How long can you live with chronic heart failure of the first degree? Chronic heart failure HSN 4 fk prognosis treatment.

Mortality from it is almost 10 times higher than mortality from myocardial infarction, and the average life expectancy from the start of this diagnosis is 5 years, which is even worse than with some cancers. However, the development of this formidable condition can be prevented.

Our experts - Head of the Department of Myocardial Diseases and Heart Failure of the Federal State Budgetary Institution "RKNPC" of the Ministry of Health of Russia, Executive Director of the Society of Specialists in Emergency Cardiology, Doctor of Medical Sciences, Professor Sergey Tereshchenko and Leading Researcher of the Department of Myocardial Diseases and Heart Failure of the Federal State Budgetary Institution "RKNPC" of the Ministry of Health of Russia, Doctor Medical Sciences Igor Zhirov.

Experts do not get tired of repeating: with heart failure, in which cardiac output and blood supply to all organs and systems are reduced, jokes are bad. In such patients, not only the heart suffers, but also the liver, kidneys, nervous, and muscular systems. A patient with heart failure seems to be walking on the edge of the abyss: each case of decompensation (exacerbation) of heart failure brings him closer to death.

To prevent such a development of events, it is important to know that:

Heart failure is not a disease, but a complication of various diseases. First of all - arterial hypertension, coronary heart disease, heart rhythm disturbances, myocardial infarction, diabetes mellitus, heart defects and other causes, as well as their combinations. Chronic kidney disease, anemia can also lead to the development of heart failure. The earlier these diseases are identified and the sooner they are treated, the less likely a person is to develop a life-threatening condition.

The risk of developing heart failure increases with age. But, if in America and Europe the average age of those who have a similar situation is 70-89 years old, in our country it is 50-69 years old, which is largely due to late seeking medical help and low adherence of patients to the treatment prescribed by the doctor. . The impetus for exacerbation of heart failure can also be: a severe infection (pneumonia, influenza), emotional and physical stress.

The greatest danger to life are periods of exacerbation (decompensation) of heart failure, each of which damages the heart muscle, as well as the target organs mentioned above. Decompensation is characterized by worsening symptoms of heart failure, which include: shortness of breath, cough, swelling in the ankles and abdomen, fatigue, difficulty breathing when lying down, rapid weight gain (indicative of swelling), and rapid heartbeat. If these symptoms appear, as well as in case of any significant deterioration in their condition, the patient should immediately consult a doctor, and in case of severe exacerbation of heart failure, he should be hospitalized and placed in cardio intensive care.

Standards for examining patients with heart failure include: ECG, ECHO-KG, blood tests for markers of cardiovascular diseases - cardiospecific proteins, the level of which changes with various heart diseases.

Standards for the treatment of chronic heart failure include: ACE inhibitors (angiotensin-converting enzyme), beta-blockers, diuretics and aldosterone blockers. At the same time, it is important that the doctor selects the optimal doses of these drugs for this patient, which must be taken regularly, without interruptions.

In men, heart failure tends to develop earlier. However, in Russia the situation is somewhat different from the world: 60% of all hospital patients with this diagnosis are women, which is associated not only with their closer attention to their health, but also with hormonal changes during menopause, as well as with hormone replacement therapy, which with uncontrolled intake increases the risk of developing cardiovascular diseases, making them worse.

From this article you will receive comprehensive information about heart failure disease: why it develops, its stages and symptoms, how it is diagnosed and treated.

Article publication date: 12/18/2016

Date of article update: 05/25/2019

In heart failure, the heart is unable to fully cope with its function. Because of this, tissues and organs receive an insufficient amount of oxygen and nutrients.

If you have a suspicion of heart failure, do not hesitate to contact a cardiologist. If addressed at an early stage, the disease can be completely eliminated. But with heart failure of grade 2 and above, doctors usually give a not so favorable prognosis: it is unlikely that it will be completely cured, but it is possible to stop its development. If you neglect your health and do not contact specialists, the disease will progress, which can lead to death.

Why does pathology occur?

Causes of heart failure can be congenital or acquired.

Causes of congenital pathology

Causes of Acquired Heart Failure

• Chronic arterial hypertension (high blood pressure);
• vasospasm;
• stenosis (narrowing) of blood vessels or heart valves;
• endocarditis - inflammation of the inner lining of the heart;
• myocarditis - inflammation of the heart muscle;
• pericarditis - inflammation of the serous membrane of the heart;
• heart tumors;
• transferred myocardial infarction;
• metabolic disorders.

Acquired heart failure affects mainly people over 50 years of age. Also at risk are smokers and those who abuse alcohol and (or) drugs.

Often, heart failure occurs and progresses due to excessive physical activity during adolescence, when the load on the cardiovascular system is already high. To prevent heart failure, young athletes are advised to reduce the intensity of training at the age when puberty begins, and body growth is most active. If at this age the initial symptoms of heart failure appear, most likely, doctors will ban sports for 0.5–1.5 years.

Classification and symptoms

Signs of heart failure may vary in severity depending on the severity of the condition.

Classification of heart failure according to Vasilenko and Strazhesko:

Stage 1 (initial, or latent)

Symptoms appear only with intense physical activity, which was previously given without difficulty. Signs: shortness of breath, strong heartbeat. At rest, no circulatory disorders are observed.

For patients with this stage of heart failure, there are no restrictions in terms of physical activity. They can do any job. However, it is still necessary to undergo a preventive examination by a cardiologist once every six months or a year, and you may also need to take medications that support heart function.

Treatment at this stage is effective and helps to get rid of the disease.

Stage 2 A

Sports with such heart failure are prohibited, however, physical education and moderate physical activity at work are not contraindicated.

Symptoms can be eliminated with proper treatment.

Stage 2 B

Blood circulation is disturbed both in small and large circles.

All symptoms appear at rest or after minor physical exertion. This:

• cyanosis of the skin and mucous membranes,
• cough,
• dyspnea,
• wheezing in the lungs,
• limb edema,
• aching pain in the chest,
• liver enlargement.

Patients experience discomfort in the chest and shortness of breath even with the slightest physical exertion, as well as during intercourse. Walking exhausts them. Climbing up the stairs is very difficult. Such patients are usually recognized as disabled.

Treatment helps reduce symptoms and prevent further heart failure.

Stage 3 (final, or dystrophic)

Due to severe circulatory disorders, the main symptoms are aggravated. Pathological changes in internal organs also develop (cardiac cirrhosis of the liver, diffuse pneumosclerosis, congestive kidney syndrome). Metabolic disorders progress, depletion of body tissues develops.

Treatment of heart failure disease at this stage is usually already ineffective. It helps to slow down the development of changes in the internal organs, but does not entail a significant improvement in well-being.

Patients with stage 3 heart failure are not able to fully perform even household tasks (cooking, washing, cleaning). Patients are recognized as disabled.

The prognosis is poor: the disease can lead to death.

Diagnosis of heart failure

Before starting treatment, the doctor needs to find out the severity and nature of the disease.

First of all, you need to see a therapist. With the help of a stethoscope, he will listen to the lungs for wheezing, and also conduct a superficial examination to detect cyanosis of the skin. Measure heart rate and blood pressure.

Sometimes additional tests are carried out on the reaction of the heart to physical activity.

