Heart failure - a disorder multisystem nature, which is caused by disorders of the SSS, the urinary system and skeletal muscle in conjunction with changes in neurohumoral nature, thereby forming a kind of pathologicalsyndrome. Heart failure occurs as a result of heart failure in the normal blood supply to the body, due to poor blood pumping euvolemii background or normal vascular tone.
Heart failure is characterized by two types, such as stable (CHF) and unstable, which includes DOS (cardiogenic shock and pulmonary edema) and decompensated heart failure.This pathological syndrome is not a disease of self-nature.As a rule, it is considered a complication of other disorders and conditions, and its prevalence is constantly increasing with the age of patients, thus reaching 10% among men after 70 years.Heart failure is characterized by fairly frequent hospitalizations and deaths.
Heart failure causes
etiological factors influencing its development, are divided on the causes and
main causes of heart failure are primary myocardial damage, disturbance of cardiac filling and ventricular hemodynamic overload them.The primary lesion are diffuse lesions of the heart muscle (myocarditis, cardiomyopathy), focal (acute form of myocardial infarction, myocardial infarction, atherosclerotic cardiosclerosis) and iatrogenic (drugs, radiation).
Impaired ventricular filling acts stenosis atrioventricular holes on both the left and right, pericardial effusion and constrictive nature fibroelastosis, hypertrophy of the heart muscle of different etiology, endomyocardial fibrosis.For ventricular hemodynamic overload include processes improve the resistance to expel the blood, pulmonary and systemic hypertension, aortic stenosis.In addition, the volume overload is also the causative factor of heart failure, which develops due to valve insufficiency and congenital malformations.Also this syndrome with high ISO (cardiac output) as a hypoxic conditions (chronic pulmonary heart in the form of anemia);increased metabolism (hyperthyroidism), pregnancy and promote the formation of cardiac insufficiency.
also factors that provoke the development of this disease are discontinued therapeutic treatment of heart failure or reduced activity;Surge of various origins;unfavorable environment in the form of heat or high humidity.Also, nutritional factors associated with abuse of fluid and salt;abnormal heart rhythm and conduction;intercurrent infections character;TEVLA (thromboembolism pulmonary artery branches);hypertension, fever;Various drugs which are capable of holding the fluid in the body and many of the attendant cardiac disease that may be undetected, contribute to the formation of multi-system state.
Heart failure symptoms
Symptoms of heart failure can develop from minor symptoms, which occur only during physical stress, as well as severe forms of dyspnea at rest.
Patients who reduced pumping function when the ejection fraction of about 40% and does not impose specific complaints and characteristic symptoms of heart failure, referred to as asymptomatic LV dysfunction.However, this condition can not be considered a clinical picture, which is characteristic for the first stage of the pathological process, since it is characterized by symptoms of worsening hemodynamics, which is triggered by the functional nature of the samples.Typically, heart failure is a kind of syndrome progression of disease.
The earliest symptom is shortness of breath LZHSN, which at first appears during fast running, exercise or walking, while lifting up the stairs.Difficulty breathing and eventually begins to appear in an absolutely quiet state, which can be enhanced with a change in body position, even if the conversation or meal.
various heart diseases that cause shortness of breath, only contribute to strengthening it in the horizontal position of the patient.This fact is forcing patients to take the position of the type orthopnoea in which they experience significant relief.Half-upright position relieves the heart due to the reduction of blood coming to the right side of the heart, as a result of reduced pressure in the IWC.
Shortness of breath is usually characterized by a lack of air and subjectively manifested swelling and tension of the wings of the nose, with the participation in the process of breathing muscles more.At the same time the patient feels tired, she starts to sweat profusely, constantly feels the beating of his heart, and he reduced physical activity.Furthermore, disturbed sleep as a result of increasing breathlessness at night.These symptoms, as well as poor appetite, do not refer to specific manifestations of heart failure, and if patients are quite actively present their complaints, the early symptoms of left ventricular heart disease may go undetected.
addition, manifests itself a typical sign of heart failure, tachycardia, a reflex that occurs as a consequence of increased pressure in the left atrium and processes baroreceptor stimulation in it.
