Chronic heart failure
Chronic heart failure - is symptomatic complex, characterized by a pathological condition which is peculiar to the structural, functional and neurohumoral disorders regulation SSS, causing inadequateperfusion of tissues and organs that are not dependent on their metabolic needs.
Chronic heart failure is a disease with a variety of characteristic symptoms as fatigue, edema, shortness of breath, decreased performance and at rest, and the application loads.This condition is marked fluid retention in the body tissues.The root cause of chronic heart failure is considered to be a reduced ability of the heart to be filled or emptied as a result of damage to the heart muscle, as well as an imbalance of vasodilating and vasoconstrictor neurohumoral systems character.
Chronic heart failure is widespread.It serves as an indicator for decompensated hospitalized almost 49% of patients in the department of cardiology.But in 80% of patients with chronic heart failure develops as a co
Chronic heart failure causes
etiological causes, causes the development of this syndrome are a variety of diseases, which are characterized by heart disease and violation of the processes associated with contractile function.
First, the causes of chronic heart failure, myocardial injury may be noted due to the genetic or acquired abnormalities (myocarditis, coronary heart disease, myocardial dystrophy, cardiomyopathy, etc.).Second, a typical cause of chronic heart failure include heart muscle overload pressure (pulmonary hypertension, aortic stenosis, hypertension) and volume (increased CBV, portal or mitral regurgitation, etc.).In addition, in the third, breach of the process of filling of the ventricles at nemiokardialnom genesis (tumors of the heart, pericarditis, etc.)
To the main causative factor of chronic heart failure continues to refer CHD defects in heart valves, cardiomyopathy, hypertension, myocarditis, andOther.
Among the possible causes of the disease are considered bradyarrhythmia, cardiac myxoma, anemia, tachyarrhythmia, thyrotoxicosis, alcohol abuse and constrictive pericarditis character.
Chronic heart failure symptoms
Symptoms consists of the patient's presenting complaints and diagnostic studies data that caused severe picture of chronic heart failure (CHF).To classify the disease into three stages: primary (first stage), with severe clinical symptoms (second) and the terminal (third).In addition, be aware that the picture is symptomatic chronic heart failure will also consist of the symptoms of the underlying disease, which was the reason for the lack of blood circulation in the chronic form.
Patients with this diagnosis in the first stage complain of fatigue, which is basically always comes too quickly, rapid heart beat, and sometimes sleep disturbance.With such physical activities as rambling, climbing up the stairs, a few physical labor intensified, there are characteristic symptoms of labored breathing and rapid pulse.When the diagnosis of chronic heart failure observed symptoms of underlying pathology, which caused a lack of blood circulation function.
the second stage of the disease all the previous clinical symptoms of the patient's complaints only intensified.This is manifested rapid onset of shortness of breath and almost always can be observed tachycardia, and the size of the heart chambers is significantly increased.With insufficient functioning of the right ventricle is mainly marked stagnation in the venous vessels BPC (the systemic circulation);there is the appearance of swelling in the lower extremities.Initially, they formed in the evening, and then during the day.In addition, even the amount of urine diminishes as a result of the delay in the fluid in the body, and then a hepatomegaly syndrome "congestive buds" with minor proteinuria and hyaline casts.
Visual inspection on the face of the patient noted a slight cyanotic lips, ears and nose, as well as fingertips.Circulatory failure, left ventricular stagnant processes are observed in the vessels of the ICC and are characterized by cough, sputum, shortness of breath;In applying the method defined in the lung auscultation finely crackles stagnant.