Test	Progress	Evaluation of results
20 squat test	All heart rate measurements are carried out in 1 minute. The heart rate is measured at rest in a sitting position (result No. 1 - R No. 1). The patient squats 20 times in 30 seconds. Heart rate is measured immediately after squats (P No. 2). Measure the heart rate after 1 minute (P No. 3). Then after another 2 minutes (P No. 4).	The reaction of the heart to the load: R # 2 is 25% more than R # 1 - excellent, 25-50% more - normal, 51% or more more - bad. Recovery of the heart after exercise: P # 3 is close to P # 1 - excellent, P # 4 is close to P # 1 - normal, P # 4 is greater than P # 1 - bad.
Rufier-Dixon test	All heart rate measurements are carried out in 15 seconds. The heart rate is measured after a 5-minute rest in the supine position (P1). The patient squats 30 times in 45 seconds. The heart rate is measured immediately after the load (P2) (the patient lies down after squats). Wait 30 seconds. The last time the heart rate is measured for 15 seconds.	The result is calculated by the formula: (4 * (P1 + P2 + P3) - 200) / 10 Rating: less than 3 - excellent, from 3 to 6 - good, from 7 to 9 - normal, from 10 to 14 - bad, more than 15 - very bad. In patients with tachycardia, this test may give an objectively poor result, so the first test is used.

Tests are used for patients in whom wheezing in the lungs is mild. If the tests gave poor results, the patient most likely has heart failure. If wheezing in the lungs is severe, tests are not required.

When the initial examination by the therapist is over, he gives a referral to a cardiologist who will conduct further diagnostics and prescribe treatment.

• ECG - will help to identify pathologies of the heart rhythm.
• Daily ECG (Holter mount or Holter) - electrodes are attached to the patient's body and a device is fixed on the belt that records the work of the heart for 24 hours. The patient during these days leads his normal life. Such an examination helps to more accurately fix arrhythmias if they manifest themselves in the form of seizures.
• (ultrasound of the heart) - necessary to detect structural pathologies of the heart.
• Chest x-ray. Helps to identify pathological changes in the lungs.
• Ultrasound of the liver, kidneys. If the patient has heart failure stage 2 or higher, it is necessary to diagnose these organs.

Methods for diagnosing heart pathologies

Sometimes CT or MRI of the heart, blood vessels, or other internal organs may be needed.

After receiving the results of these diagnostic methods, the cardiologist prescribes treatment. It can be either conservative or surgical.

Treatment

Medical therapy

Conservative treatment includes taking various groups of drugs:

Drug group	the effect	Examples of drugs
cardiac glycosides	Maintain and improve the contractile function of the heart muscle	Digitoxin, Digoxin, Methyldigoxin, Strofantin K
Nitrates	Relieve pain in the chest, expand the veins	Nitroglycerine
ACE inhibitors	Reduce blood pressure, dilate blood vessels, reduce the risk of cardiac arrest	Captopril, Lisinopril, Fosinopril
Beta blockers	Reduce blood pressure, slow heart rate	metoprolol, atenolol
calcium antagonists	Expand arteries, reduce pressure, eliminate arrhythmias	Verapamil, Cinnarizine, Diltiazem, Amlodipine, Nitrendipine
Diuretics	Remove excess fluid from the body, prevent the formation of edema, increase the effectiveness of drugs that reduce pressure	Spironol, Urakton, Furosemide, Aldactone
Other	Stimulate metabolism in the myocardium	ATP, Riboxin, Carnitine

Drugs for the treatment of heart failure

If a patient has grade 1 heart failure due to excessive exercise, the doctor may decide that the patient does not yet need to take serious drugs. In this case, he will prescribe only medications that improve the metabolism in the heart muscle, as well as B vitamins to strengthen the heart and blood vessels.

Surgery

For some congenital or acquired heart defects, drug treatment is ineffective. It may temporarily relieve symptoms, but does not affect the cause of the disease.

Plant	Recipe
Purple foxglove - contains the substance digitoxin	Take 1.5 tsp. (1 g) dry leaves. Pour 1 tbsp. boiling water. Insist 12 hours. Take 1 tsp. 2 times a day. Note! In no case do not exceed the dosage. Digitalis - a plant that can be poisoned! With severe heart defects, after a heart attack, with stenosis of the coronary arteries and some types of arrhythmias, it is forbidden to use foxglove! Folk remedies, like medicines, can be hazardous to health if used improperly. Be sure to consult with your doctor!
Woolly foxglove - contains digoxin, celanide
May lily of the valley - contains corglicon	Take 8-10 fresh flowers. Pour 1 tbsp. boiling water. Insist 1-2 hours. Drink throughout the day in small portions. Attention! Corglicon is contraindicated in WPW syndrome, as it causes tachycardia attacks.

Herbs for treating heart failure

Diet and lifestyle in heart failure

First of all, you should give up bad habits, if you have them. If you have heart failure of 2 degrees or higher, sports are contraindicated. Doctors recommend physiotherapy exercises, taking into account the patient's well-being.

The diet should also be adjusted:

To reduce swelling and reduce the load on the kidneys, reduce the amount of water (you can drink no more than 0.75–1 l per day).

To prevent a large amount of blood from rushing to the head, it is recommended to sleep with a large pillow under the head. And for the prevention of edema, one more pillow is needed - it is placed under the legs.

Chronic heart failure (CHF) is a condition in which the volume of blood ejected by the heart for each heartbeat decreases, that is, the pumping function of the heart decreases, as a result of which organs and tissues experience a lack of oxygen. About 15 million Russians suffer from this disease.

Depending on how quickly heart failure develops, it is divided into acute and chronic. Acute heart failure can be associated with trauma, toxins, heart disease, and can quickly be fatal if left untreated.

Chronic heart failure develops for a long time and is manifested by a complex of characteristic symptoms (shortness of breath, fatigue and decreased physical activity, edema, etc.), which are associated with inadequate perfusion of organs and tissues at rest or during exercise and often with fluid retention in the body.

We will talk about the causes of this life-threatening condition, symptoms and methods of treatment, including folk remedies, in this article.

Classification

According to the classification according to V. Kh. Vasilenko, N. D. Strazhesko, G. F. Lang, three stages are distinguished in the development of chronic heart failure:

• I st. (HI) initial or latent insufficiency, which manifests itself in the form of shortness of breath and palpitations only with significant physical exertion, which previously did not cause it. At rest, hemodynamics and organ functions are not disturbed, working capacity is somewhat reduced.
• II stage - expressed, prolonged circulatory failure, hemodynamic disturbance (stagnation in the pulmonary circulation) with little physical exertion, sometimes at rest. In this stage, there are 2 periods: period A and period B.
• H IIA stage - shortness of breath and palpitations with moderate exertion. Slight cyanosis. As a rule, circulatory insufficiency is predominantly in the pulmonary circulation: periodic dry cough, sometimes hemoptysis, manifestations of congestion in the lungs (crepitus and inaudible moist rales in the lower sections), palpitations, interruptions in the heart area. At this stage, there are initial manifestations of stagnation in the systemic circulation (small swelling in the feet and lower legs, a slight increase in the liver). By morning, these phenomena are reduced. Employability is drastically reduced.
• H IIB stage - shortness of breath at rest. All objective symptoms of heart failure increase dramatically: pronounced cyanosis, congestive changes in the lungs, prolonged aching pain, interruptions in the heart area, palpitations; signs of circulatory insufficiency in the systemic circulation, constant edema of the lower extremities and torso, enlarged dense liver (cardiac cirrhosis of the liver), hydrothorax, ascites, severe oliguria join. The patients are disabled.
• Stage III (H III) - final, degenerative stage of insufficiency In addition to hemodynamic disturbances, morphologically irreversible changes in organs develop (diffuse pneumosclerosis, cirrhosis of the liver, congestive kidney, etc.). Metabolism is disturbed, exhaustion of patients develops. Treatment is ineffective.

Depending on the phases of cardiac dysfunction are isolated:

1. Systolic heart failure (associated with a violation of systole - the period of contraction of the ventricles of the heart);
2. Diastolic heart failure (associated with a violation of diastole - a period of relaxation of the ventricles of the heart);
3. Mixed heart failure (associated with a violation of both systole and diastole).

