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 impaired blood flow. The condition is noted at rest and under stresses and is accompanied by a delay in the body's fluid. Treatment of cardiovascular diseases in most cases is medicated and complex. Timely contact with a doctor promotes faster recovery of blood supply and elimination of pathology. Further we will consider in detail what is CHF. Classification of the disease, signs 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 the organ that pumps the blood to emptying or filling. This condition is due, in the first place, 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 pathology are as follows:

• Shortness of breath - shallow and frequent breathing.
• Increased fatigue - reduced tolerance of normal physical activity.
• Peripheral edema. As a rule, they appear on the legs and feet, as time goes up, spreading to the hips, the front wall of the peritoneum, the lower back and so on.
• Cardiopalmus
• Cough. At the initial stages it is dry, then scant sputum begins to be allocated. Subsequently, it can detect inclusions of blood.
• Position orthopnea. At the patient there is a necessity to lay with the raised head (on pillows, for example). Dyspnoea and cough begin to increase in an even horizontal position.

Forms of pathology

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

• The first (initial). At this stage of CHF there are no circulatory disorders. When carrying out echocardiography, latent dysfunction in the left ventricle is found.
• Second A (clinically pronounced). The condition is characterized by disorders of hemodynamics (blood flow) of one of the circles.
• The second B (heavy). This stage is characterized by a violation of hemodynamics in both circles. Also, damage to the structure of the organ and blood channels is noted.
• The second (final). The condition is accompanied by violations of hemodynamics of a pronounced nature. Severe, often irreversible changes in the structure of target organs are also characteristic of this form of CHF.

Classification of pathology can also be carried out in accordance with the functional type. There are four in total.

Functional types

As in the previous division, the changes can be either in the direction of improvement or deterioration, even against the background of ongoing therapeutic measures in the presence of CHF. The classification according to the functional types is as follows:

• For the first type, there is no restriction on physical activity. The patient can endure the physical load physically without showing signs of pathology. Delayed recovery of the condition or shortness of breath may occur with overexertion.
• The second type is characterized by a restriction of activity to an insignificant extent. Pathology does not manifest itself at rest. Ordinary physical exercise is tolerated by patients with dyspnea, increased fatigue, or increased rhythm. At this stage, heart diagnostics are highly recommended.
• At the third type there is a more noticeable restriction of activity. Unpleasant sensations in the patient at rest are absent. Less intense than usual physical activity is accompanied by the manifestation of signs of pathology.
• In the fourth type, any activity of the patient is accompanied by the appearance of unpleasant sensations. Signs of pathology are noted in the patient at rest, intensifying with little physical exertion.

Zones of blood stagnation

Depending on the primary localization of the disorder, the patient may be identified:

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

Phases

Treatment of cardiovascular diseases is selected in accordance with the clinical picture. Manifestations of pathologies depend on localization of disturbances and provoking factors. Important role in the selection of therapy has a history of the disease. CHF may be associated with a diastole or / and systole disorder. In accordance with this, several phases of pathology are distinguished. In particular, there are:

• Systolic heart failure. It is associated with a breakdown in systole - the time of contraction of the ventricles.
• Diastolic insufficiency. This phase is caused by a diastolic disturbance - the time of relaxation of the ventricles.
• The mixed form. In this case diastole and systole disorders occur.

Causes

When choosing a therapeutic method to eliminate CHF, the degrees, phases and forms are of great importance. However, it is important to identify the causes of the development of pathology. Chronic heart failure may be a consequence of:

• Myocardial infarction. In this condition, a part of the heart muscle is destroyed, which is associated with the cessation of blood flow to it.
• IHD in the absence of a heart attack.
• Arterial hypertension is a persistent increase in blood pressure.
• Reception of drugs. In particular, pathology can develop due to the use of antitumor drugs and medications to restore the rhythm.
• Cardiomyopathies - defeats the cardiac muscle in the absence of pathologies of the body's own arteries and lesions of its valves, as well as arterial hypertension.
• Diabetes mellitus.
• Lesions of the thyroid gland.
• Dysfunction of the adrenal glands.
• Obesity.
• Cachexia.
• Lack of a number of trace elements and vitamins.
• Amyloidosis.
• Sarcoidosis.
• HIV infection.
• Terminal insufficiency of the kidneys.
• Atrial fibrillation.
• Blockade of the heart.
• Excessive and dry pericarditis.
• Congenital and acquired heart defects.

