Heart failure is a multi-systemic disorder, which is caused by disruption of the SSS, urinary system and skeletal muscles in conjunction with changes in the neurohumoral nature, thus forming a peculiar pathological syndrome. Heart failure occurs as a result of cardiac failure to provide a normal blood supply to the body, due to poor blood pumping on the background of euvolemia or normal vascular tone.
Heart failure is characterized by two types, such as stable (CHF) and unstable, which includes OCH ( cardiogenic shock and pulmonary edema) and decompensated CHF. This pathological syndrome is not a disease of an independent nature. As a rule, it is considered a complication of other pathologies and conditions, and its prevalence is constantly increasing with the age of patients, reaching 10% among people after 70 years. Heart failure is characterized by a fairly frequent hospitalization and death.
Heart failure of the cause
The etiological factors affecting its development are divided into causal and contributing factors. The most common causes of heart failure include arterial hypertension, IHD in various forms, valvular heart defects and non-coronary anomalies of the myocardium. Determination of the causes and factors contributing to the development of the disease, as well as their timely correction, are of great importance in increasing the effectiveness of therapeutic treatment.
The main causes of heart failure are primary myocardial damage, disturbances in the processes of filling the heart ventricles and overloading their hemodynamics. The primary lesions include diffuse lesions of the heart muscle ( myocarditis , cardiomyopathy ), focal (acute form of myocardial infarction, postinfarction cardiosclerosis , atherosclerotic cardiosclerosis) and iatrogenic (medicinal, radiation).
Violations of the filling of the ventricles is stenosis of the atrioventricular aperture both to the left and to the right, pericarditis of exudative and constrictive nature, fibroelastosis, cardiac muscle hyperthyre of different etiology, endomyocardial fibrosis. The hemodynamic overloads of the ventricles include the processes of increasing resistance to expulsion of blood, pulmonary and systemic arterial hypertension, aortic stenosis. In addition, volume overload is also a causative factor of heart failure, which is developing because of the inadequacy of valves and congenital malformations. Also this syndrome with a high MOC (minute heart volume) in the form of hypoxic conditions ( pulmonary heart in chronic form, anemia); increased metabolism ( thyrotoxicosis ), and pregnancy contribute to the formation of heart failure.
Also, the factors that trigger the development of this pathology include a discontinued therapeutic treatment of heart failure or decreased activity; overvoltages of various genesis; adverse environment in the form of heat or strong humidity. Also, nutritional factors associated with the abuse of fluid and salt; heart rhythm and conduction disorders; infections of an intercurrent nature; TEVLA (thromboembolism of the branches of the pulmonary artery); arterial hypertension, febrile state; various drugs that are capable of retaining fluid in the body and many concomitant cardiac pathologies that may be unrecognized contribute to the formation of this multi-systemic condition.
Heart failure symptoms
Symptoms of heart failure may consist of minor manifestations that occur only when performing physical exertion, as well as severe dyspnoea in a calm state.
Patients who have a reduced pump function with an ejection fraction of about 40% and who do not show any special complaints and characteristic symptoms of heart failure are referred to as asymptomatic LV dysfunction. However, this condition can not be considered a clinical picture, which is characteristic of the first stage of the pathological process, since its symptoms are characterized by worsening hemodynamics, which is provoked by functional tests. As a rule, heart failure is a kind of syndrome of progression of pathology.
The earliest symptom of LUF is shortness of breath, which first appears when running fast, exercising or walking, while climbing up the stairs. And later, labored breathing begins to appear and in an absolutely calm state, which can intensify with a change in the position of the body, even when talking or eating.
Various heart diseases that cause shortness of breath, only contribute to its increase in the horizontal position of the patient. It is this fact that forces patients to adopt a position such as orthopnea, in which they experience considerable relief. The semi-sitting position relieves the heart due to a drop in incoming blood to the right side of the heart, which as a result reduces the pressure in the ICC.
