about the project
Medical news
For authors
Licensed books on medicine
<< Previous Next >>

Chronic heart failure

Pathogenesis. Basic concepts:

• Preload. This is the degree of diastolic filling of the left ventricle, determined by the venous return of blood to the heart, pressure in the pulmonary circulation. The most appropriate level of preload reflects the final diastolic pressure in the pulmonary artery (KDLA).

• Afterload - systolic myocardial tension required to expel blood. Practically, afterload is judged by the level of intra-aortic pressure, total peripheral resistance.

• Frank-Starling Law: an increase in the diastolic tension of the myocardial fibers (the equivalent is the final diastolic pressure in the cavity of the left ventricle - CEDAW) up to a certain point is accompanied by an increase in its contractility, an increase in cardiac output (ascending knee curve). With further stretching of the heart into the diastole, the ejection remains the same (does not increase) - the plateau of the curve; if the extension into the diastole increases even more, exceeding 150% of the initial length of the muscle fibers, then the cardiac output decreases (the descending knee of the curve). In heart failure, the heart operates in the “plateau” or “descending knee” mode of the Frank-Starling curve.

The main “starting point” of heart failure is a decrease in systolic volume (the equivalent is the ejection fraction of the left ventricle), an increase in the final diastolic pressure in the left ventricle (CEDAW). Further events are illustrated by schemes 6 and 7.

It is seen that the “launch” of the neurohumoral module begins with an increase in pressure in the left atrium and in the pulmonary veins. Stimulation of baroreceptors leads to irritation of the vasomotor center, the release of catecholamines. A decrease in renal blood flow is the reason for the increase in renin secretion. Angiotensin-2 causes vasoconstriction, increased secretion of aldosterone, hypersympathicotonia. Hyperaldosteronism is the cause of Na ° delay and an increase in circulating blood volume. Compensatory factors (see Scheme 6) are powerless before renin-angiotensin-aldosterone (RAA) activity. An increase in post- and preload contributes to a decrease in systolic ejection. This starts a vicious cycle of heart failure.

Based on the leading pathogenetic mechanism, N.M. Mukharlyamov distinguished:

• heart failure due to volume overload (diastolic overload of the left ventricle) with aortic and mitral insufficiency, defects of the heart walls, open ductus arteriosus;

due to resistance overload (hypertension of the large or small circle, stenosis of the aorta, pulmonary artery);

• primary myocardial form in dilated cardiomyopathy, myocarditis, myocardial infarction, post-infarction cardiosclerosis;

• heart failure due to impaired filling of the ventricles with hypertrophic cardiomyopathy, “hypertensive heart” with its expressed hypertrophy without dilatation, pericardial mitral stenosis;

• conditions with high cardiac output, when tissues require a greater amount of oxygen than actually delivered. This situation is possible with thyrotoxicosis, severe anemia, obesity.

Clinic, classification. The leading symptoms of left ventricular heart failure: shortness of breath, tachycardia, weakness; right ventricular failure - swelling of the cervical veins, enlarged liver, swelling of the lower extremities.

Features of additional methods:

• resting ECG clarifies the presence or absence of post-infarction scars, "diffuse" changes, tachycardia, arrhythmias and heart block;

• X-ray examination informs about the size of the heart chambers, helps to clarify the nature of valvular or congenital malformation, the presence and severity of stagnation in the pulmonary circulation;

• echo cardiographic method gives information about the thickness of the myocardium of the atria and ventricles, the main parameters of the violation of the contractile function of the myocardium.
The most important parameter is the ejection fraction of the left ventricle, which normally is 65-80%.

The classification of chronic heart failure is based on patient tolerance of physical activity.

N.D. Strazhesko, V.Kh. Vasilenko (1935) identified three stages:

• 1 stage (initial). At rest, there are no signs of heart failure. With physical exertion, shortness of breath, tachycardia, increased fatigue appear.

• 2 A stage. Dyspnea, tachycardia at rest (with left ventricular left) or enlarged liver, swelling of the legs (with right ventricular failure) - monoventricular heart failure.

• 2 B stage. Shortness of breath, tachycardia at rest; enlarged liver, swelling of the legs, sometimes ascites, hydrothorax. Biventricular heart failure.

• Stage 3 (terminal, dystrophic). Severe biventricular heart failure, irreversible organ changes (cardiogenic cirrhosis, cardiogenic pneumosclerosis, encephalopathy, pluriglandular endocrine insufficiency).