Pathognomonic symptoms of left ventricular cardiac pathology is a different kind of cough, which may be dry or wet when separating the mucous sputum.Basically it develops in different forms and loads during sleep.But at break of varicose veins in the bronchi may occur pulmonary hemorrhage and hemoptysis, although very rarely.
In some cases where the recurrent nerve is compressed by increasing or expanding the LP LA left, appears in the patient's voice hoarseness or aphonia.In addition, if the characteristic symptoms of stagnation of blood in the MCC number of respiratory movements does not increase, and dyspnea developed, that is difficult inhaling and exhaling is extended as a result of the rigidity of the lungs.At the same time tapped wet, different caliber, wheezing, in the beginning at the bottom and sides of the lungs, and then everywhere, that is,diffusely.As a result of insufficient work of the respiratory center appears cyanotic mucous membranes and skin.The main cause of cyanosis is considered to be an increased amount of reduced hemoglobin in the blood character.It appears purple-red color of the lips and fingertips.
patients diagnosed with heart failure have a characteristic cyanosis of both central and peripheral.In the first case it develops as a result of impaired blood oxygenation in the lungs, and by mixing the blood.Typically, this cyanosis is characterized by diffuse localization and often not a consequence of severe circulatory disorders.Acrocyanosis or peripheral cyanosis is not due to increased oxygen consumption, so cyanotic characterized in remote areas of the body and its severity depends on the severity of impaired circulation.As a rule, in patients with heart failure the left ventricle indicated a mixed type of cyanosis.
Symptoms of disruption of the right ventricle, typical of heart failure, is made up of the patient's fatigue, disturbed sleep, his weaknesses.Symptoms such as shortness of breath, cough, cyanosis, and have varying degrees of severity and often perform the severity of congestive processes in the BPC.It mainly depends on the underlying pathology, which is based on the lack of work, right side of the heart.As a result of a weak heartbeat bad emptied the large veins of the heart and all the departments are not able to produce a normal cardiac output.Thus, the whole venous blood is collected in the venous system of the BPC, and it becomes a cause of venous congestion in certain organs and blood stagnation.It is manifested by swelling of the veins that are very close to the heart, particularly the jugular.A vein in the periphery largely expanded, and those that are seen - increased.
Gradually increases pressure in the veins and the growth is due to the volume of blood that is involved in the circulation.Congestion in CCL leads to hepatomegaly.First, increased left lobe of the liver, and then the right.On palpation it is soft, with a smooth surface and rounded end, sometimes painful, especially rapidly developing FLL.When making a marked pressure on the liver jugular veins and enhanced surge.When a significant increase in the liver may feel its pulsation.Against the background of chronic venous stasis liver painless, dense, reduced in size.Thus, a type of cardiac cirrhosis.
Clinical liver disorder detected at the second (B) and third-stage heart failure.Also changing laboratory indicators: increased bilirubin, transaminase, there disproteinuriya.
sometimes identify violations of the gastrointestinal tract as a result of stagnation of blood in the mesenteric vessels of the type, which is manifested by pain, disorders in the bowel as constipation and diarrhea, and often vomiting.
In addition, a common symptom of heart failure is a hidden form of edema.Edema in the periphery, usually appearing at the end of the day.First, they are marked in the lower limbs and then spreads to other places due to hydrostatic pressure, that is, if the patient is constantly, the swelling appear on the rump, and in the case of forced sitting and while walking - on the feet.Later they go to the internal organs.At the same time the patient begins to secrete less urine, nocturia increases, turning into oliguria.In extreme cases, kidney unit developed with anuria possible, which requires emergency treatment.
Signs of heart failure
They depend on the stagnation of blood in the IWC and BPC, or simultaneously in two.This process can be characterized by a chronic course or urgent condition.We differentiate between a variety of symptoms of heart failure.
In acute manifestations of the formation of stagnation in the ICC formed cardiac asthma and pulmonary edema type.At long process develops sclerosis and seal in vessels.
main feature of heart failure is considered to shortness of breath, which is characterized by lack of air inhaled, changes in the depth and frequency of breathing, that is observed inspiratory breath.At the beginning of the pathological process of breathing difficulties occur when performing intense physical work, and later, in progressive heart failure processes that occur even in the prone position, especially at night.