Dyspnea, as a rule, is characterized by a lack of air and is subjectively manifested by inflation and tension of the wings of the nose with the participation of additional muscles in the process of breathing. At the same time the patient feels tired, begins to sweat profusely, constantly feels the beating of his heart and his motor activity decreases. In addition, sleep is disturbed as a result of increasing choking at night. This symptomatology, as well as a poor appetite, does not refer to specific manifestations of heart failure, and if patients do not actively present their complaints, the early symptoms of cardiac left ventricular pathology may go unnoticed.
In addition, such a characteristic symptom of heart failure as tachycardia manifests itself as reflexively as a result of increased pressure in the left atrium and processes of irritation in it of the baroreceptors.
Patognomonichnymi symptoms of cardiac pathology of the left ventricle is a different kind of cough, which can be dry or wet when separating the mucous sputum. In general, it develops under various forms of exercise and during sleep. But with the rupture of dilated veins in the bronchi, pulmonary hemorrhage and hemoptysis may occur, although very rarely.
In some cases, when the reflex nerve is squeezed when the LL increases or the LA widening is on the left, the patient has a hoarse voice or aphonia. In addition, with characteristic symptoms of blood stagnation in the ICC, the number of respiratory movements does not increase, and dyspnea develops, that is, it is difficult to inhale and the exhalation is prolonged as a result of the rigidity of the lungs. At the same time, wet, different calibres are heard, rattling, at the very beginning below and at the sides of the lungs, and then everywhere, i.e. diffusely. As a result of insufficient work of the respiratory center, cyanosis of the mucous membranes and skin appears. The main cause of cyanosis is an increased amount of hemoglobin in the blood of a restored character. This is manifested by the crimson-red color of the lips and fingertips.
Patients with a diagnosis of heart failure have a characteristic cyanosis both central and peripheral. In the first case, it develops as a result of impaired oxygenation of blood in the lungs, as well as as a result of the mixing of blood. As a rule, this cyanosis is characterized by diffuse localization and quite often it is not a consequence of severe circulatory disturbances. Acrotsianosis or peripheral cyanosis has no connection with increased oxygen consumption, therefore it is characterized by cyanoticity in the remote parts of the body and its severity depends on the severity of the disturbed blood circulation. As a rule, a mixed type of cyanosis is observed in patients with heart failure of the left ventricle.
The symptomatology of the disturbance of the right ventricle, characteristic of heart failure, consists of rapid fatigability of the patient, disturbed sleep, and his weakness. Symptoms such as shortness of breath, cyanosis and cough have a different degree of severity and quite often appear as a burden of stagnant processes in the CCB. This mainly depends on the underlying pathology, which is based on insufficient work of the right side of the heart. As a result of a weak heart contraction, large veins are poorly emptied and all cardiac units are not able to produce a normal cardiac output. Thus, all venous blood is collected in the CCB of the venous system, and this causes venous plethora of certain organs and blood stagnation. Outwardly this is manifested by swelling of the veins, which are very close to the heart, in particular, the jugular ones. And the veins on the periphery are mostly dilated, and those that are visible are enlarged.
The increasing increase in the pressure in the veins is also due to the increase in the volume of blood that participates in the circulation. Stagnation of blood in the CCB leads to hepatomegaly. First, the left lobe of the liver increases, and then the right lobe. With palpation, it is soft, with a flat surface and a rounded tip, sometimes painful, especially if the PZHN is rapidly developing. When pressure is applied to the liver, there is swelling of the cervical veins and their increased pulsation. With a significant increase in the liver, it is possible to feel its pulsation. Against the background of chronic venous congestion, the liver is painless, dense, reduced in size. Thus, hepatic cirrhosis of the heart type is formed.
Clinical violations of the liver are found in the second (B) and third stage of heart failure. Laboratory parameters are also changing: bilirubin, transaminase is increased, dysproteinuria is observed.
Sometimes they reveal abnormalities on the part of the digestive tract as a result of stagnation of blood in the vessels of the mesenteric type, which is manifested by pain, impaired intestinal function in the form of constipation and diarrhea, and frequent vomiting.