In Europe and America, the classification of the Cardiology Association of New York (NYHA), adopted in 1964, is used.

• 1st functional class (f. Cl.). A patient with heart disease without significant limitation of physical activity. Normal physical activity does not cause premature fatigue, shortness of breath, tachycardia. The diagnosis is made using instrumental research methods using stress tests.

• 2nd f. class A patient with a moderate restriction of physical activity. At rest, there are no complaints, normal physical activity leads to shortness of breath, tachycardia.

• 3rd f. class A patient with a pronounced limitation of physical activity satisfactorily feels at rest. Fatigue, shortness of breath and tachycardia with minimal exertion.

• 4th f. class Symptoms of biventricular heart failure at rest.

A general practitioner and a community therapist can use any of these classifications. It is important that the diagnosis is dynamic and reflects what the doctor managed to achieve during treatment. Chronic heart failure reduces the patient's quality of life (WO Spitzer; PA Li-bis, Ya.I. Kots). The decrease in the quality of life index is due to the need to be treated, the restriction of physical activity, the change in relationships with relatives, friends and colleagues, the restriction of labor activity, the decrease in incomes, demotion, restrictions on leisure activities, decreased activity in everyday life, and restrictions on nutrition and sex life.

Hence the psychological problems that result, depending on the basic structure of the personality, in asthenic, astheno-neurotic, hypochondriacal and other syndromes. A typology of the patient’s attitude to the disease is being formed, which is reflected in the rubric “psychological status”. Knowledge of the social status of the patient is necessary to develop a treatment strategy that is adequate to the capabilities of a particular patient and his family.

Diagnostic wording.

• IHD: post-infarction cardiosclerosis.

Chronic heart failure 2 A Art. (3 f. C.) with the transformation into the 1st art. (2 F. cl.). Astheno-neurotic syndrome, moderate.

• Rheumatism, inactive phase. Combined mitral defect with a predominance of stenosis of the left atrioventricular opening. Atrial fibrillation, tachysystolic form. Chronic heart failure 2 B Art. (4 f. Cl.) With transformation into the 2nd A art. (3 f. Cl.). Astheno-depressive syndrome, moderate.

• Dilated cardiomyopathy. Complex disturbance of rhythm and conduction: atrial fibrillation, tachysystolic form, polytopic ventricular extrasystole, blockade of the right bundle branch block. Chronic heart failure 2 B Art. (4 f. Cl.), Refractory. Astheno-hypochondria syndrome.
<< Previous Next >>
= Skip to textbook content =

