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Chronic heart failure

In Europe every year to 0.5 million new cases of the disease, and die from it about 350 thousand people. Especially heart failure often occurs in countries with high living standards, and the number of patients is steadily increasing.

The frequency of chronic heart failure increases with age - from 1% among people aged 50-59 to 10% over the age of 80 years. However, at any age, this disease requires treatment. Timely and proper treatment of chronic heart failure not only prolongs life but also gives the person an active longevity.

Causes of heart failure

Heart failure is a pathological condition in which the cardiovascular system does not provide the body with the necessary amount of blood and therefore oxygen. Initially, this occurs only at a high load on the body, and eventually at rest. Depending on the rate of heart failure produce acute and chronic forms. Acute failure occurs within minutes or hours, and chronic - the result of a process lasts from several weeks to several years.

Causes of chronic heart failure are diverse:

  • myocardial damage as a result of coronary heart disease, myocarditis (inflammation of the heart muscle), rheumatic fever, cardiomyopathy (noninflammatory lesion of the heart muscle), chronic poisoning (most commonly alcohol and nicotine);
  • overload of the myocardium due to hypertension, heart disease, a significant increase in blood volume (eg, kidney disease);
  • compression of the myocardium in tumors, pericardial effusion (inflammation of the "heart shirts" surrounding the heart muscle);
  • extracardiac disease that significantly increases the load on the myocardium (increased thyroid function, obesity, liver cirrhosis, severe anemia).

Clinical manifestations

At the beginning of the disease the symptoms usually are nonspecific and long written off by man in fatigue, exhaustion, or age.

The most characteristic manifestations of heart failure following:

  • Fatigue during normal physical activity, which was previously transferred easily;
  • Shortness of breath that occurs after high physical exertion and persistent inadequate for a long time (in the severe stages of apnea occurs when the minimum load and even at rest, there is a shortage of air);
  • Heart rate, and long-lasting after exercise;
  • Dizziness;
  • Drying and cooling of the palms and soles;
  • The emergence of acrocyanosis - cyanosis toes and hands, ears and nose (the result of poor blood supply to the most remote parts of the body from the heart);
  • Dry or wet cough, hemoptysis possible;
  • Heaviness and pain in the right upper quadrant (due to increase in the liver);
  • The appearance of edema, initially more often on the ankles;
  • Swelling of the neck veins.

If you notice at least some of the above symptoms should seek medical attention.

Diagnosis

In the rest of the surveyed determine the number of respiratory movements and heart rate (pulse on the forearm) for 1 min. After that surveyed are asked to do 5 sit-ups and repeated measurements. Normally, these figures after the load is increased by 50% and returned to its previous value, not later than 10 minutes. Repeated measurements of heart rate and the number of breaths to hold until they return to the indicators that are registered to the load. If this time surveyed more than 10 minutes, you should assume the pathology of the cardiovascular system.

For accurate diagnosis of heart failure using different methods: veloergometry and research on the treadmill (the definition of the basic parameters of the cardiovascular system treatment at increasing physical activity, which is defined by bicycle or treadmill), radiography, electro-and echocardiography.

Treatment

Complete recovery in chronic heart failure is extremely difficult to achieve. In most cases this is an irreversible condition, because the long term disease compensatory mechanisms are exhausted and practically all organs, the blood supply which has suffered long enough, develop severe changes. However, as a rule, the patient's condition can improve.

Resolve the cause of the disease. Congestive heart failure develops secondary and a consequence of the underlying disease. It is by eliminating or at least reduce the influence of the primary causes and start treatment with chronic heart failure. The first thing to stop smoking and alcohol abuse.

Together with your doctor to decide on possible further work in the same place. Selection of appropriate loads are strictly individual. Should at least protect themselves from stress at some time - a trip on a fishing trip or a few days of home rest. If before you could save time by sleeping, try not to do this anymore. And, of course, it should be "understanding" with excess body weight and feed efficiently.

Clinical nutrition

Need to limit salt intake - up to 2-3 grams per day. This requires nedosalivat food and indulge in foods that contain too much salt (pickles, meats, salami, etc.).

Be sure to restrict your fluid intake - up to 1000-1300 ml per day, of course, if you're not in the summer in the hot parts. This will prevent the heart from excessive work for pumping liquids.

Food must be fractional: 5-6 receptions a small amount of food per day. And more fresh fruits and vegetables rich in vitamins and dairy dishes. Down with the rich broth and fried cutlets!

It is advisable to abandon the usual stimulants - coffee and strong tea. Try to switch to green tea.

Should eat foods rich in potassium (especially in the treatment program includes diuretics). The products include: dried apricots, raisins, nuts, potatoes, cabbage, rose hips, citrus fruits, prunes, black currants, cheese.

Medication

Have long believed that the drug treatment of chronic heart failure rests on "three pillars": diuretics (diuretics), cardiac glycosides and vasodilator drugs. Currently, the treatment of this disease are increasingly being used beta-blockers and cardiac glycosides virtually "passed" their positions.