In addition, a characteristic symptom of heart failure is the latent form of edema. Edema on the periphery, as a rule, appears at the end of the day. Initially, they are noted in the area of the lower extremities, and then spread to other places due to hydrostatic pressure, that is, if the patient constantly lies, edema appears on the sacrum, and in the case of forced sitting and while walking - on the legs. Later they pass to internal organs. In this case, the patient begins to excrete less urine, increases nocturia, turning into an oliguria. In a pinch, a kidney block with a possible anuria develops, which requires emergency treatment.
Signs of heart failure
They depend on the stagnation of blood in the ICC and the CCB, or simultaneously in two. This process can be characterized by a chronic course or an emergency condition. At the same time, various signs of heart failure are distinguished.
In acute formation of stagnation in the ICC, cardiac asthma and pulmonary edema are formed. With long-term processes, sclerosis and densification in the vessels develop.
The main sign of heart failure is shortness of breath, which is characterized by a lack of inhaled air, changes in depth, as well as respiratory rate, that is, inspiratory breathing is observed. At the very beginning of the pathological process, difficulty breathing occurs when performing intensive physical work, and later, with progressive heart failure processes that appear even in a lying position, especially at night.
The second important sign of heart failure is orthopnea (semi-sitting position), when the patient is even forced to sleep in this state. This sign refers to the objective indicators of CHF, which can be identified by examining a patient seeking to sit. It is in the horizontal position that the patient feels a shortage of air due to the accumulation of blood in the lungs.
A characteristic sign of the disease is the appearance of dry cough, and sometimes even with the separation of sputum. Cough occurs as a result of edema of the bronchi as a consequence of fullness and irritation of the nerve with enlarged dimensions of the left side of the heart. In some cases, due to damaged vessels in the alveoli, blood is ingested, and therefore sputum is given off a rusty shade.
The onset of cardiac asthma manifests itself rapidly onset asphyxiation followed by a possible respiratory arrest. For cardiac asthma, in contrast to the bronchial asthma, it is difficult to breathe in and out. In the blood, the concentration of carbon dioxide increases and the amount of oxygen decreases, so the respiratory center begins to activate. This leads to frequent and shallow breathing with the appearance of a feeling of fear for one's life, and as a result is manifested by aggravation of the pathological process.
Lung edema refers to the last stage of hypertension in LCC. As a rule, this symptom develops against the background of OSN, as well as during decompensation of CHF. In this case, the patient coughs up foamy phlegm with a pink tint. In the severe course of the pathology, the patient loses consciousness, breathes superficially and ineffectively.
In heart failure, signs of stagnation of blood in the CCR are edemas, pain in the liver, palpitations, fast fatigue, dyspepsia and irregularities in kidney function.
Edema is one of the most common signs of chronic heart failure. As a rule, their primary appearance falls on the foot area, and later, with the progression of the disease, they spread to the upper parts of the body, penetrating even the front wall of the peritoneum. With heart failure edema has characteristic distinctive features: symmetrical; after a night appear on the back and buttocks, and when walking - on the lower limbs; they are not localized in the face, neck and shoulders, which distinguishes them from edema in kidney disease. Swelling, which for a long time is present in the patient, leads to various complications in the form of trophic skin changes, ulcer formations, ruptures and cracks with fluid that flows out of them.
As a result of the fact that the liver is filled with blood and develops hepatomegaly, there is pain in the right part, under the ribs. With CHF, there is a change in the liver cells with the transition to cirrhosis and a violation of its work. In the last stage of heart failure, there is an increase in pressure in the vein, and this is the result of ascites. A characteristic feature of ascites is the increase in the subcutaneous veins around the navel in the form of a jellyfish head.
For such a sign of heart failure as a strong heartbeat, a rapid contraction of the myocardium is characteristic as a result of increased susceptibility of the nervous system. Tachycardia is considered a replacement mechanism, which is directed to the processes of normalization of hemodynamics. Such an intensified contraction of the heart rapidly depletes the myocardium and causes stagnation.
Rapid fatigue of patients with CHF is considered as a specific sign of the disease, which is associated with increased blood filling of the muscles, which is typical for other pathologies.