Chronic heart failure

    Attempts to give a full definition of this condition have been undertaken for several decades. With the development of medical science, ideas about the nature of heart failure, about the causes leading to its development, pathogenetic mechanisms, processes occurring in the heart muscle itself and various organs and tissues of the body in conditions of inadequate blood supply have changed
  2. Chronic heart failure
    Chronic heart failure is a pathological condition characterized by the gradual development of a mismatch in the amount of blood ejected from the heart to the needs of the body, as well as the resulting retention of sodium and water, leading to central and / or peripheral edema. ETIOLOGY. Among the causes of chronic heart failure in children, the most important are congenital
    Chronic heart failure is a syndrome that develops with various cardiovascular diseases and leads to the inability of the heart muscle to provide normal blood circulation. This disease in cats often contributes to a lack of taurine. More often the disease occurs in cats than in cats. Symptoms: shortness of breath, fatigue, tachycardia, cough, swelling, ascites, partial paralysis of the back
  4. Chronic systolic heart failure
    In the most common diseases associated with primary damage or chronic overload of the left ventricle (CHD, post-infarction cardiosclerosis), clinical signs of chronic left ventricular failure, pulmonary arterial hypertension, and right ventricular failure progressively develop. At certain stages of cardiac decompensation, signs begin to appear.
  5. Chronic Diastolic Heart Failure
    DEFINITION Diastolic heart failure is a heart failure with normal or slightly reduced contractile function of the left ventricle, but with a pronounced violation of its diastolic relaxation and filling, which is accompanied by an increase in end-diastolic pressure in the ventricle, stagnation of blood in the pulmonary circulation and other signs of heart failure. This form of heart failure occurs in 20-30% of patients with clinical signs.
  6. Classification of Chronic Heart Failure
    In the Russian Federation, two classifications of chronic heart failure are used, which significantly complement each other. One of them, created by N.D. Strazhesko and V.Kh. Vasilenko with the participation of G.F. Langa and approved at the XII All-Union Congress of Therapists (1935), is based on functional-morphological principles for assessing the dynamics of clinical manifestations of heart failure (table 48). The classification is given with modern additions N.M.
    Tasks: - eliminating the symptoms of heart failure - slowing the progression of the disease - reducing the number of hospitalizations - improving the prognosis. Ways to achieve the objectives: - regimen - diet - regimen of physical activity - psychological rehabilitation - smoking cessation - vaccination against influenza, hepatitis B - drug treatment Diet:
  8. LECTURE No. 5. Chronic heart failure in children. Clinic, diagnosis, treatment
    Heart failure is a condition in which the heart, despite a sufficient flow of blood, does not provide the body with a need for blood supply. Causes of chronic circulatory failure: direct effect on the myocardium (toxic, infectious, traumatic), cardiovascular disease. Classification. Classification of chronic heart failure (according to
  9. Examination of the workability of patients with chronic heart failure
    When considering the issues of disability in patients with chronic heart failure, it is necessary to take into account that this syndrome complex is the final stage of the development of IHD. Even with an insignificant and moderate degree of severity (I and 2 FC according to NYHA), mortality during the year in patients with coronary artery disease is 10–20%, and with severe and severe disorders (3 and 4 FC according to NYHA)
  11. Chronic Heart Failure Syndrome - CHF
    CHF is a pathological condition in which the cardiovascular system does not deliver the necessary amount of blood, and, consequently, oxygen, to organs and tissues, first with increased physical and emotional stress, and then at rest. Leading symptoms: - tachycardia; - shortness of breath; - swelling; - cyanosis (acrocyanosis); - hepatomegaly. Etiology. Causes of CHF: - defeat
  12. The main manifestations in the oral cavity of chronic insufficiency of the cardiovascular system
    In patients with chronic insufficiency of the cardiovascular system, cyanosis of the mucous membrane of the soft palate, tongue, and oral cavity is noted. Patients with chronic cardiovascular insufficiency II - III degree often suffer from ulcerative necrotic processes in the oral cavity. Ulcers on the oral mucosa do not have a specific location. They usually hit everyone
  13. Reconstructive treatment of patients with chronic heart failure
    Useful dosed physiotherapy exercises, jogging in the morning, walks in the fresh air. When performing a standard load on a bicycle ergometer, in trained men, the volume of coronary blood flow is almost 2 times less than that of untrained men, respectively, 2 times less and myocardial oxygen demand. With an increase in the level of fitness, myocardial oxygen demand decreases as in a state
  14. Chronic glomerulonephritis in children. Acute and chronic renal failure
    Questions for repetition: 1. Samples used to study the functional state of the kidneys. Test questions: 1. Definition, etiopathogenesis of chronic glomerulonephritis. 2. Classification of chronic glomerulonephritis. 3. The clinical picture and laboratory diagnosis of various forms of chronic glomerulonephritis. 4. Differential diagnosis of chronic glomerulonephritis. 5. A kidney biopsy,
  15. Heart failure
    ICD code: 150 150.0 Congestive heart failure 150.1 Left ventricular failure 150.9 Heart failure, unspecified. Heart failure is divided into acute and chronic, right and left ventricular. Currently, the term “heart failure” usually refers to chronic heart failure, more often left ventricular (Table 32). This
  16. Heart failure in children
    Heart failure is a pathological condition that develops in connection with heart failure as a pump that provides adequate blood circulation, i.e. when the heart is not able to pump as much blood as the body needs, or when it is unable to transfer venous return to an adequate cardiac output. Based on the classification of heart failure
  17. Heart failure in children
    Questions for repetition: 1. Cardiac glycosides and their characteristics. Test questions: 1. Etiopathogenesis of heart failure. 2. Classification of heart failure. 3. Clinic and diagnosis of acute and chronic heart failure. Features of heart failure in young children. 4. Therapy of heart failure: 4.1. rational treatment regimen. 4.2. healing
  18. Heart failure
    Definition Heart failure is a condition in which the circulatory system is not able to deliver arterial blood to organs and tissues in an amount adequate to the metabolic demand. Statistics. Heart failure accounts for 1-2% of all causes of patients seeking medical attention (Yu.N. Belenkov, F.T. Ageev, 1999). This problem is especially relevant for patients of older age groups.
Medical portal "MedguideBook" © 2014-2019