Depending on the zones of preferential stagnation of blood secrete:

1. Right ventricular heart failure (with stagnation of blood in the pulmonary circulation, that is, in the vessels of the lungs);
2. Left ventricular heart failure (with stagnation of blood in the systemic circulation, that is, in the vessels of all organs except the lungs);
3. Biventricular (biventricular) heart failure (with stagnation of blood in both circles of blood circulation).

Depending on the physical examination results are determined by classes on the Killip scale:

• I (no signs of heart failure);
• II (mild heart failure, few wheezing);
• III (more severe heart failure, more wheezing);
• IV (cardiogenic shock, systolic blood pressure below 90 mmHg).

Mortality in people with chronic heart failure is 4-8 times higher than in their peers. Without proper and timely treatment in the stage of decompensation, the survival rate for a year is 50%, which is comparable to some oncological diseases.

Causes of chronic heart failure

Why does CHF develop, and what is it? The cause of chronic heart failure is usually damage to the heart or a violation of its ability to pump the right amount of blood through the vessels.

The main causes of the disease called:

• ischemic heart disease;
• heart defects.

There are also other precipitating factors disease development:

• cardiomyopathy - a disease of the myocardium;
• - violation of the heart rhythm;
• myocarditis - inflammation of the heart muscle (myocardium);
• cardiosclerosis - damage to the heart, which is characterized by the growth of connective tissue;
• smoking and alcohol abuse.

According to statistics, in men the most common cause of the disease is coronary heart disease. In women, this disease is caused mainly by arterial hypertension.

The mechanism of development of CHF

1. The throughput (pumping) capacity of the heart decreases - the first symptoms of the disease appear: intolerance to physical exertion, shortness of breath.
   Compensatory mechanisms are activated, aimed at maintaining the normal functioning of the heart: strengthening the heart muscle, increasing the level of adrenaline, increasing blood volume due to fluid retention.
2. Malnutrition of the heart: muscle cells became much larger, and the number of blood vessels increased slightly.
3. Compensatory mechanisms are exhausted. The work of the heart deteriorates significantly - with each push it pushes out insufficient blood.

signs

The following symptoms can be distinguished as the main signs of the disease:

1. Frequent shortness of breath - a condition when there is an impression of lack of air, so it becomes rapid and not very deep;
2. Fatigue, which is characterized by the speed of loss of strength during the performance of a particular process;
3. Ascending number of heart beats in a minute;
4. Peripheral edema, which indicate a poor removal of fluid from the body, begin to appear from the heels, and then move higher and higher to the lower back, where they stop;
5. Cough - from the very beginning of the clothes it is dry with this disease, and then sputum begins to stand out.

Chronic heart failure usually develops slowly, many people consider it a manifestation of the aging of their body. In such cases, patients often delay contacting a cardiologist until the last moment. Of course, this complicates and lengthens the treatment process.

Symptoms of chronic heart failure

The initial stages of chronic heart failure can develop according to the left and right ventricular, left and right atrial types. With a long course of the disease, there are dysfunctions of all parts of the heart. In the clinical picture, the main symptoms of chronic heart failure can be distinguished:

• fast fatiguability;
• shortness of breath, ;
• peripheral edema;
• heartbeat.

Complaints of rapid fatigue are presented by the majority of patients. The presence of this symptom is due to the following factors:

• low cardiac output;
• insufficient peripheral blood flow;
• state of tissue hypoxia;
• development of muscle weakness.

Shortness of breath in heart failure increases gradually - at first it occurs during physical exertion, then it appears with minor movements and even at rest. With decompensation of cardiac activity, the so-called cardiac asthma develops - episodes of suffocation that occur at night.

Paroxysmal (spontaneous, paroxysmal) nocturnal dyspnea can manifest itself as:

• short attacks of paroxysmal nocturnal dyspnea, passing on their own;
• typical attacks of cardiac asthma;
• acute pulmonary edema.

Cardiac asthma and pulmonary edema are essentially acute heart failure that developed against the background of chronic heart failure. Cardiac asthma usually occurs in the second half of the night, but in some cases it is provoked by physical effort or emotional excitement during the day.

1. In mild cases the attack lasts for several minutes and is characterized by a feeling of lack of air. The patient sits down, hard breathing is heard in the lungs. Sometimes this condition is accompanied by a cough with a small amount of sputum. Attacks can be rare - after a few days or weeks, but can also be repeated several times during the night.
2. In more severe cases, a severe prolonged attack of cardiac asthma develops. The patient wakes up, sits down, tilts the body forward, rests his hands on his hips or the edge of the bed. Breathing becomes rapid, deep, usually with difficulty inhaling and exhaling. Wheezing in the lungs may be absent. In some cases, bronchospasm may be associated, which increases ventilation disorders and the work of breathing.

The episodes can be so unpleasant that the patient may be afraid to go to bed, even after the symptoms have disappeared.

Diagnosis of CHF

In diagnosis, you need to start with an analysis of complaints, identifying symptoms. Patients complain of shortness of breath, fatigue, palpitations.

The doctor asks the patient:

1. How does he sleep?
2. Has the number of pillows changed in the last week?
3. Whether the person began to sleep sitting, and not lying down.

The second stage of diagnosis is physical examination, including:

1. skin examination;
2. Assessment of the severity of fat and muscle mass;
3. Checking for edema;
4. Palpation of the pulse;
5. Palpation of the liver;
6. auscultation of the lungs;
7. Auscultation of the heart (I tone, systolic murmur at the 1st auscultation point, analysis of the II tone, "gallop rhythm");
8. Weighing (a decrease in body weight by 1% in 30 days indicates the onset of cachexia).

Diagnostic goals:

1. Early detection of the presence of heart failure.
2. Clarification of the severity of the pathological process.
3. Determining the etiology of heart failure.
4. Assessment of the risk of complications and rapid progression of pathology.
5. Forecast evaluation.
6. Assessment of the likelihood of complications of the disease.
7. Monitoring the course of the disease and timely response to changes in the patient's condition.

Diagnostic tasks:

1. Objective confirmation of the presence or absence of pathological changes in the myocardium.
2. Identification of signs of heart failure: shortness of breath, fatigue, palpitations, peripheral edema, moist rales in the lungs.
3. Identification of the pathology that led to the development of chronic heart failure.
4. Determination of the stage and functional class of heart failure according to NYHA (New York Heart Association).
5. Identification of the predominant mechanism for the development of heart failure.
6. Identification of provoking causes and factors that aggravate the course of the disease.
7. Identification of concomitant diseases, assessment of their relationship with heart failure and its treatment.
8. Collecting enough objective data to prescribe the necessary treatment.
9. Identification of the presence or absence of indications for the use of surgical methods of treatment.

Diagnosis of heart failure should be made using additional examination methods:

1. The ECG usually shows signs of myocardial hypertrophy and ischemia. Quite often this research allows to reveal the accompanying arrhythmia or disturbance of conductivity.
2. An exercise test is performed to determine tolerance to it, as well as changes characteristic of coronary heart disease (ST segment deviation on the ECG from the isoline).
3. 24-hour Holter monitoring allows you to clarify the state of the heart muscle with typical patient behavior, as well as during sleep.
4. A characteristic sign of CHF is a decrease in ejection fraction, which can be easily seen with ultrasound. If you additionally conduct Dopplerography, then heart defects will become obvious, and with proper skill, you can even identify their degree.
5. Coronary angiography and ventriculography are performed to clarify the state of the coronary bed, as well as in terms of preoperative preparation for open interventions on the heart.

When diagnosing, the doctor asks the patient about complaints and tries to identify signs typical of CHF. Among the evidence for the diagnosis, the discovery of a history of heart disease in a person is important. At this stage, it is best to use an ECG or determine the natriuretic peptide. If no deviations from the norm are found, the person does not have CHF. If manifestations of myocardial damage are detected, the patient should be referred for echocardiography in order to clarify the nature of cardiac lesions, diastolic disorders, etc.

