Causes and classification of chronic heart failure

Chronic heart failure is the most common cause of death in people over 60 years of age.

Only half of patients live more than three years after diagnosis. There are also many unpleasant symptoms (shortness of breath, tachycardia, edema) that impair the quality of daily life.

CHF is a condition in which the main function of the heart, pumping blood, is disrupted. Pathology is caused by damage to the heart muscle and an imbalance in the systems that ensure the functioning of the cardiovascular system.

Symptoms of pathology

Here's how these symptoms appear:

Tachycardia is a symptom that almost always accompanies patients with heart failure. A characteristic feature of tachycardia is an increase in the number of heart contractions. This condition occurs in the initial stages of the disease during physical exertion, and in the future it can disturb the patient at rest.

Shortness of breath is one of the first signs of heart failure. A feature of this symptom is a feeling of lack of air, similar to suffocation. Patients change the frequency and depth of breathing. Shortness of breath may be accompanied by cough, which occurs due to the expansion of the left atrium. Shortness of breath has a complex pathogenesis. Blood stagnates in the pulmonary circulation, therefore:

• respiratory function is impaired;
• lactic acid and carbon dioxide accumulate in the blood.

This leads to an increase in the acidity of the body. At first, shortness of breath occurs during physical exertion, and later even minor efforts, such as a few steps, can cause it. When lying down, shortness of breath may increase, and when a person sits down, breathing becomes easier. Therefore, people who often experience shortness of breath usually sleep on high pillows in a semi-sitting position. Shortness of breath with CHF can also occur at night. The patient is disturbed by attacks of suffocation. This condition is called cardiac asthma. Shortness of breath can cause pulmonary edema.

With this disease:

• blood accumulates in the lungs;
• it begins to pass from the vessels into the tissues and respiratory tract;
• as a result, the lungs gradually fill with fluid.

Shortness of breath can also be accompanied by severe fatigue, cyanosis of the lips and limbs.

Edema occurs due to the fact that fluid stagnates in the body. There are several features of this symptom:

• Both legs swell equally.
• Edema can develop over several weeks or even months.
• When pressing on the edema, a dent is formed, which gradually disappears.
• Edema can occur on the arms, legs, lower back.
• Edema is dense to the touch.

If edema occurs in the abdomen, then the liver enlarges. If at the beginning of the development of the disease, edema occurs only in the evening and usually in the feet, then in chronic heart failure, edema already exists all the time. The limbs swell more in the evening, and the renal swelling is more pronounced in the morning. With a severe degree of the disease, such signs can occur throughout the body. Edema occurs because not only the subcutaneous tissue begins to accumulate fluid, but also the internal organs. Edema can occur in the liver, pleural and abdominal cavities.

It has signs like:

• digestive disorders;
• enlargement of the abdomen;
• malfunctions of the kidneys.

Edema also leads to an increase in body weight.

Dyspepsia is a symptom of digestive problems. Violation of blood circulation in the liver and gastrointestinal tract leads to the development of:

• constipation;
• flatulence;
• nausea;
• pain in the stomach.

Chronic heart failure leads to impaired kidney function. They cannot remove fluid from the body, so very little urine is produced. At night, the urge to urinate may increase.

Signs of the disease are also depression and emotional disorders. The severity of depression depends on how much fatigue the patient has. If chronic heart failure leads to impaired cerebral circulation, this is evidenced by such signs as frequent headaches, memory problems, psychosis and confusion.

Etiology of CHF

In people over 60 years of age, the etiology of the disease also includes arterial hypertension. Age-related changes in the heart muscle also increase the chances of developing the disease. So, over the years, the muscle element decreases, fibrous tissue forms in the myocardium. Another important cause of pathology is diabetes mellitus.

In Europe and Russia, studies were conducted that revealed that in 60% of patients the disease develops due to myocardial ischemia. Also, after a myocardial infarction, the risk of developing the disease increases six times.

The etiology of chronic heart failure is divided into several groups:

1. Deterioration of the heart muscle.
2. Overloading of the myocardium as a result of a violation of the movement of blood through the vessels.
3. Diastolic disorders of the ventricles.
4. Combination of myocardial overload and diastolic disturbance.

The division into groups makes it possible to understand that the etiology of heart failure is presented quite clearly. Although sometimes the etiology of disorders in the myocardium is not associated with the disease.

The etiology of heart failure can combine several factors in people in their 70s and 80s.

The etiology of the disease is directly related to external factors. Their elimination can stop the development of heart failure and significantly prolong a person's life. Unlike diseases that contribute to the development of CHF, external factors in themselves do not cause pathology, they only contribute to its development due to a decrease in compensatory capabilities.

The etiology of chronic heart failure is quite complex. Therefore, its consideration can result in the study of the course of cardiology.

Pathogenesis

The pathogenesis of CHF has been studied for centuries. Previously, he had the disadvantage that cardiologists were studying certain aspects of this phenomenon. But over the years, pathogenesis has been studied in more detail and revealed that several systems are involved in the development of the disease at once. The modern pathogenesis of the disease proves that, regardless of the etiology of damage, neurohormonal systems are activated in the process of pathology development. This has a major impact on the pathogenesis of the disease.

The pathogenesis of this disease is a combination of several processes that serve as a trigger and contribute to the progression of the disease.

This:

1. Overload by volume and pressure.
2. Reducing the size of the myocardium as a result of various heart diseases.

The causes of chronic heart failure and pathogenesis continue to be studied in order to find more effective treatments for the disease.

Disease classification

The New York Heart Association identifies four stages in the development of the disease, depending on how the patient can tolerate physical activity. This classification is also recommended by the World Health Organization.

Classification will only help doctors if it is not too complicated or confusing. It should be easily perceived, although its principles cause a lot of controversy. The main classification of heart failure, which divides it into four stages, was adopted in 1964 and is successfully used throughout the world.