The second important feature of heart failure is considered orthopnea (semi-sitting position), when the patient is forced to even sleep in this state.This feature refers to the objective indicators of heart failure, which manages to identify when viewed from the patient, seeking to adopt a sitting position.It is in the horizontal position the patient experiences shortness of breath due to accumulation of blood in the lungs.
characteristic feature of the disease is the appearance of dry cough, and sometimes even with the sputum.Cough occurs as a result of edema of the bronchi as a result of plethora and irritation of the nerve increased the size of the left heart.In some cases, due to damaged blood vessels into the alveoli gets blood, sputum and therefore stands a rusty hue.
attack of cardiac asthma is manifested soon coming suffocation followed by a possible respiratory arrest.For cardiac asthma, in contrast to the bronchial, and is characterized by shortness of breath, and exhale.In the blood increases the concentration of carbon dioxide and decreases the amount of oxygen, so breathing starts to become active center.This leads to frequent and shallow breathing with the advent of fear for their lives, and ultimately manifested exacerbation of the pathological process.
pulmonary edema refers to the last stage of hypertension in the LRC.Typically, this feature is developed on the background of DOS, as well as in heart failure decompensation.In this case, the patient coughs frothy sputum with a pink tinge.In severe course of disease the patient loses consciousness, breathing is superficial and ineffective.
In heart failure signs of stagnation of blood in the BPC considered swelling, pain in the liver, palpitations, fatigue, dyspeptic phenomena of nature and violations in the work of the kidneys.
Edemas refer to the most ground to popular forms of chronic heart failure.As a rule, their initial appearance falls on the feet, and later, with the progression of the disease, they are distributed to the upper parts of the body, penetrating even to the front abdominal wall.In heart failure, edema have characteristic features: symmetrical;after a night there on the back and buttocks, and walking - in the lower extremities;They are not localized in the face, neck and shoulders, which distinguishes them from swelling when kidney disease.Edema, which for a long time present in the patient, leading to various complications in the form of trophic skin changes, ulcers, tears and cracks with liquid flowing from them.
Due to the fact that the liver is filled with blood and developed hepatomegaly, there is pain in the right side under the ribs.In CHF there is a change of liver cells with the transition to cirrhosis and a violation of its work.The final stage of heart failure, there is an increase of pressure in the vein and this becomes the result of ascites.A characteristic feature of ascites is an increase in subcutaneous veins around the navel as the head of Medusa.
for signs of heart failure such as a strong heartbeat, characterized by a rapid reduction in the myocardium as a result of increased susceptibility of the nervous system.Tachycardia is considered a replacement mechanism, which is aimed at the process of normalization of hemodynamics.This increased heart beat quickly drains the myocardium and causes congestion.
Fatigue patients with chronic heart failure is considered as a specific sign of the disease, which is associated with increased blood content of muscle that is found in other pathologies.
As a result of the decreased oxygen delivery to the organs, marked dyspepsia.And since there is a spasm of the renal vessels, the reduced production of urine, so the liquid and retained in the body.This process causes the development of decompensated heart failure, chronic form.
Heart failure in children
The disease in children is caused by the inability of the heart to fully function, that is normal to pump blood in accordance with the metabolic needs of the tissue that appears changes in the processes of circulation and neuroendocrine disorders.
Pediatric heart failure acute form manifests itself very rarely during neonatal development.It is expressed as a rule, signs of asphyxia, congenital cardiomyopathy, tachyarrhythmia, bradycardia, congenital heart defects, severe sepsis.
The cause of the disease in the first day of a child's life can be fetal myocarditis, congenital heart defect with insufficient work atrioventricular valves, hypoplasia of the left ventricle and aortic atresia.
Later, closer to the third day after birth, heart failure can be caused by posthypoxic myocardial ischemia, diabetic cardiomyopathy nature, a severe form of anemia, metabolic disorders and arrhythmias.