At the subsequent stages of diagnosis, doctors identify the causes of chronic heart failure, clarify the severity, reversibility of changes in order to determine adequate treatment. Additional studies may be ordered.

Complications

Patients with chronic heart failure may develop dangerous conditions such as

• frequent and protracted;
• pathological myocardial hypertrophy;
• numerous thromboembolism due to thrombosis;
• general depletion of the body;
• violation of the heart rhythm and conduction of the heart;
• dysfunction of the liver and kidneys;
• sudden death from cardiac arrest;
• thromboembolic complications (, thromboembolism of the pulmonary arteries).

Prevention of the development of complications is the use of prescribed medications, the timely determination of indications for surgical treatment, the appointment of anticoagulants according to indications, antibiotic therapy for lesions of the bronchopulmonary system.

Treatment of chronic heart failure

First of all, patients are advised to follow an appropriate diet and limit physical activity. You should completely abandon fast carbohydrates, hydrogenated fats, in particular, animal origin, and carefully monitor salt intake. You should also stop smoking and drinking alcohol immediately.

All methods of therapeutic treatment of chronic heart failure consist of a set of measures that are aimed at creating the necessary conditions in everyday life, contributing to a rapid decrease in the load on the C.S.S., as well as the use of drugs designed to help the myocardium work and influence the disturbed processes of water salt exchange. The appointment of the volume of therapeutic measures is associated with the stage of development of the disease itself.

Treatment of chronic heart failure is long-term. It includes:

1. Medical therapy aimed at combating the symptoms of the underlying disease and eliminating the causes that contribute to its development.
2. rational mode, including the restriction of labor activity according to the forms of the stages of the disease. This does not mean that the patient must always be in bed. He can move around the room, physical therapy is recommended.
3. Diet therapy. It is necessary to monitor the calorie content of food. It should correspond to the prescribed regimen of the patient. For overweight people, the calorie content of food is reduced by 30%. And patients with exhaustion, on the contrary, are prescribed enhanced nutrition. If necessary, unloading days are held.
4. Cardiotonic therapy.
5. Treatment with diuretics aimed at restoring the water-salt and acid-base balance.

Patients with the first stage are fully able-bodied, with the second stage there is a limited ability to work or it is completely lost. But in the third stage, patients with chronic heart failure need permanent care.

Medical treatment

Drug treatment of chronic heart failure is aimed at improving the functions of contraction and ridding the body of excess fluid. Depending on the stage and severity of symptoms in heart failure, the following groups of drugs are prescribed:

1. Vasodilators and ACE inhibitors- angiotensin-converting enzyme (, ramipril) - lower vascular tone, dilate veins and arteries, thereby reducing vascular resistance during heart contractions and contributing to an increase in cardiac output;
2. Cardiac glycosides (digoxin, strophanthin, etc.)- increase myocardial contractility, increase its pumping function and diuresis, contribute to satisfactory exercise tolerance;
3. Nitrates (nitroglycerin, nitrong, sustak, etc.)- improve blood supply to the ventricles, increase cardiac output, dilate the coronary arteries;
4. Diuretics (, spironolactone)- reduce the retention of excess fluid in the body;
5. Β-blockers ()- reduce heart rate, improve blood supply to the heart, increase cardiac output;
6. Drugs that improve myocardial metabolism(vitamins of group B, ascorbic acid, riboxin, potassium preparations);
7. Anticoagulants ( , )- prevent thrombosis in the vessels.

Monotherapy in the treatment of CHF is rarely used, and only ACE inhibitors can be used in this capacity in the initial stages of CHF.

Triple therapy (ACE inhibitor + diuretic + glycoside) - was the standard in the treatment of CHF in the 80s, and now remains an effective regimen in the treatment of CHF, however, for patients with sinus rhythm, it is recommended to replace the glycoside with a beta-blocker. The gold standard from the early 90s to the present is a combination of four drugs - ACE inhibitor + diuretic + glycoside + beta-blocker.

Prevention and prognosis

To prevent heart failure, proper nutrition, sufficient physical activity, and the rejection of bad habits are necessary. All diseases of the cardiovascular system must be detected and treated in a timely manner.

The prognosis in the absence of CHF treatment is unfavorable, since most heart diseases lead to wear and tear and the development of severe complications. When conducting medical and / or cardiac surgical treatment, the prognosis is favorable, because there is a slowdown in the progression of insufficiency or a radical cure for the underlying disease.

For citation: Mareev V.Yu., Danielyan M.O., Belenkov Yu.N. Influence of therapy on the prognosis and survival of patients with chronic heart failure // RMJ. 1999. No. 2. S. 9

Treatment of patients with chronic heart failure (CHF), in addition to eliminating the symptoms of decompensation and improving the quality of life, should ideally be aimed at improving the prognosis and prolonging the life of patients. This is especially important, since CHF syndrome has an unfavorable course and leads most patients to death within a few years. Approximate annual mortality rates are 10-12% in FC I, 20-25% in FC II, up to 40% in FC III, and up to 66% in the most severe FC IV. According to the Framingham Study, the median 5-year survival rate for men was 38% and for women, 58%. And this despite the fact that the analysis included all patients, most of whom had initial signs of CHF.

Mortality in patients with severe CHF is comparable to mortality from complicated lung cancer. According to V.V. Gerasimova, who analyzed the course of CHF in patients observed at the Institute of Cardiology. A.L. Myasnikov in 1977 - 1986, the 3-year survival rate of patients with CHF was only 27%. Therefore, so much attention has recently been paid to the impact of ongoing therapy on the survival of patients with CHF.
A special 16-year study of the survival of patients with CHF in two groups (1977-1986, 323 patients and 1987-1992, 141 patients) was aimed at assessing the change in the prognosis of patients in accordance with the change in views on the tactics of treating decompensation. The patients of the two groups did not differ in age (50.2 ± 13.4 years vs. 48.7 ± 12.4 years), predominance of men (67.5% vs. 3 months versus 42.3 ± 7.5 months) and the severity of FC CHF (3.58 ± 0.48 versus 3.59 ± 0.62). About half of the patients had atrial fibrillation (47.7% from 1977 to 1986 and 52.5% from 1987 to 1992), about 70% had ventricular arrhythmias (69.6% and 70, 6% respectively), the average EF was 20.2% and 20.6%, respectively.
Changes in the tactics of CHF treatment over the years of observation led to noticeable differences in the prescription of essential drugs for patients of the two groups. All patients, taking into account the severity, regularly received treatment with diuretics. Of the remaining drugs, we analyzed the dynamics of the prescription of cardiac glycosides (in our study, in 97% of cases it was digoxin), ACE inhibitors (in our group, 96% of patients were treated with captopril), negative ino- and chronotropic drugs, to which we included amiodarone and b -blockers, as well as vasodilators (in most cases, nitrates and nifedipine). The results are presented in .
Table 1. Prescription of essential drugs (in %) in patients of two groups

A drug	1977 - 1986 (n=323)	1987 - 1992 (n=141)
Digoxin	96,3	90,8
Captopril		58,2
Amiodarone	10,2	24,8
b-blockers
(-) Ino and chronotropic	11,4	34,6
Vasodilators	66,4	65,0