With appropriate therapeutic treatment and bed rest symptoms of chronic heart failure can be somewhat reduced, but ultimately it will never disappear, that distinguishes this from the first stage of the disease.
third stage of chronic heart failure is all the previous events with a significant increase of.In this case, cyanosis greatly enhanced patient breathing becomes difficult, even at rest, and the patients can fall asleep, occupying only half upright position.In addition, there is an increase with the emergence of edema ascites and hydrothorax.In this process of stagnation and grow stronger in organs such as the lungs, kidneys and liver.Stagnation in these organs located in the abdominal cavity, causing a sharp drop in appetite and greatly sick patient, and the intestines are not able to perform suction because of irregularities in it, so there is diarrhea.Gradually decreases subcutaneous fat layer (cardiac cachexia), reduced muscle mass.Thus, patients become like "dried up."Heart size increases significantly characterized by its pulse arrhythmia, soft with a small filling.In the application of specific therapeutic interventions with which fail to achieve the goal, there is a significant mortality among patients on the background of the growing phenomena of insufficient heart function.
Chronic heart failure in children
If you have chronic heart failure, children tend to lag behind in physical development, they have been anemia and underweight.Violated symptoms of the respiratory, circulatory systems of the central and peripheral character.
When viewed such children pallor due to centralization of blood circulation and anemia.It is these children's symptoms are different chronic heart failure from this disease in adults who have very often observed acrocyanosis and compensatory polycythemia properties.
characteristic symptoms of chronic heart failure in children are: sleep disorders caused by anxiety and irritability.A circulatory failure characterized by signs of anorexia, nausea, vomiting, and in rare cases - abdominal pain.
One of the earliest signs of chronic heart failure is shortness of breath in children, depending on the degree of hemodynamic disorders.The cause of labored breathing is a stagnation in the vessels of the ICC, as well as impaired gas exchange in the lungs.Thus, in the blood of the child as a result of these violations accumulated lactic acid, increases the content of carbon dioxide, the pH is reduced and this leads to the stimulation of the respiratory center with decreased oxygen capacity of the blood.
At the beginning of the chronic heart failure, in a first step, all of these processes may occur if a certain physical strain.But already at the later stages, blood stagnation in the IWC is stable and pronounced, so sick children, taking a horizontal position, start to breathe heavily and is difficult, due to venous return to the heart.Cupping or decrease at the beginning of pathology achieved the transition to a sitting position.
orthopnoea characterized by circulatory failure, the left ventricle.When connecting and progression of RV failure is sometimes the symptom is reduced as a result of reduced ability to pump blood into the right ventricle, and reduced congestion in the IWC.But the formation of sclerotic changes in the pulmonary vessels and stagnation in the ICC are considered the main causes of shortness of breath later stages of the pathological process.In addition, children with this anomaly in the impaired function of the left departments of heart develops cardiac asthma, then possible and pulmonary edema.
primarily in chronic heart failure in patients with cyanotic child marked skin condition with characteristic venous and arterial cyanosis.This is due to a quantitative increase in the blood content of reduced hemoglobin.Peripheral cyanosis (acrocyanosis) is characterized by cyanosis of the hands, feet, the outer surface of the cheeks, nose and lips.The reason is the lack of blood cyanosis delivery of blood in the pulmonary capillaries in respiratory diseases, congestive processes in the ICC or by mixing blood from the veins and arteries in congenital heart defects blue.In this case, cyanosis is localized on the body, mucous membranes, limbs, tongue and face, which is gaining momentum, when the child is crying, screaming, eating, as well as loads of other physical and emotional.
appearance of edema in children indicates chronic heart failure, the cause of which is the accumulation of excess fluid in the body tissues outside the cell, and sodium, as a consequence of the reduced cardiac volume.In the earliest period of the disease is almost hidden and edema fluid is retained in the child's body imperceptible by visual inspection.Identification of this symptom, perhaps by controlling the body weight of the patient.