As a result of the fact that oxygen delivery to the organs decreases, dyspeptic disorders are noted. And since there is a spasm of the kidney vessels, then the secretion of urine decreases, so the fluid lingers in the body. This process causes the development of decompensation of chronic heart failure.
Heart failure in children
This disease in children is due to the impossibility of the heart to function fully, that is, it is normal to inject blood in accordance with metabolic needs of tissues, which is manifested by changes in circulation processes and neuroendocrinal disorders.
In children, cardiac insufficiency of the acute form is very rare in the period of neonatal development. This is expressed, as a rule, in signs of asphyxia, congenital cardiomyopathy, tachyarrhythmia, bradycardia, congenital heart defects, severe sepsis.
The cause of this disease in the first day of life of the child may be intrauterine myocarditis, congenital heart disease with insufficient work of atrioventricular valves, left ventricular hypoplasia and aortic atresia.
Later, closer to the third day after birth, heart failure may occur as a consequence of posthypoxic cardiac ischemia, diabetic cardiomyopathy, severe anemia , metabolic disorders and arrhythmia.
The middle and end of the early neonatal period are characterized by the development of heart failure as a result of various circulatory disorders and movements of large vessels.
The late neonatal period of heart failure is caused by congenital heart defects such as stenosis and coarctation of the aorta, large defects of the ventricles.
In newborns, heart failure is mainly caused by insufficient LV work, as the MCC is overloaded. In children, this pathology is characterized by development in several stages. Hypoxemia, hypocapnia and tachypnea of a reflex character cause an increase in the volume of blood in the lungs and edema of the lungs of the interstitial property. Hypoxemia promotes the appearance of hypercatecholemia, which supports heart failure due to palpitation and centralization of blood circulation.
To date, in medical pediatric practice, heart failure of the right ventricle, left ventricle and mixed form are considered, as well as three stages of its development.
Children's heart failure is characterized by rapid progression with unclear symptoms. Sometimes they even hide behind the difficult state of the child.
Heart failure, in the initial stage, is the appearance of dyspnea at the time of eating or during crying. The frequency of respiratory movements can exceed eighty per minute. When listening to the heart, there is a tachycardia with cardiac contractions of 180-190 ud. in a minute. The skin is pale with peripheral cyanosis as a result of increased pressure in the ICC and stagnant processes in the CCB.
In newborns, heart failure in later stages is characterized by difficulty in sucking, significant weight gain, and sweating on the head. Tachypnea is always accompanied by a shortness of breath of an expiratory nature, and rattles are audible over the lungs. In addition, the cyanoticity of the central parts of the body is noted, the heart beat is diminished and a heart rhythm of the gallop type appears. A characteristic feature of this period is hepatomegaly and oliguria.
Also, newborns appear pastosity of the lower lumbar region, in the perineal region and in the lower abdomen. Ascites and edemas of a peripheral nature are typical of older children diagnosed with heart failure. Dyspeptic disorders refer to the characteristic symptoms of this pathology.
For the first stage of pediatric heart failure is characterized by the appearance of shortness of breath, rapid heartbeat, fatigue after minor loads. In this case, everything is noted without hemodynamic disorders.
The second (A) stage of the pathological process is characterized by mild dyspnoea at rest, then the heart rate increases and breathing becomes more difficult, signs of acrocyanosis appear, the wheezing of wetness in the lower part of the lungs is heard, the liver is slightly enlarged, and edema is noted.
For the second, irreversible (B) stage, shortness of breath is typical for small loads, involuntary semi-sitting position, wet rales are persistent in the lungs, wet rales, hepatomegaly, edema rises and does not pass after rest.
The third stage of heart failure is presented by shortness of breath in absolute rest, cardiac asthma, orthopnea, jugular veins, pulmonary edema, hepatomegaly, hydrothorax, ascites and oliguria.