Detection of pathology

The diagnosis of "CHF" is based on the 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 shows what illnesses a person and his relatives had. The specialist should know about all medications taken by the patient. When physical examination is evaluated skin color, the presence of swelling. When listening to the heart, it is determined if there are noises. There is also a stagnation in the lungs. As mandatory research, an analysis of urine and blood is prescribed. Studies can identify concomitant pathologies that may affect the course of CHF. Treatment in this case will be comprehensive, aimed at eliminating background ailments. A biochemical blood test is also prescribed. The results determine the concentration of cholesterol and its fraction, urea, creatinine, sugar, potassium. The thyroid gland hormones are analyzed. A specialist can prescribe an immunological study. During it, the level of antibodies to heart tissue and microorganisms is determined.

Research using equipment

The ECG makes it possible to evaluate the rhythm of the heartbeats, to determine the rhythm disturbances, the size of the organ's divisions, and to detect cicatricial changes in the ventricles. To analyze the noise, a phonocardiogram is used. With its help, the projection of the valves determines the presence of systolic or diastolic noise. For evaluation of the structure of the lungs and the heart, an overview radiograph of the sternum is used. This study also allows you to determine the size and volume of the departments of the organ that pumps the blood, to determine the presence of stagnation. Echocardiography is used to examine all areas of the heart. During the procedure, the thickness of the walls of the departments and valves is determined. Also, using echocardiography, it is possible to detect how pronounced increase in pressure in the pulmonary vessels. The analysis of the movement of blood is carried out during Doppler EchoCG. The doctor may prescribe other studies in addition to those described.

Treatment of CHF: recommendations

First of all, the patient is assigned a special diet. The diet limits the amount of table salt to three grams and a liquid to 1-1.2 liters per day. Products should be easily digested, be high in calories, contain vitamins and protein in the required volume. The patient should be weighed regularly. Adding weight more than 2 kg for 1-3 days, usually indicates a delay in the body fluid and decompensation of CHF. Treatment may include psychological help. It aims to accelerate the recovery of the patient. Psychological help can be provided to the relatives of the patient. It is undesirable for patients to abandon the load completely. The level of activity for each patient is determined on an individual basis. Preference should be given to dynamic loads.

Basic medicamental therapy

Preparations for heart failure are divided into groups: the main, supplementary and auxiliary. The first includes:

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

Additional resources

• Satines are prescribed in the event that the cause of CHF is IHD.
• Anticoagulants of indirect action. Preparations of this group are prescribed with a high probability of thromboembolism and atrial fibrillation.

Auxiliary medications

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

• Nitrates. These remedies improve blood flow and dilate blood vessels. Medications of this group are prescribed for angina pectoris.
• Antagonists of calcium. These medications are indicated for persistent angina pectoris, arterial hypertension (stance), increased pressure in pulmonary blood channels, insufficiency of valves of pronounced character.
• Antiarrhythmic drugs.
• Disaggregants. These agents have the ability to degrade coagulation, preventing the adhesion of platelets. Medicines of this group are indicated in secondary prevention of a heart attack.
• Inotropic non-glycoside stimulants. These drugs are used in the marked decrease in blood pressure and cardiac output.

Surgical methods

In the absence of effectiveness of medicamentous effect, operative, mechanical intervention is used. In particular, the patient may be assigned:

• Aortocoronary bypass. The operation is performed with pronounced atherosclerotic vascular damage.
• Surgical correction of valve defects. Intervention is performed in case of severe stenosis (constriction) or failure of the valves.
• Organ transplantation. Heart transplantation is a fairly radical measure. Its implementation involves a number of difficulties:
  
  - probable rejection;
  - inadequate number of donor organs;
  - damage to the blood channels of the transplanted organ, which is not amenable to therapy.

• The use of artificial devices that provide auxiliary circulation. They are introduced directly into the patient's body. Through the cutaneous surface they are connected with the batteries located on the patient's belt. However, the use of apparatus is also accompanied by problems. In particular, infectious complications, thromboembolism and thrombosis are likely. It interferes with the vast application of devices and their high cost.
• Use of an elastic mesh frame. They envelop the heart in dilated cardiomyopathy. This measure allows to slow down the increase in the size of the body, improve the effectiveness of drug treatment, improve the patient's condition.