• Cardiomyopathies - damage to the heart muscle in the absence of pathologies of the organ’s own arteries and lesions of its valves, as well as arterial hypertension.
• Diabetes mellitus.
• Thyroid lesions.
• Adrenal dysfunction.
• Obesity.
• Cachexia.
• The lack of a number of trace elements and vitamins.
• Amyloidosis.
• Sarcoidosis.
• HIV infection.
• Terminal renal failure.
• Atrial fibrillation.
• Blockade of the heart.
• Exudative and dry pericarditis.
• Congenital and acquired heart defects.

Pathology detection

The diagnosis of CHF is made on the basis of an analysis of complaints and anamnesis. In a conversation with a doctor, the patient should be told when signs of pathology appeared and with what the patient connects them. It also turns out what ailments the person and his relatives had. The specialist needs to know about all the medications the patient takes. On physical examination, skin color, the presence of puffiness are assessed. When listening to the heart, it is determined if noises are present. The presence of stagnation in the lungs is also detected. As mandatory studies, a urine and blood test is prescribed. Studies can detect concomitant pathologies that can affect the course of heart failure. In this case, the treatment will be comprehensive, aimed at eliminating background ailments. A biochemical blood test is also prescribed. The results determine the concentration of cholesterol and its fractions, urea, creatinine, sugar, potassium. An analysis is made for thyroid hormones. The specialist may prescribe an immunological study. During it, the level of antibodies to heart tissue and microorganisms is determined.

Equipment Research

An ECG allows you to assess the rhythm of heartbeats, determine rhythm disturbances, the size of the departments of the organ, and also identify cicatricial changes in the ventricles. For the analysis of noise, a phonocardiogram is used. With its help, the presence of systolic or diastolic noise is determined in the projection of the valves. To assess the structure of the lungs and heart, a chest x-ray is used. This study also allows you to determine the size and volume of the departments of the body that pumps blood, to determine the presence of stagnation. Echocardiography is used to examine all areas of the heart. During the procedure, the wall thickness of the departments and valves is determined. Also, using echocardiography, it is possible to identify how pronounced an increase in pressure in the pulmonary vessels. Analysis of blood movement is carried out when conducting doppler echocardiography. The doctor may prescribe other studies in addition to those described.

CHF treatment: recommendations

First of all, the patient is assigned a special diet. The diet limits the amount of sodium chloride to three grams and liquid to 1-1.2 liters per day. Products should be easily digested, be high-calorie, contain vitamins and protein in the required amount. The patient should be weighed regularly. Weight gain of more than 2 kg over 1-3 days, as a rule, indicates a delay in the body fluid and decompensation of heart failure. Treatment may include psychological assistance. It aims to accelerate patient recovery. Psychological assistance may also be provided to the patient's relatives. For patients, it is undesirable to abandon the load completely. The level of activity for each patient is determined individually. Preference should be given to dynamic loads.

Basic drug therapy

Drugs for heart failure are divided into groups: primary, secondary and auxiliary. The first includes:

• ACE inhibitors. They help slow the progression of pathology, provide protection for the heart, kidneys, blood vessels, and control over blood pressure.
• Angiotensin receptor antagonists. These drugs are recommended for intolerance to ACE inhibitors or in combination with them.
• Beta-blockers (drugs "Concor", "Anaprilin" and others). These tools provide control over the pressure and frequency of contractions, have an antiarrhythmic effect. Beta-blockers are prescribed in conjunction with ACE inhibitors.
• Diuretics (preparations "Amilorid", "Furosemide" and others). These funds help eliminate excess fluid and salt from the body.
• Cardiac glycosides. These funds are prescribed mainly in small doses for atrial fibrillation.

Additional funds

• Satins are prescribed if the cause of CHF is IHD.
• Indirect anticoagulants . Drugs of this group are prescribed with a high probability of thromboembolism and with atrial fibrillation.

Auxiliary medicines

These funds are prescribed in special cases, with severe complications. These include:

• Nitrates. These drugs improve blood flow and dilate blood vessels. Medicines of this group are prescribed for angina pectoris.
• Calcium antagonists. These medications are indicated for persistent angina pectoris, arterial hypertension (persistent), increased pressure in the pulmonary blood channels, valve insufficiency of a pronounced nature.
• Antiarrhythmic drugs.
• Disaggregants. These agents have the ability to impair coagulation, preventing platelet adhesion. Medicines of this group are indicated for secondary prevention of heart attack.
• Inotropic non-glycoside stimulants. These funds are used for a pronounced decrease in blood pressure and heart strength.

Surgical methods

In the absence of the effectiveness of drug exposure, surgical, mechanical intervention is used. In particular, the patient may be prescribed:

• Coronary artery bypass grafting. The operation is performed with severe atherosclerotic vascular damage.
• Surgical correction of valve defects. Intervention is carried out in case of severe stenosis (narrowing) or valve insufficiency.
• Organ transplantation. Heart transplantation is a fairly radical measure. Its implementation is fraught with a number of difficulties:
  
  - probable rejection;
  - insufficient number of donor organs;
  - defeat of the blood channels of the transplanted organ, poorly amenable to therapy.

• The use of artificial devices providing auxiliary circulation. They are introduced directly into the patient's body. Through the skin surface they are connected to the batteries located on the patient’s belt. However, the use of devices is also accompanied by problems. In particular, infectious complications, thromboembolism and thrombosis are likely. It prevents the wider use of devices and their high cost.
• The use of an elastic mesh frame. They are wrapped in a heart during dilated cardiomyopathy. This measure allows you to slow down the increase in body size, increase the effectiveness of drug exposure, improve the patient's condition.