Heart failure is the inability of the heart to fully perform its pumping (contractile) function, as well as provide the body with the necessary amount of oxygen contained in the blood. Heart failure is not an independent disease.
Content
Causes of heart failure
In the overwhelming majority of cases, heart failure is the natural outcome of many diseases of the heart and vessels (valve heart defects, coronary heart disease (IBS), cardiomyopathy, arterial hypertension, etc.). Only occasionally heart failure is one of the first manifestations of the heart disease, for example, dilated cardiomyopathy. With hypertension, there may be many years from the occurrence of the disease before the appearance of the first symptoms of heart failure. Whereas as a result, for example, an acute myocardial infarction, accompanied by the death of a considerable part of the heart muscle, this time can make several days or weeks. In the event that heart failure progresses for a short time (minutes, hours, days), talk about acute heart failure. All other cases of disease include chronic heart failure. In addition to cardiovascular diseases, feverish conditions, anemia, an increased function of the thyroid gland (hyperthyroidism), abuse of alcohol and others contribute to the appearance or exacerbation of manifestations of heart failure.
Development of heart failure
The timing of the onset of explicit heart failure is individual for each patient and its cardiovascular disease. Depending on which ventricle of the heart suffers more as a result of the disease, distinguishes the right-and left ventricular heart failure.
In cases of referentially heart failure, the excess volume of fluid is delayed in the vessels of a large circle of blood circulation, as a result of which swelling occurs, at first - in the field of stop and ankles. In addition to these basic signs, fast fatigue explained by low oxygen saturation, as well as the feeling of cutting and ripples in the neck area, is characteristic of the right-hand heart failure.
Left-deceiving heart failure is characterized by a fluid delay in the pulmonary circle of blood circulation, as a result of which the amount of oxygen incoming to the blood decreases. As a result, shortness of breath arise, amplifying during exercise, as well as weakness and fast fatigue.
The sequence of appearance and severity of symptoms of heart failure are individual for each patient. In case of diseases accompanied by the defeat of the right ventricle, the symptoms of heart failure appear faster than in cases of left-deuded failure. This is due to the fact that the left ventricle is the most powerful heart department. Usually takes a lot of time before the left ventricle «pass» His position. But if it still happens, then heart failure develops with catastrophic speed.
Complaints of patients with heart failure
Edehs are one of the first manifestations of the right-hand heart failure. Initially, patients are disturbed by minor swelling, usually affecting feet and legs. Swelling evenly affect both legs. Swelling arise closer in the evening and pass to the morning. With the development of sweeps of swelling, they become dense and completely at the morning no longer pass. Patients noted that the usual shoes are no longer suitable for them, often they feel comfortable only in domestic sneakers. In the further spread of edema in the direction of the head increase in the diameter of the shin and hips.
The liquid is then accumulated in the abdominal cavity (ascites). During the development of an anasarca, the patient usually sits, because in the position lying there is a sharp shortage of air. Hepatomegaly develops – Increased liver in size due to overflowing its venous network with liquid blood. Patients with increased liver size often celebrate discomfort (discomfort, gravity) and pain in the right hypochondrium. When hepatomegali in the blood accumulates the pigment of bilirubin, which can paint a sclera («Proteins» eye) in yellowish color. Sometimes such jaundice scares the patient, being a reason for appeal to the doctor.
Fast fatigue is a sign, characteristic of both the right, and for left-deceased failure. At first, patients note the shortage of forces when performing a previously transportable physical activity. Over time, the duration of the periods of physical activity decreases, and the pause for rest – Increases.
Dyspnea is the main and often the first symptom of chronic left vehicles. During shortness of breath, patients breathe more often than usual, as if trying to fill their lungs with a maximum amount of oxygen. At first, patients note shortness of breath only when performing intensive exercise (running, fast lift on the stairs and T.D.). Then, as heart failure progress, patients may mark shortness of breath under the usual conversation, and sometimes – And in full peace. No matter how paradoxically, it sounds, the patients themselves do not always realize the presence of shortness of breath - they are noticed by the people around them.
The parole cough arising mainly after the intensive load is fully perceived by the patients are often perceived as a manifestation of chronic lung diseases, for example, bronchitis. Therefore, when surveying a doctor, patients, especially smokers, do not always complain about coughing, believing that it is not related to heart disease. Papered heartbeat (sinus tachycardia) is perceived by patients as a feeling «trepgy» In the chest, which occurs with any motor activity and disappears after some time on its completion. Often patients get used to rapid heartbeat, without fixing their attention on it.
Diagnosis of heart failure
Heart failure is a consequence of various diseases and states both cardiovascular and other. To establish the presence of heart failure, sometimes there is enough ordinary medical inspection, whereas to clarify its reasons may require the use of a number of diagnostic methods.
Electrocardiography (ECG) Helps doctors to identify signs of hypertrophy and insufficiency of blood supply (ischemia) myocardium, as well as various arrhythmias. As a rule, these ECG signs may occur at various diseases, t.E. are not specific to heart failure.
Based on the ECG, so-called load tests are created and widely used, which are that the patient must overcome the gradually increasing load levels. For these purposes, special equipment is used, which allows you to dose the load: Special bicycle modification (cycle ergometry) or «treadmill» (Tredmil). Such tests provide information on the backup capabilities of the pump function of the heart.
The main and publicly available at the diagnosis of diagnosis of diseases occurring with heart failure is the ultrasound study of the heart - echocardiography (ECCG). With this method, you can not only establish the cause of heart failure, but also evaluate the contractile function of the ventricles of the heart. Currently, only one echoca is enough to make a diagnosis of congenital or acquired heart defects, assume the presence of IBS, arterial hypertension and many other diseases. This method can also be used to evaluate the results of the treatment.
Radiographic study of the chest organs With heart failure, it makes a stagnation of blood in a small circle of blood circulation and an increase in the size of the cavities of the heart (cardiomegaly). Some heart diseases, for example, valve heart defects, have their own characteristic x-ray «Picture». This method is also echoch, can be useful to control the treatment.
Radioisotope Heart Research Methods, In particular, radioisotope ventriculography, allow with high accuracy in patients with heart failure to estimate the contractile function of the ventricles of the heart, including the amount of blood they fit. These methods are based on the introduction and subsequent distribution in the organism of radioisotope drugs.
One of the latest achievements of medical science, in particular, the so-called nuclear diagnosis is Method of positron emission tomography (PET). It is very expensive and while a small prompt study. PET allows using a special radioactive «Tags» identify zones of viable myocardium in patients with heart failure in order to be able to adjust the conducted treatment.