With the progression of disease, edema appear on the ankles, legs, lower back, but this is very rare in children.However, to exclude this feature is also impossible.In babies and infants puffiness around the eye area is fixed, the sacrum, the scrotum and perineum.They are then applied to localized subcutaneous layer, serous cavities, with the abdominal cavity covered before pleural.Swelling associated with FLL develop later than reveal hepatomegaly.At the same time they are quite extensive, dense and with ulcer symptoms.But those swellings caused by a decreased contractile function of the left ventricle, soft, very mobile with pale skin over them.
hepatomegaly is one of the leading clinical sign of lack of work right heart.Later it formed ascites.
comprehensive assessment of hemodynamics occurring within the heart, based on clinical and radiological findings, invasive methods of diagnosis, electrocardiogram, PCG with symptoms of impaired blood flow allows you to put this diagnosis as chronic heart failure, considering the etiology and pathogenesis of the disease.Without all this, it is impossible to identify and assign the optimal treatment of the child, and then to stabilize the circulatory disorders.
Chronic heart failure diagnosis
This pathological condition is a consequence of many diseases SSSand it is considered the most frequent cause of hospitalization of patients, their disability and death.Thus, to reduce these indicators, in particular, death, and timely appointment of qualified treatment is necessary to conduct proper diagnosis.
Usually, the diagnosis of chronic heart failure is not based only on clinical symptoms and signs, which can not be objective enough to make a diagnosis.And this requires methods of instrumental examination that objectively prove a serious change of heart and myocardial dysfunction in confirming the diagnosis.Thus, these two criteria, characteristic symptoms and objective evidence, are the basis in making a diagnosis of chronic heart failure.
Symptoms of the disease can be determined and at rest and during exercise.But objective evidence of cardiac abnormalities only going alone.Under certain doubts used to confirm the diagnosis positive for the therapeutic use of diuretics.
At the time of diagnosis is necessary to determine the cause of the disease, the patient's age and comorbidities that provoke the process of decompensation and progression of chronic heart failure.The most frequent reasons contributing to the formation of the disease include myocardial infarction and coronary heart disease.In other etiological group includes: dilated cardiomyopathy and heart defects rheumatic.Thus, patients with chronic heart failure are mostly after the age of sixty years.
addition, carry out various methods of laboratory examination, which determines the gas and electrolyte composition of blood, the balance of acid and alkali ratios indicators proteins, carbohydrates, creatinine, urea and enzymes cardiospecific character.
Electrocardiographic examination reveals hypertrophy of myocardial ischemia and its arrhythmic changes.It uses on the basis of various ECG tests as veloergometry and treadmill test.With their help, find out the spare capacities in the work of the heart.
Through echocardiography establish the cause of which contributed to the development of chronic heart failure.In addition, this diagnostic method determines whether the heart muscle can cope with the pumping function.Application of MRI to successfully diagnose coronary artery disease, defects of different etiology, hypertension, and others.
X-ray examination of the lungs helps to identify the stagnation of blood in the vessels of the IWC and cardiomegaly.Also used ventriculography that more accurately assesses ventricular contractile function and determine their volume.
to diagnose severe forms of the pathological process to determine the associated lesions, administered ultrasound of the pancreas, spleen, liver and abdominal cavity.
Chronic heart failure treatment
All methods of therapeutic treatment of chronic heart failure consists of a set of measures aimed at creating the necessary conditions in the home, contributing to a rapid reduction in the load on the SSS, as well as the use of drugs aimedhelping run infarction and influence the processes of broken water-salt metabolism.Assigning the volume of medical activities related to the stage of development of the disease.
The first patients are advised to observe proper diet and limited exercise.
At the first stage of chronic heart failure contraindications to physical activity does not exist.Even allowed to physically hard work, which includes exercise without stress.
For the second stage, characterized by exclusion athletic training and physical work.In this case it is recommended to reduce the time in time and enter an extra day to rest.
patients with third stage of chronic heart failure shows stay on the home mode, and progressive symptoms when prescribed mode polupostelnogo character with enough sleep at least eight hours per day.
also in chronic heart failure limit the use of the second stage daily dosage of common salt is not more than three grams per day.And the third stage - salt-free diet in which the presence of salts of about a gram.In addition, patients with this diagnosis completely eliminate alcohol intake, strong tea and coffee, that is, means that excite the heart work.
use of drug therapy aimed at enhancing the contractile function and excretion of excess water and ions Na.