Edema with heart failure
With this pathological process, edemas are a serious symptom that requires a thorough comprehensive examination of the patient and the appointment of appropriate therapeutic treatment. As a rule, this sign is a symptom of not only heart failure, but also many other diseases: allergies , liver and kidney diseases. Therefore, in order to diagnose the edema of cardiac pathology, it is necessary to determine the cause that contributes to their occurrence, and be able to differentiate with the edema of another pathology.
As a rule, with DOS as a result of violations in the MCC, there may appear abundant, liquid, foamy sputum with blood or it can be evenly colored in pink. This is a characteristic sign of the development of pulmonary edema, which is a common cause of death in patients with prolonged heart failure. The cause of the development of pulmonary edema can be cardiac overload of a temporary nature, emotional overstrain and even hypothermia. In this case, pulmonary edema serves as a vicious circle.
But heart failure of a chronic form is characterized by the appearance of swelling of the feet and shins (first in the evening, and then in the daytime). This is due to the inability of the heart to cope with the stresses, which causes a slowing of the blood flow in the channel and the accumulation of a sufficient amount of fluid in the tissues of the lower limbs. A simple test is used to confirm cardiac swelling. In this case, you can press your finger on the shin area above the bone and hold for about two seconds. In the event that, as a result of pressure, the fossa appears slowly disappearing, it is possible to assert the presence of edema. Another sign of the underlying concealed edema is considered to be an increase in body weight, as a consequence of accumulation and retention in the body of the fluid.
Edema, characteristic of heart failure, at the very beginning of the disease appear on the legs and lower abdomen, and in patients who are forced to lie on the sacrum and waist. Symptoms for cardiac edema are symmetry. In addition, they appear gradually with a slow buildup over several months. When pressed, they are dense and leave a deepening after themselves. Also, they are characterized by simultaneous hepatomegaly.
With severe heart failure, the development of edema is accompanied by ascites. In addition, they note their combination with the characteristic signs of heart failure, which include shortness of breath; tachycardia; pallor, turning into cyanotic lips; poor tolerance of physical activity. Cardiac edema can disappear after reaching the treatment of compensation for the pathological process.
Edema of the legs with heart failure
Since heart failure does not belong to an independent disease, therefore, it is considered a violation of the work of the heart and various consequences of pathological processes. For heart failure characterized by quite distinct symptoms, among which there are foot swelling, which are the cause of stagnant processes of blood in the vessels and fluid in the tissues.
Practically always this pathology of the heart is characterized by edema, the localization of which depends on the violations in the circulatory system and the specificity of heart failure. When violations of the left heart, namely the ventricle as a result of hypertension or ischemic heart disease, develops pulmonary edema, which is accompanied by shortness of breath and tachycardia. And with insufficient functioning of the prostate in the body, a significant amount of fluid is retained, causing swelling of the legs. Also for heart failure is characterized almost always bilateral puffiness of the legs. The main cause of swelling of the lower limbs is the stagnation of blood in the veins of the BPC.
Heart failure in progression causes a worsening of the symptoms of the disease. If in the early stages of the pathological process the legs swell slightly (only edema of the feet and legs) and this swelling quickly passes, then in the future it develops into a chronic form. Therefore, as a rule, at the beginning of the disease, swelling on the legs does not cause any special complaints in patients and is considered a natural manifestation after a prolonged stay on the legs or an uncomfortable position.
Since the swelling of the legs is noted mostly closer to the evening time, and after the night rest it passes, the patient first does not attach special importance to this symptom. However, in the future, puffiness continues to intensify and no longer disappears as before, but, on the contrary, spreads to the upper part of the limbs, capturing already thighs. In this case, there are other signs that characterize heart failure: dyspnea, hepatomegaly, liver soreness, cyanosis and fast fatigue.
To eliminate edema on the legs, it is necessary to find out the cause of its onset, and then proceed with the appointment of the appropriate treatment. At the very beginning of the disease sometimes helps rest, massage, foot compresses or baths. But heart failure at later stages requires specialized medical examination and treatment. Diuretics (Furosemide, Torasemide, Piretanide, Bumetanide) are prescribed to cause fluid outflow from the body, which have a pronounced diuretic effect. Simultaneously, cardiac glycosides are used for the therapy of heart failure, which in complex affect the SS.C. These drugs normalize circulatory processes, prevent stagnation and increase the effect of diuretics. Thus, there is a withdrawal of excess fluid from the body, which leads to the removal of edema on the legs.