Diuretics cause a temporary increase excretion of water and salts (primarily sodium) in the urine. This reduces the workload on the heart muscle, decreases the stagnation of fluid in the internal organs, eliminates edema, which greatly facilitates the condition of patients. Therefore, diuretics in the treatment of heart failure are the "first-line drugs."

Diuretics medication is a very broad group of drugs, each of which gives a different strength and duration of effect. Often, they combine with each other and with other groups of drugs for each patient individually.

Long-term use of diuretic drugs without medical supervision is undesirable, since most of them (hydrochlorothiazide, furosemide, bumetanide, ethacrynic acid, etc.) causes a significant loss in the urine critical electrolyte - potassium, and eventually decrease potassium levels in the blood. This condition often goes unnoticed, or the patient has been little overall weakness and muscle twitching, but it might represent a threat to life and, as significantly increases the risk of cardiac arrhythmias.

Among diuretic drugs are so-called "potassium-sparing and Equipment (spironolactone, triamterene, amiloride, etc.) which, in contrast, may lead to an increase in potassium in the blood.

Vasodilators increase the lumen of blood vessels (which are in compression), and the load on the heart and the work burden on the heart muscle is significantly reduced, the degree of heart failure is reduced and the patient's condition improves.

Go to vasodilator agents include various pharmacological groups: nitrates, ACE inhibitors (angiotensin-converting enzyme), calcium antagonists, alpha-blockers, beta-blockers with the properties of alpha-blockers, etc.

The most commonly used ACE inhibitors. These drugs prevent the formation of angiotensin peptides - one of the main "culprits" of chronic heart failure. In addition to pronounced vasodilator actions of this group of drugs prevents the pathological changes in heart muscle and even lead to their regression. They improve blood flow to the myocardium, brain, kidneys, muscles and other organs, enhance the effect of nitrate, lower usually elevated in patients with chronic heart failure, high blood pressure. ACE inhibitors have a potassium-sparing effect, and concomitant administration of diuretics (the need for such a combination occurs quite often) is the mutual elimination of side effects.

Increasingly apply the obtained in the early 90-ies of preparations of antagonists of angiotensin II (losartan, valsartan). These drugs provide an almost complete blockade of adverse effects of angiotensin and very effective in chronic heart failure. In addition, they have virtually no side effects.

More than 200 years to treat heart failure using cardiac glycosides. These substances, which have a natural origin (they are derived from plants), improve myocardial contractility, improve metabolism in heart muscle, slowed heart rate and increase their efficiency, which leads to a weakening of the symptoms of heart failure.

When using cardiac glycosides is relatively easy to overdose occurs (glycoside intoxication). Her symptoms: loss of appetite, vomiting, diarrhea, hallucinations, color (color of the surrounding objects in the yellow-green), weakness, confusion, headaches, sexual dysfunction.

To reduce the risk of overdose treatment cardiac glycosides chooses a doctor, and it is carried out under his supervision.

Currently, indications for cardiac glycosides is limited, and some cardiologists and does not recommend their use.

In recent years, for the treatment of chronic heart failure are widely used drugs of beta-blockers. They increase myocardial contractility, have antiarrhythmic effects, thereby reducing the incidence of sudden death and significantly improve the condition of patients with coronary heart disease. Acceptance of these funds is carried out under medical supervision and under the special scheme. It is advisable to mix with drugs of other groups.

Aids used in heart failure include acetylsalicylic acid (aspirin), "thinning" the blood and thereby improve the microcirculation and metabolism in tissues, heparin and chimes> Clock, preventing thrombosis, tools to improve the metabolism in the myocardium, multivitamin complexes etc.

Heart transplant

There is also a radical solution to the problem of chronic heart failure - heart transplantation. Worldwide, the number of patients who underwent this operation, tens of thousands. For the majority of our countrymen phrase "heart transplant" sounds like something out of the field of experimental medicine.

Given that the results of heart transplantation have improved significantly and is now the survival of more than 6 years exceeds 60%, the number of potential candidates for this operation has increased significantly. These include, in particular, patients with diabetes, previously considered an absolute contraindication.

Modern tactics of selecting candidates for heart transplantation is to identify those patients with heart failure who have no other treatment options, and to whom such an operation would bring the greatest improvement in quality of life.

Potential candidates for heart transplantation, assessed by the level of risk of death (25-50%) within one year.

Contraindications to heart transplantation following:

  • age over 70 years;
  • irreversible dysfunction of the liver, kidneys, lungs;
  • severe peripheral or cerebral arteries;
  • an active infection;
  • newly identified tumor with an uncertain prognosis;
  • mental illness;
  • systemic disease that can significantly limit the lifespan;
  • increased pressure in the small (pulmonary) circulation.

Heart transplantation limit the high cost of surgery and postoperative support, as well as the disparity between the demand for donor heart, and his proposal.

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