There are such stages of the development of the disease:

• First. In the first stage, the patient may not be aware of the presence of the disease. He leads a normal life, and during physical exertion he may feel slight discomfort. At rest, there are no symptoms.
• Second A. This stage is characterized by more serious damage to the heart than the first. The patient begins to notice the first signs of the disease. Most often it is shortness of breath.
• Second B. At this stage, the heart is seriously damaged. Congestive processes began in the large and small circles of blood circulation. Often, patients at this stage show all the signs of the disease.
• Third. The name of this stage is final. Irreversible processes began in the heart and internal organs, which in most cases lead to the death of patients.

The classification of the disease determines not only the ability of patients to endure physical activity, but also shows how damaged the functions of all organs are.

Diagnosis of CHF

First of all, the suspicion of chronic heart failure syndrome falls on people who have had a heart attack or suffer from any disorders of the heart.

Clinical diagnosis consists in examining and questioning the patient. The doctor collects an anamnesis, finds out what drugs the patient has taken or is currently taking, and asks for complaints.

Laboratory diagnosis consists of a blood and urine test. In some cases, daily diuresis is performed, that is, they determine how much urine is formed per day. Such a diagnosis provides information about the degree of development of the disease.

Instrumental diagnostics consists in the appointment:

1. Electrocardiograms. It provides information on the severity of the disease based on cardiac conduction disorders, ventricular hypertrophy and other pathological changes that can be found on the ECG.
2. Another common diagnosis is Doppler echocardiography. This study allows the doctor to see the heart on the monitor screen, evaluate its work, and obtain information about the degree of myocardial dysfunction.
3. A chest x-ray allows you to find out if there are any pathological changes in the lungs.
4. An abdominal ultrasound may be ordered to check the condition of the liver and abdomen.
5. At a severe stage of the disease, an MRI of the heart and coronography may be prescribed. These methods provide more accurate information about the state of the heart and blood vessels.

Pathology therapy

Treatment of chronic heart failure is based on the following principles:

• Minimize the symptoms of the disease.
• Protection of internal organs from possible damage.
• Improving the patient's well-being.
• Life extension.
• Reduced need for frequent hospitalization.

Resynchronization therapy is a high-tech operation, which consists in program stimulation of the heart. This procedure improves the patient's quality of life. Resynchronization therapy is prescribed when drug treatment ceases to produce results.

Medical treatment

The principles of such treatment are based on the use of drugs, the effectiveness and safety of which have been proven by numerous studies. All drugs are divided into basic, auxiliary and additional.

The main drug group includes:

1. Angiotensin-converting enzyme inhibitors. These drugs are prescribed to all patients with CHF, regardless of the stage and degree of development of the disease. They significantly slow down the progression of pathology. They are even used to treat children.
2. Angiotensin receptor antagonists. They are prescribed to people who do not tolerate ACE drugs or in combination with them.
3. Beta blockers. The drugs have antiarrhythmic properties. They control blood pressure and pulse, but are not suitable for treating children.
4. Diuretics. Assign to get rid of edema in children and adults, with enlarged liver and congestion in the lungs. For children, use the minimum dose of the drug. This reduces the risk of complications.
5. cardiac glucosides. Herbal preparations that strengthen the heart. For the treatment of children, they are prescribed in combination with diuretics.
6. Peripheral vasodilators are prescribed for the treatment of children.

Additional medications include:

1. Statins. These drugs are necessary to prevent the deposition of fats inside the vessels of the liver, as they close the lumen and disrupt blood circulation. They are prescribed if the disease caused ischemia.
2. Indirect anticoagulants. They prevent the formation of blood clots. Assign if there is a risk of thromboembolism.

In special cases, if the disease is complicated by other clinical processes, auxiliary drugs may be prescribed. For example, nitrates to reduce pain and eliminate an angina attack, antiplatelet agents to worsen blood clotting, and others.

All drugs should be taken only under medical supervision.

Non-drug methods

With CHF in children and adults, a special diet and correction of the daily regimen are prescribed. The main condition for proper nutrition is to reduce salt intake, as it contributes to the development of edema. Food should be light and contain all the nutrients the body needs.

For children and adults with chronic heart failure, there is no need to completely abandon physical activity. The main thing is to correctly calculate the intensity of the loads depending on the degree of development of the disease. Especially recommend running, swimming, cycling.

In this state, it is dangerous to be in a humid climate and intense heat, as well as highlands.

During the treatment of children and adult patients, psychological rehabilitation is also necessary. Any stress can worsen the patient's condition and cause complications, so this should be avoided.

In severe CHF, a heart transplant may be needed. But this method does not give a 100% guarantee of recovery. The body may reject the transplanted heart, or the donor organ will not function well, which is difficult to treat. In addition, it is very difficult to obtain a donor heart and such treatment is expensive.

The effectiveness of treatment increases the nursing process in chronic heart failure. This method is necessary due to the fact that patient care has its drawbacks. The nurse receives information about the doctor's prescriptions and makes sure that the patient strictly adheres to them. This extra care is especially necessary for the elderly.

Complications of CHF

Chronic heart failure can have the following complications:

1. The rhythm and conduction of the heart is disturbed.
2. With severe CHF, there is a high risk of sudden death.
3. The heart may increase in size.
4. As a result of stagnation of blood, the work of the liver is disrupted.
5. Due to circulatory disorders, the body is depleted. This can lead to weight loss and skin wounds that are difficult to treat.

Complications most often develop at the third and second B stages of the development of the disease.

The pathogenesis, etiology and therapy of CHF are very complex, so it is better to try to avoid the development of the disease. To do this, you need to lead a healthy lifestyle, play sports and regularly visit a cardiologist.