First aid for heart failure
There are many reasons that can contribute to the inability of the heart to decrease sufficiently. As a result, stagnant processes occur in the vessels, causing the development of heart failure. And it, in turn, can cause a lethal outcome of the patient.
Very often heart failure of an acute form is characterized by the development of cardiac asthma and pulmonary edema. Therefore, it is necessary in these situations to be able to properly carry out first aid before the arrival of a doctor.
To understand that a patient has an attack of cardiac asthma, one must know that this is a characteristic suffocation related to stagnation of blood in the lungs. Cardiac asthma does not belong to an independent disease, but is a symptomatic complex of acute left ventricular failure.
Causes of cardiac asthma can be acute or prolonged overstrain of the heart muscle.
Symptomatic of an attack can occur at any time of the day, but more often at night with a characteristic suddenness. Suffocation is manifested by difficult processes of inhalation and exhalation combined with a sense of fear of death. The patient at the same time takes a forced position for him - sits with his legs down or orthopnea. During an attack, the patient's skin becomes covered with a cold sweat, and acquires a cyanotic shade.
At first, cardiac asthma manifests itself by the appearance of a dry cough or cough with scanty separation of mucous sputum. Breathing begins to drastically increase, and when the attack is protracted, it is characterized by bubbling, which can be heard from a distance. The frequency of breathing is noted up to thirty to fifty per minute, the pressure can be increased, and the pulse rate is greatly increased. Cardiac asthma is complicated in 1/4 of cases by pulmonary edema and is characterized by the appearance of liquid, foamy, pink sputum and loud bubbling breath.
First aid in case of an attack of cardiac asthma, as a symptom of heart failure, is, first of all, in calling a doctor and measuring blood pressure. Then the patient assumes a sitting position, at which it is necessary to lower the legs. It is also necessary to put a tablet of Nitroglycerin under the tongue, and if the systolic pressure does not fall below a hundred, then repeat the drug in ten minutes. Then you can apply the tourniquets to the veins of the three limbs, and after fifteen minutes, you can remove one of the tourniquets and then put them round for no more than an hour. A good effect is achieved when staging cans, mustard plasters or warm foot baths. And the last step in helping is oxygen therapy with defoamers through the nose with the help of a catheter.
Under the supervision of a doctor, intravenously administered, Staphantine, Fentalin, and Eufillin are injected, and with the growth of wet wheezing, intravenously, Lasix. Occasional bleeding to 300-500 ml. After arresting the attack, the patient is hospitalized in the cardiology department.
The second sign of the pathological process is pulmonary edema, which is a threatening condition for the patient. The causes of its occurrence are various infections, intoxications, CNS lesions, anaphylactic shock , heart defects , hypertension, repeated myocardial infarction .
Symptomatic of interstitial pulmonary edema is a feeling of suffocation; the patient sits in bed, leaning on the edge; the respiration rate is thirty per minute; face pale, gray-cyanotic and covered with sweat; it is frightened, tense, focused; cyanosis on the lips and nails; difficult to speak; tachycardia, rhythm of the "gallop"; The blood pressure is increased; the expansion of the boundaries of the heart, systolic noise, wheezing may not be, but with alveolar edema - small-medium-large-bubble rales; sound boxed.
In alveolar edema, the liquid penetrates into the alveoli and a persistent protein foam appears - pink or white to 3-5 liters. A tickling breath over the entire surface. Wet wheezing with strong foaming can provoke a lethal outcome in a few minutes.
The first aid is to call the doctor and the mandatory measurement of blood pressure. Then the patient is seated, limbs are attached to the limbs, as in the case of an attack of cardiac asthma. They give a tablet of Nitroglycerin under the tongue. If possible, put cans, mustard plasters, and the legs are lowered into hot water. And in the end, oxygen therapy is carried out or fresh air can be inhaled.