As seen from , the main differences were revealed in a sharp (more than 13-fold) increase in the frequency of prescription of captopril, a significant increase in the use of amiodarone, or b-blockers (3 times) and some reduction in the frequency of digoxin administration. In the last reviewed in 1992, digoxin was used in 82.1% of patients and an ACE inhibitor was used in the same percentage of patients.
Analysis of the survival curves of patients in the two groups revealed obvious differences (Fig. 1).
As can be seen from fig. 1, a significant improvement in the survival of patients treated with in 1987 - 1992 After 1 year of treatment, 33% of patients died, after 2 years - 43%, and after 3 years of observation - 53% (in the comparison group 37, 53 and 64%, respectively). The reduction in the risk of death was 20%, the divergence of the curves became significant, starting from the 39th month.
The improvement was especially pronounced in the group of patients with DCM, in which the reduction in the risk of death was 49%, the divergence of the curves was significant, starting from the 15th month. Mortality after 1, 2 and 3 years was 36, 39 and 52%, respectively, while in the group of 1977 - 1986. these figures were significantly worse (52%, 70% and 81%, respectively). However, in the group of patients with ischemic etiology of CHF, there were practically no discrepancies in survival curves and the reduction in the risk of death was only 2%. Obviously, the lethality of patients with IHD and CHF depends not only on the progression of decompensation, but also on the possible exacerbation of coronary insufficiency. Therefore, a real contribution to improving the prognosis of this category of patients can be not only a change in drug therapy, but also measures aimed at myocardial revascularization.
The analysis of the influence of each of the components of the ongoing therapy was intended to identify the "contribution" of each of the types of treatment for CHF in changing the prognosis of patients with CHF.
Digoxin. Analysis of survival in groups of patients who received and did not receive treatment with digoxin showed very small differences. The overall reduction in the risk of death was not significant and amounted to 5%. One-year mortality was 36% in both groups, two-year mortality was 49% in the digoxin group and 56% without digitalis, three-year mortality was 60 and 64%, respectively. These results were confirmed in a large multicenter placebo-controlled study DIG, which observed the effect of digoxin on the prognosis of patients with CHF and sinus rhythm (7788 patients, five years of follow-up). The results of this study confirmed that digitalis does not affect the prognosis of patients with CHF. The risk of death when using digoxin increased by 1%, which, of course, is not significant, at the same time, treatment with digoxin made it possible to significantly reduce (by 28%) the number of hospitalizations associated with exacerbation of CHF. The current view on the role of digoxin in the treatment of CHF is as follows: digitalis improves symptoms and reduces the frequency of exacerbations of decompensation, but does not improve the prognosis of patients with CHF. Especially careful should be the appointment of digoxin in patients with postinfarction cardiosclerosis with preserved sinus rhythm.
Diuretics. Special studies on the effect of diuretics on the prognosis of patients with CHF have not been conducted, since it is impossible from an ethical point of view to create a placebo group from decompensated patients with dyspnea and hyperhydration. Nevertheless, many side effects of the use of diuretics are known, which can negatively affect the prognosis of patients - activation of neurohormones and electrolyte disturbances. Therefore, the principle of prescribing diuretic drugs in patients with CHF is only according to indications, in the minimum effective doses and together with ACE inhibitors that block most of the negative reactions from the action of diuretic drugs.
ACE inhibitors. In our study, captopril was used, which has become the "gold standard" in the treatment of CHF. Analysis of survival curves was performed in groups of patients who received or did not receive treatment with captopril. The effect of prescribing the drug was expressed both in the group as a whole and in all subgroups of patients with different etiologies of CHF.
As can be seen from fig. 2, the reduction in the risk of death when using captopril was 39%, and a significant divergence of the curves was noted already 6 months after the start of treatment.
Mortality after 1, 2 and 3 years of treatment in the group treated with captopril was 24%, 31% and 46%, respectively, which is significantly lower than in patients who did not receive ACE inhibitors (39%, 54% and 64%, respectively). Captopril was the only drug we studied that significantly reduced the risk of death in patients with coronary artery disease (by 26%). In patients with DCM, the use of captopril literally changed lives - a 60% reduction in the risk of death.
There is a certain pattern in the frequency of use of ACE inhibitors and mortality in patients with CHF. Thus, in a study commissioned by the US Institute of Health in 1994, it was shown that in groups of patients with a poor prognosis (who died suddenly or from progression of CHF), the appointment of ACE inhibitors was carried out significantly less frequently than in patients who had a favorable prognosis. forecast.
Table 2. Influence of the main classes of drugs on the clinic, quality of life and prognosis of patients with CHF.

DrugPrognosis
Digitalis
Diuretic
ACE inhibitor
b-blockers*
Amiodarone*
Vasodilators*
BMKK*
Note. * - "top" (additionally) for ACE inhibitors.

However, it must be recalled that according to the modern requirements of "evidence-based medicine", it is impossible to disseminate data obtained with the use of one of the drugs to the entire group of drugs. To date, only six ACE inhibitors (captopril, enalapril, lisinopril, ramipril, trandolapril and zofenopril) have proven their positive effect on the prognosis of patients with decompensation (most of the studies are listed in articles published in this issue of the journal).
The positive effect of ACE inhibitors on the prognosis of patients with CHF was noted in almost all studies. It is this property of ACE inhibitors that has allowed them to become the "cornerstone" in the treatment of decompensation.
Preparations with negative ino- and chronotropic action. This category of drugs includes primarily b adrenoblockers and amiodarone. Questions related to application b -blockers and their influence on the prognosis of patients with CHF are discussed in detail in a special article in this issue of the journal. Our data indicate that the use b -blockers in addition to ACE inhibitors, diuretics and glycosides leads to a decrease in the risk of death of patients by 61%. As mentioned above, today b -adrenergic blockers are becoming a full-fledged fourth drug for the complex treatment of CHF.

The question of the advisability of using amiodarone in the complex therapy of CHF is less clear. The results of multicenter studies are largely contradictory. A meta-analysis of all known studies on the use of amiodarone in the complex therapy of patients with symptoms of CHF indicates the ability of this drug to reduce the risk of death by 13%. However, the final answer to the question of the usefulness and safety of the use of amiodarone in the complex therapy of CHF requires further research.
Our data indicate that amiodarone reduced the risk of death in patients with severe CHF by 34%, however, in the group of patients with ischemic etiology of heart failure, the effect of amiodarone was unreliable and the reduction in the risk of death was only 11%.
Therefore, today we can talk about the advisability of using amiodarone (or a b-blocker with class III antiarrhythmic properties - sotalol) for the treatment of patients with CHF who have life-threatening ventricular arrhythmias. It is in these cases that amiodarone (sotalol) is most likely to reduce the risk of death, mostly sudden.

Peripheral vasodilators. The question of the effect of vasodilators on the prognosis of patients with CHF is rather controversial. In an old study by J.Cohn et al. it was demonstrated that the combination of isosorbide dinitrate (nitrosorbide) with hydralazine (apressin), added to complex therapy with glycosides and diuretics, somewhat reduced the risk of death in decompensated patients. This effect, without sufficient evidence, was attributed to the positive effect of nitrate. Never again have similar results been repeated. Moreover, the same group of researchers after 5 years showed that the combination of nitrosorbide with apressin was significantly inferior in terms of its effect on the prognosis of patients to the ACE inhibitor enalapril. Our data indicate the ability of nitrates to unreliably worsen the prognosis of patients with CHF.