After medical appointments, intravenous administration of Droperidol or Haloperidol with atygistamine preparations is made; conduct intravenous drip of nitroprusside sodium or Arfonada; Lasix and cardiac drugs are also administered intravenously; intramuscularly - Prednisolone, Hydrocortisone (at low pressure and intravenously). At high blood pressure - Pentamine, and at high - bleeding to 200-300 ml. It is also possible to administer Promedol.
Heart failure treatment
The acute form of heart failure requires urgent hospitalization. Then, general measures are taken to limit physical activity and diet, in which the restriction of table salt is an obligatory moment, and with significant edema, food without salt. In addition, appoint cardiac glycosides, diuretics, potassium preparations, calcium antagonists, vasodilators.
Thus, the main method of treatment of heart failure is drug therapy, and if it is ineffective, surgical treatment is used. However, it is important in the treatment of heart failure is the elimination of possible factors that provoke its occurrence. These include: anemia, alcohol abuse, stressful and febrile conditions, improper nutrition and the intake of medications that delay fluid in the body.
The basis of treatment is the elimination of the cause of heart failure and correction of its manifestations.
First and foremost, it is important to create a patient with acceptable levels of physical activity so that they do not cause fatigue and unpleasant feelings in the patient. In the case of significant restriction of loads, the patient should be more in a sitting position, and not lie. In the absence of seizures and severe shortness of breath, as well as edema, it is recommended to walk outdoors.
Patients with a diagnosis of heart failure even sleep in a semi-sitting position to avoid seizures.
To treat the disease, drugs are used that increase myocardial contractility, reduce vascular tone, reduce fluid retention, eliminate sinus tachycardia, and participate in the prevention of blood clots in the heart.
To drugs that increase the contractility of the heart muscle, include cardiac glycosides (Digoxin, Korglikon, Strofantin). They primarily increase the function of the pump in the heart, promote urination, and also help to withstand physical exertion. However, with an overdose of cardiac glycosides, there is nausea, arrhythmia, and color perception is impaired. As a rule, this group of drugs is prescribed for patients with a diagnosis of heart failure in the presence of atrial fibrillation.
To reduce the tone of the vessels used vasodilators, which enhance coronary blood flow, and with prolonged use reduce the expressed hypertrophy of the myocardium. These drugs dilate the blood vessels, causing a decrease in blood pressure and, thus, help the heart in pumping blood. These drugs include: Enalapril, Lisinopril, Monopril, Captopril, Benazepril. In the event that ACE inhibitors do not work, patients with heart failure are prescribed BRA antagonists: Diovan, Lozartan, Candesartan and Irbesartan. To date, these drugs are among the main drugs that are used to treat CHF. They contribute to increasing the tolerance of exercise, improve the filling of the heart with blood and CB, enhance urination. But Nitroglycerin is prescribed for heart failure in the presence of IHD, which mainly affects the veins with simultaneous expansion of the arteries.
To reduce the process of retention of excess fluid in the body used diuretics (Furosemide, Etacryn acid), which have a quick effect after taking. However, their frequent administration can lead to disruption of electrolyte metabolism, so they are combined with Triamteren, which is a diuretic, but it retains potassium in the body. In addition, Triampur is suitable in this case, especially for patients with Stage II CHF.
The use of beta-blockers helps to reduce the heart rate. As a result of their influence, the filling processes are improved, and ultimately the CB increases. To do this, use Carvedilol, which is initially prescribed in small doses, but further improves myocardial contraction. However, some beta-blockers can constrict bronchial vessels and promote blood glucose, so they are carefully prescribed to patients with existing asthma and diabetes .
But to prevent the formation of blood clots in the heart chambers and the appearance of thromboembolism, appoint anticoagulants (Warfamin, Heparin), which prevent blood clotting with mandatory monitoring of blood indicators.
If the medication is ineffective, surgical intervention is recommended in the form of cardiomyoplasty, implantation of an artificial LV or pacemaker.
After the necessary treatment, patients with heart failure are under the supervision of a cardiologist throughout their life.