Given the extremely high popularity of ACE inhibitors in the treatment of CHF, the issue of prescribing vasodilators to patients with CHF in recent years has been considered only in the context of their combination with one of the ACE inhibitors. And from the point of view of our current views, such a combination should be used as rarely as possible and only for obvious indications (for example, angina pectoris attacks are significantly reduced with the use of long-acting nitrates).
Blockers of slow calcium channels. The question of the effect of calcium antagonists on the prognosis of patients with CHF is also very complicated. Unfortunately, special multicenter studies with verapamil (studies DAVIT I and DAVIT II assumed the inclusion of patients who do not have signs of decompensation), allowing to analyze its impact on the prognosis of patients with CHF, have not been conducted. With regard to diltiazem, it is known that in patients with EF less than 40% this the drug significantly accelerates the development of decompensation and, although not significantly, increases mortality from 22 to 35% (p = 0.055). There are drugs of the dihydroperidine group. A lot has been said recently about the negative properties of the short-acting form of nifedipine. On fig. 3 shows the survival curves obtained by our group for patients with ischemic etiology of CHF, treated or not treated with nifedipine.
As can be seen from fig. 3, an increased risk of death in patients with IHD and CHF who are prescribed nifedipine is noted in the first six months of treatment (the maximum divergence of the curves is recorded after 2 months of therapy). In what follows, the curves run parallel, i.e. patients who "survive" the first months of treatment with nifedipine, continue to tolerate this drug quite satisfactorily.
As is known, the main adverse reactions and complications from the appointment of blockers of slow calcium channels of the dihydroperidine group in CHF are associated with their ability to activate the neurohumoral systems of the body. The situation can be changed in two ways: by prescribing new long-acting drugs that activate neurohormones to a lesser extent, and by prescribing dihydroperidines "from above" to ACE inhibitors that block the activity of the body's neurohormonal systems.
A similar attempt was made in the PRAISE study, which successfully used amlodipine. Data from more than 1000 patients showed a non-significant reduction in the risk of death by 16%. And if in the group of patients with ischemic etiology of CHF the prognosis of patients, unfortunately, did not change, then in patients with DCM, the decrease in the risk of death with high reliability was 55%. It should be assumed that a new generation of calcium antagonists (amlodipine) may have good prospects for the treatment of CHF ("on top" of ACE inhibitors).

In conclusion, we present data on the effect of the main classes of drugs on CHF symptoms, quality of life and prognosis in patients with CHF ().
Using the presented table, you can choose the best drug for each clinical situation.
However, as is well known, the treatment of CHF is a matter of complex therapy. We identified four main types of complex therapy for CHF and assessed their impact on the life expectancy of patients with cardiac decompensation (Fig. 4).
As can be seen, the use of a combination of glycosides with diuretics, which was the "gold standard" in the 60s, provides an average life expectancy for a patient with severe CHF up to 20.5 months. The addition of vasodilators to therapy and the transition to the "gold standard" of the 70s, allows you to increase life expectancy to 24.1 months. The use of an ACE inhibitor as the third drug, which became the "gold standard" of the 1980s, makes it possible to increase the average life expectancy of patients up to 31.9 months. And, finally, the use of quadruple therapy - glycosides + diuretics + ACE inhibitors + b-blockers can increase the life expectancy of patients with CHF even more - up to 36 months. It is this combination that can be called the "gold standard" of the 1990s; its use makes it possible to optimally improve the prognosis of decompensated patients.

Literature:

1. Belenkov Yu.N., Mareev V.Yu., Ageev F.T. Drug ways to improve the prognosis of patients with chronic heart failure.// Moscow, Insight, 1997, 77 p.
2.Stevenson WG, Stewenson LW, Middlekauf HR, et al. Improving survival for patients with advanced heart failure: a study of 737 consecutive patients. J Am Coll Cardiol 1995;26:1417-23.

This is the final stage of any cardiac pathology. As with strokes, it is best to prevent heart failure from developing. Five-year survival in the presence of heart failure is comparable to some cancers.

In the vast majority of cases, heart failure is a natural outcome of many diseases of the heart and blood vessels (valvular heart disease, coronary heart disease (CHD), cardiomyopathy, arterial hypertension, etc.).

Only rarely is heart failure one of the first manifestations of a heart disease, such as dilated cardiomyopathy.

Causes of heart failure

With hypertension, it can take many years from the onset of the disease to the onset of the first symptoms of heart failure. Whereas as a result, for example, of acute myocardial infarction, accompanied by the death of a significant part of the heart muscle, this time can be several days or weeks.

In addition to cardiovascular diseases, the appearance or aggravation of manifestations of heart failure is facilitated by:

• feverish conditions;
• anemia;
• increased thyroid function (hyperthyroidism);
• alcohol abuse, etc.

Acute heart failure

Acute heart failure that develops at lightning speed (from several minutes to several hours). Its manifestations are pulmonary edema, cardiac asthma and cardiogenic shock. Acute cardiovascular failure occurs with myocardial infarction, rupture of the wall of the left ventricle, acute insufficiency of the mitral and aortic valves.

Chronic heart failure

Chronic heart failure (unlike acute heart failure) develops slowly and develops over weeks, months, or even years. The following diseases can cause chronic heart failure:

• heart disease;
• hypertonic disease;
• chronic respiratory failure;
• persistent anemia.

Heart failure symptoms

Heart failure is always associated with impaired pumping function of the heart. In the human circulatory system, there are two circles of blood circulation: large and small.

In a small circle, the blood is enriched with oxygen in the lungs, in a large circle - the nutrition of all organs and tissues. With heart failure, blood can stagnate both in each of these circles individually, and in the entire circulatory system.

The main clinical symptoms of heart failure are:

• shortness of breath (lack of air);
• swelling;
• weakness;
• dry cough;
• pain in the right hypochondrium.

Shortness of breath in heart failure

Shortness of breath is one of the first signs of stagnation of blood in the pulmonary circulation. Initially, shortness of breath manifests itself only during exertion, and then at rest, especially at night.

It should be remembered that shortness of breath can also occur with pathology of the respiratory system. The main distinguishing feature of cardiac dyspnea is its strengthening in the supine position.

This is due to the fact that in a horizontal position, the outflow of blood from the lungs is impeded and the liquid fraction of blood leaks into the lung tissue. The extreme manifestation of circulatory failure in the small circle is pulmonary edema, requiring immediate hospitalization in the intensive care unit.

Edema in heart failure

Edema is a sign of circulatory insufficiency in the systemic circulation. Initially, swelling appears on the legs, on the back of the feet and ankles. With the progression of heart failure, edema grows, rising to the thigh and even the abdomen.

An extreme manifestation of circulatory failure in a large circle is anasarca (accumulation of fluid under the skin of most of the body surface). As the symptoms of heart failure appear, ulcers and age spots may form on the legs, which are a manifestation of malnutrition of the skin in these areas.

Do not forget that with chronic venous insufficiency, edema of the lower extremities will also be observed. The doctor should understand the cause of edema after receiving the results of the examination.

Weakness in heart failure

Weakness is a non-specific symptom of heart failure associated with impaired blood supply to the muscles.

Dry cough in heart failure

Dry cough in heart failure occurs due to swelling of the lung tissue due to stagnation of blood in the pulmonary circulation. This cough should be distinguished from the cough that occurs with a cold, or as a side effect of certain drugs used in the treatment of cardiac patients. Cough in heart failure is aggravated in a horizontal position.

Pain in the right hypochondrium with heart failure

Pain in the right hypochondrium occurs with stagnation of blood in the liver. Since the shell of the liver is not extensible, the blood-filled tissue of the liver presses on it, causing dull, aching pain.

Diagnosis of heart failure

Since heart failure is a secondary syndrome that develops with known diseases, diagnostic measures should be aimed at its early detection, even in the absence of obvious signs.

When collecting a clinical history, attention should be paid to fatigue and dyspnea, as the earliest signs of heart failure; the patient has coronary artery disease, hypertension, myocardial infarction and rheumatic attack, cardiomyopathy.

Identification of edema of the legs, ascites, rapid low-amplitude pulse, listening to the III heart sound and displacement of the boundaries of the heart are specific signs of heart failure.

If heart failure is suspected, the electrolyte and gas composition of the blood, acid-base balance, urea, creatinine, cardiospecific enzymes, and indicators of protein-carbohydrate metabolism are determined.

Electrocardiography for specific changes helps to detect hypertrophy and insufficiency of blood supply (ischemia) of the myocardium, as well as arrhythmias. On the basis of electrocardiography, various stress tests are widely used using an exercise bike (bicycle ergometry) and a treadmill (treadmill).

Such tests with a gradually increasing level of load make it possible to judge the reserve capacity of the heart function. With the help of ultrasound echocardiography, it is possible to establish the cause of heart failure, as well as to evaluate the pumping function of the myocardium.

With the help of echocardiography, IHD, congenital or acquired heart defects, arterial hypertension and other diseases are successfully diagnosed. X-ray examination of the chest in heart failure determines congestive processes in the small circle, cardiomegaly.

Radioisotope ventriculography in patients with heart failure allows a high degree of accuracy to assess the contractility of the ventricles and determine their volumetric capacity.

In severe forms of heart failure, ultrasound of the liver, spleen, and pancreas is performed to determine the damage to internal organs.

Heart failure treatment

Unlike past years, at present, the achievements of modern pharmacology have made it possible not only to prolong, but also to improve the quality of life of patients with heart failure.

However, before starting medical treatment of heart failure, it is necessary to eliminate all possible factors provoking its occurrence:

Feverish conditions; anemia stress; excessive consumption of table salt; alcohol abuse; taking drugs that contribute to fluid retention in the body.

The main emphasis in the treatment of heart failure is both on the elimination of the causes of the disease and on the correction of its manifestations.

Among the general measures for the treatment of heart failure, rest should be noted. This does not mean that the patient needs to lie down all the time. Physical activity is acceptable and desirable, but it should not cause significant fatigue and discomfort.

If exercise tolerance is significantly limited, then the patient should sit as much as possible, and not lie down. In periods of absence of severe shortness of breath and edema, walks in the fresh air are recommended.

It should be remembered that the performance of physical activity in patients with heart failure should be devoid of any elements of the competition.

It is more convenient for patients with heart failure to sleep with a raised head end of the bed or on a high pillow. Patients with swelling of the legs are also recommended to sleep with a slightly raised foot end of the bed or a thin pillow placed under the legs, which helps to reduce the severity of edema.

The diet should be low in salt; cooked food should not be salted. It is very important to achieve a reduction in excess weight, as it creates a significant additional burden on a diseased heart.

Although with advanced heart failure, weight can decrease on its own. To control weight and timely detection of fluid retention in the body, daily weighing should be carried out at the same time of day.

Currently, for the treatment of heart failure, drugs are used that contribute to:

• increased myocardial contractility;
• decrease in vascular tone;
• reduce fluid retention in the body;
• elimination of sinus tachycardia;
• prevention of thrombus formation in the cavities of the heart.

Among the drugs that increase myocardial contractility, we can note the so-called cardiac glycosides (digoxin, etc.) that have been used for several centuries.

Cardiac glycosides increase the pumping function of the heart and urination (diuresis), and also contribute to better exercise tolerance. Among the main side effects observed with their overdose, I note nausea, the appearance of arrhythmias, and a change in color perception.

If in past years cardiac glycosides were prescribed to all patients with heart failure, at present they are prescribed primarily to patients with heart failure in combination with the so-called atrial fibrillation.

To drugs that lower vascular tone, include the so-called vasodilators (from the Latin words vas and dilatatio - "vasodilation"). There are vasodilators with a predominant effect on the arteries, veins, as well as mixed-action drugs (arteries + veins).

Vasodilators, which dilate the arteries, help reduce the resistance created by the arteries during cardiac contraction, resulting in an increase in cardiac output. Vasodilators, which dilate the veins, increase venous capacity.

This means that the volume of blood placed in the veins increases, as a result of which the pressure in the ventricles of the heart decreases and cardiac output increases. The combination of exposure to arterial and venous vasodilators reduces the severity of myocardial hypertrophy and the degree of dilatation of the heart cavities.

Mixed-type vasodilators include the so-called angiotensin-converting enzyme (ACE) inhibitors. Some of them:

• captopril;
• enalapril;
• perindopril;
• lisinopril;
• ramipril.

Currently, it is ACE inhibitors that are the main drugs used to treat chronic heart failure.

As a result of the action of ACE inhibitors, exercise tolerance increases significantly, blood filling of the heart and cardiac output improve, and urination increases.

The most commonly reported side effect associated with the use of all ACE inhibitors is a dry, irritating cough ("as if a brush were being tickled in the throat").

This cough does not indicate any new disease, but may disturb the patient. Cough may disappear after short-term discontinuation of the drug. But, unfortunately, it is cough that is the most common reason for stopping ACE inhibitors.

As an alternative to ACE inhibitors in the event of a cough, so-called angiotensin II receptor blockers (losartan, valsartan, etc.) are currently used.

To improve ventricular blood supply and increase cardiac output in patients with chronic heart failure in combination with coronary artery disease, nitroglycerin preparations are used, a vasodilator that mainly affects the veins.

In addition, nitroglycerin also dilates the arteries that supply the heart itself - the coronary arteries. To reduce the retention of excess fluid in the body, various diuretic drugs (diuretics) are prescribed, differing in strength and duration of action.

The so-called loop diuretics (furosemide, ethacrynic acid) begin to act very quickly after taking them. Through the use of furosemide, in particular, it is possible to get rid of several liters of fluid in a short time, especially when it is administered intravenously.

Usually the severity of the existing shortness of breath decreases right before our eyes. The main side effect of loop diuretics is a decrease in the concentration of potassium ions in the blood, which can cause weakness, convulsions, and interruptions in the work of the heart.

Therefore, simultaneously with loop diuretics, potassium preparations are prescribed, sometimes in combination with the so-called potassium-sparing diuretics (spironolactone, triamterene, etc.).

Spironolactone is often used alone in the treatment of chronic heart failure. The diuretic drugs of medium strength and duration of action used in the treatment of chronic heart failure include the so-called thiazide diuretics (hydrochlorothiazide, indapamide, etc.).

Thiazide drugs are often combined with loop diuretics to achieve a greater diuretic effect. Since thiazide diuretics, like loop diuretics, reduce the amount of potassium in the body, its correction may be required.

To reduce the heart rate, so-called (beta)-blockers are used. Due to the effect of these drugs on the heart, its blood supply improves, and, consequently, cardiac output increases.

For the treatment of chronic heart failure, an adrenergic blocker carvedilol has been created, which is initially prescribed in minimal doses, ultimately contributing to an increase in the contractile function of the heart.

Unfortunately, the side effects of some adrenergic blockers, in particular, the ability to cause bronchial constriction and increase blood glucose levels, may limit their use in patients with bronchial asthma and diabetes mellitus.

To prevent thrombosis in the chambers of the heart and the development of thromboembolism, so-called anticoagulants are prescribed, which inhibit the activity of the blood coagulation system.

The so-called indirect anticoagulants (warfarin, etc.) are usually prescribed. When using these drugs, regular monitoring of the parameters of the blood coagulation system is necessary.

This is due to the fact that with an overdose of anticoagulants, various internal and external (nasal, uterine, etc.) bleeding can occur. Treatment of an attack of acute left ventricular failure, in particular, pulmonary edema, is carried out in a hospital.

But already the doctors of the "ambulance" can introduce loop diuretics, oxygen inhalation and other urgent measures. In the hospital, the therapy started will be continued.

In particular, continuous intravenous administration of nitroglycerin, as well as drugs that increase cardiac output (dopamine, dobutamine, etc.), can be established.

Surgical treatment of heart failure

If the current arsenal of drugs used to treat chronic heart failure is ineffective, surgical treatment may be recommended.

The essence of the operation of cardiomyoplasty is that a flap is surgically cut out of the so-called latissimus dorsi muscle of the patient. Then, this flap is wrapped around the heart of the patient himself to improve the contractile function.

Subsequently, electrical stimulation of the transplanted muscle flap is performed simultaneously with contractions of the patient's heart. The effect after the operation of cardiomyoplasty appears on average after 8-12 weeks.

Another alternative is implantation (suturing) into the patient's heart of a circulatory assist device, the so-called artificial left ventricle. Such operations are expensive and rare in Russia.

And, finally, at present, special pacemakers have been created and are being used, which help to improve the blood filling of the ventricles of the heart, primarily by ensuring their synchronous work. Thus, modern medicine does not abandon attempts to intervene in the natural course of heart failure.

Prognosis for heart failure

The five-year survival threshold for patients with heart failure is 50%. The long-term prognosis is variable, it is influenced by the following factors:

• severity of heart failure;
• accompanying background;
• effectiveness of therapy;
• Lifestyle.

Treatment of heart failure in the early stages can fully compensate for the condition of patients; the worst prognosis is observed in stage III heart failure.

Prevention of heart failure

Measures to prevent heart failure is to prevent the development of the diseases that cause it (CHD, hypertension, heart defects, etc.), as well as the factors contributing to its occurrence.

In order to avoid the progression of already developed heart failure, it is necessary to comply with the optimal regimen of physical activity, taking prescribed drugs, and constant monitoring by a cardiologist.

Questions and answers on the topic "Heart failure"

Question:Hello, tell me if somewhere once a month the heartbeat begins to clear. My heart hurts a lot. Yes, so that already the pressure rises to 140/100. Cardiogram shows that everything is fine. What to do?

Answer: Perhaps paroxysmal tachycardia is a sudden onset and just as suddenly ending attack of rapid heartbeat. For diagnosis, daily ECG monitoring or ECG recording under stress is used. Address to the cardiologist internally.

Question:After prolonged stress (my son had a heart attack, treatment and death), my left arm began to hurt. At first I thought it was just stress. Then shortness of breath appeared and the hand continues to hurt. I take various soothing infusions - there is not much pain in my heart - just weakness and shortness of breath. I am 68 years old, 10 years ago I had an oncological operation to remove my left breast and my heart was exposed to radiation. I'm afraid to take strong medicines. What do you advise? Especially how to treat the hand?

Question:The man is 56 years old, persistent cough in the supine position, it is on the back with sputum production, shortness of breath, increased pulse and heart rate.

Answer: Hello. Your letter suggests that the cause of the cough, shortness of breath, and increased heart rate is heart failure. In heart failure, the occurrence of coughing in the supine position is due to an increase in the return of blood to the heart and stagnation of blood to the vessels of the lungs. The cough is usually dry, painful, accompanied by a feeling of lack of air. Sputum with such a cough is allocated in small quantities and may be frothy, sometimes pink. Similar symptoms (cough, shortness of breath) can also occur during exercise. We repeat that our assumption is based purely on the facts set forth in your letter. It is possible that the patient suffers from some disease of the respiratory system (for example, bronchitis), but we do not have enough information to suggest this. We recommend that you consult with a specialist cardiologist.

Question:Hello. My father had two heart attacks in January, three days apart. He is 56 years old. He spent a month in the hospital. After being discharged, I was at home for a month, shortness of breath began at the slightest movement and cough, swelling of the legs appeared, I smoked for about 30 years before a heart attack and now quit abruptly, now I was again admitted to the hospital with changes in the ECG, according to the attending physician, the heart works only at 35%. Please give me advice on how to restore the heart? Can anything help?

Answer: Hello. Obviously, after suffering heart attacks, your father developed heart failure, but you should not despair, because provided that the heart attack does not recur, his heart will soon begin to gradually adapt and heart failure will subside. However, there are no special recipes for restoring heart function. Unfortunately, it is not possible to restore parts of the heart muscle that died during a heart attack. In this case, all hopes should be associated with the adaptation of the heart and supportive treatment. Strictly follow the instructions of the cardiologists involved in the treatment of the patient.

Question:Chills, sweating, but at the same time the child is cold, fatigue, fatigue, drowsiness, pale complexion can these be signs of heart failure, if there is a heart murmur from birth (the valve does not close completely and one chord has grown in the wrong place).

Answer: Yes, the symptoms you describe can be a sign of congenital heart failure.

Question:Hello! Please tell me how best to get rid of fluid in the lungs, legs, stomach, with heart failure of the 3rd degree. What kind of sleep aid should I use? Woman 70 years old.

Answer: Hello. The development of edema in heart failure indicates decompensation of the patient's condition. In such cases, patients must be treated in a hospital, or at home under the supervision of a physician. The condition of your patient is dangerous, since at any time she may develop pulmonary edema. Regarding sleeping pills: taking most sleeping pills is contraindicated in heart failure, however, high-quality cardiological treatment can not only improve the general condition of the patient, but also restore her sleep.

Question:Good day! My child, 3 years old, has appeared around the mouth, as it were, small bruises, or it still looks like burst capillaries or a bruise. Although, the rest of the behavior and state has not changed. He is also active, mobile, does not complain about anything. Could these spots be evidence of heart failure?

Answer: In all likelihood, your suspicions of heart failure are false, since this disease is manifested not only by perioral cyanosis, but also by many other symptoms. However, we recommend that the child be shown to a pediatrician (to exclude heart pathology, it is enough just to listen to the child's heart and do an ultrasound of the heart). With heart defects, blueness increases during crying - have you noticed this in your child?

Question:I am 36 years old, not married, no children. For the past 3 years, BP has been rising frequently. Max 240/160, mostly 200/130. There were no injuries or serious illnesses. From birth predisposed to completeness. Now pains in the region of the heart, shortness of breath, swelling, weakness have begun.

Answer: The symptoms you describe indicate an unfavorable course of the disease (possibly, against the background of arterial hypertension, you developed heart failure and angina pectoris). Treatment of such cases of hypertension cannot be done at home! You need to contact the cardiological hospital as soon as possible and undergo a course of treatment. You can start treatment at home only after the stabilization of the disease. Do not waste time in vain - for you it may be a matter of life!

Question:Good day! I am 23 years old. At the age of 10-12, I was diagnosed with bradycardia (44 beats per minute), then with ECG, respectively, it was detected every time. Lately I have been working hard, besides that I have been doing sports for 6 years (3-4 times a week) at home - exercise bike and Yoga. Since the age of 2, I have had unpleasant sensations when breathing (I can’t breathe completely, as if not completely, like you’re yawning, but you can’t yawn), sometimes it presses in the sternum, not much, sometimes I wake up from this at night, from the fact that can't breathe. And somehow lately there have been strange sensations in my chest - as if I feel the heart, sometimes it presses a little, but tolerable. Please tell me - are these signs of increasing heart failure?

Answer: No, the symptoms you describe cannot be a sign of heart failure. You should consult at the cardiologist and the neuropathologist. The symptoms you describe can be observed with vegetative-vascular dystonia.

Question:Good day! My son is 7 years old. In closed rooms and in rooms with a large crowd of people, he begins to yawn, and very often, almost without stopping. Recently, a dry cough has been added to the yawning. Sometimes the son complains of pain in the left hypochondrium. All these symptoms appeared within the last year. Previously observed by a neurologist due to increased intracranial pressure. A year and a half ago, we visited a cardiologist: nothing was revealed. Whether prompt, please, these signs can be signs of heart failure? Which specialist should we contact?

Answer: Considering the fact that earlier the child did not show any signs of heart pathology and that since then he has not suffered serious diseases that could affect the heart muscle (at least you don’t mention them), we can say with a high degree of certainty that your child does not have heart failure and that the symptoms you describe are related to something else. Perhaps the cause of yawning and coughing is the lack of oxygen in the rooms by a large number of people (children feel oxygen starvation more acutely than adults). We recommend that you contact a general practitioner (therapist), take a blood test (you need to exclude anemia), and do an ultrasound of the internal organs.