Congestive heart failure
Congestive heart failure (CHF) is the main complication of heart disease. It is a pathological condition caused by damage to cardiac pump function (transient or sustained). The heart is not able to carry enough blood to meet the metabolic needs of the tissues.
Types of ICC:
- Systolic failure - failure contractile function of the left vent 626f510g riculului resulting in ejection fraction decrease.
- Diastolic failure - failure left ventricular relaxation function resulting in ventricular filling pressure increase, reducing the volume of ejection.
- Left ventricular failure - caused by decreased left ventricular ejection.
- Right ventricular failure - caused by right ventricular dysfunction defined by lung or left ventricular failure.
Systems affected: - cardiovascular, pulmonary.
Heredity: N / I.
Incidence / Prevalence - ICC comes a certain stage in almost all cases of heart disease. During the event, however, will depend on the etiology of the disease. ICC prevalence increases with age. Manifest forms attesting frequently after age 60. For European populations ICC prevalence is 0.4 to 2%.
Vârsta- predominant etiologic depends on the cause.
Dominance of sex- Men> Woman aged 40-75 years; Men = Women at age> 75 years.
Signs and symptoms
- Early stage: exertional dyspnea; decreased physical capacity; fatigue; asthenia; tachypnea moderate exertion; Rales nesonore based small lungs (especially after exercise);
- Advanced stage: dyspnea, tachypnea at rest; nocturnal cough; Paroxysmal nocturnal dyspnea; orthopnoea; The nocturnal wheeze "wheezing" anamnczci without asthma or respiratory infection (cardiac asthma); anorexia; heaviness in the right costal margin, hepatomegaly; multiple rales in the lungs basis; effusion peaks, often right; swelling in the legs, cold hands; gallop rhythm; diastolic hypertension; increased pressure in the jugular veins (jugular venous distension, hepato-jugular reflux); cardiomegaly.
- Severe impairment: brain disorders; cyanosis; ascites; hypotension; alternating pulse; anasarca; rozata sputum, frothy; Noise II emphasis on pulmonary artery; Chein-Stokes breathing.
- Common: ischemic heart disease, hypertension, rheumatic carditis, valvular heart disease, cardiomyopathy.
Less common causes.
- Infectious agents: viruses, bacteria, fungi.
- Infiltrative diseases: amyloidosis, hemochromatosis, sarcoidosis.
- Toxic: cocaine, heroin, alcohol, amphetamines, doxorubicin, cyclophosphamide, sulfonamides, lead, arsenic, cobalt, phosphorus, ethilenglicolul.
- Nutritional deficiencies: protein, thiamine and selenium.
- Electrolytic: hypocalcemia, hipophosphatemia, hyponatremia, hypokalemia.
- System disease lupus erythematosus, rheumatoid arthritis systemic roza, poliarteriita nodosa, allergic vasculitis, Takayasu pressure, polymyositis, Reiter's syndrome.
- Endocrine and metabolic diseases: diabetes, hyperthyroidism, hypothyroidism, hypoparathyroidism with hypocalcemia, pheochromocytoma, acromegaly.
- Tachyarrhythmias: supraventricular tachyarrhythmias uncontrolled atrial fibrillation tahisistolica.
Class I - physical activity is not limited. Ordinary physical activity does not cause symptoms.
Class II - moderate limitation of physical activity. Ordinary physical activity causes symptoms of fatigue, palpitation, dyspnea or angina pain.
Class III - marked limitation of physical activity. The patient feels comfortable at rest, moderate physical activity cause the appearance of symptoms mentioned above.
Class IV - no physical strain does not cause discomfort country. Symptoms may be present at rest.
Risk factors - infections; arrhythmias; insufficient nutrition; beta-blocker medications; calcium channel blockers; nonsteroidal anti-inflammatory; steroids; pulmonary artery embolism; Acute myocardial ischemia, myocardial infarction; thyrotoxicosis / hipotireoza; anemia; kidney failure; pregnancy.
Nephrotic syndrome is excluded by the absence of kidney disease, edema, asymptomatic proteinuria in history.
Cirrhosis: anamnesis excluded by the absence of liver disease, liver stigmelor exclusion risk factors of liver disease.
- Blood count,
- Na +, K + levels,
- General protein and serum albumin (in patients with edema).
- Lipids (if you have not been determined last 5 years)
- T4 and TTH * in patients with atrial fibrillation, with signs of thyroid disease in patients aged> 65 years.
- Serum Ca 2+ and Mg 2+ in patients receiving diuretics,
- * Thyroid stimulating hormone.
Disorders that may alter lab results: N / I.
Medicines that may change the results of laboratory: N / I.
ECG (ischemic ST-T changes, rhythm disorders, signs of pericarditis)
Chest X-ray: baseline - increased heart size in advanced stages - interstitial pulmonary edema, Kerley B lines, perivascular edema, pleural effusion severe changes - alveolar edema, pattern "butterfly" of pulmonary edema.
Diagnostic Procedures - ECO-cardiograph.
Treatment - ICC general aim of treatment is to reduce existing functional class and maintains the compensation, affecting as little patient quality of life.
Appropriate medical care
In most cases ensure home. Indications for consultation cardiologist:
- NYHA class III or IV refractory to treatment.
- Rapid progression of symptoms despite medical therapy with high doses.
- Patients with syncope of unknown causes or those who were treated with cardioversion.
- Patients who can not, for some reason, tolerate medication with vasodilators.
- The need for intravenous inotropic remedies.
- Young patients with NYHA class I - II associated with severe LV dysfunction with severe dilated valvular regurgitation LV or marked.
Indications for hospitalization:
- ICC outpatient treatment resistance;
- Present clinical or electrocardiographic signs of acute myocardial ischemia;
- Acute pulmonary edema and respiratory failure;
- Associated pathologic serious;
- Marked hypotension or syncope;
- Thromboembolic complications;
- Clinically significant arrhythmias;
- Inadequate social support for safe conduct in ambulatory conditions.
- Immediate initiation of treatment;
- Highlighting correctable causes and treatment;
- Elimination of precipitating factors.
Regime - in advanced states in positions semisezânda bed rest, use strampilor antiembolici, gradual increase in activity (as improving manifestations ICC).
Exercise can relieve dosed functional status in certain clinical situations (except acute myocarditis and acute stage of MI). The program must be consistent with reabilitolog specialist.
Diet - limiting liquids (not all require this indication), in the presence of edema - fluid restriction up to 2000 ml / day (includes liquids from solid foods).
NACE limitation up to 2g / day.
Patient education / family
- Explain the nature and causes of circulatory failure symptoms.
- Cases circulatory failure.
- How to recognize the symptoms.
- Limit consumption of salt up to 2000 mg / day and no more than 700 mg a diet.
- Daily monitoring of body mass (consultation in case of accumulation of 800-900g body weight per day or 2.5 kg / week).
- Arguments to follow treatment.
- The importance of following drug treatment and non-medical indications.
- Effects of prescribed drugs, dose and time of administration, adverse effects, signs of overdosing / poisoning, the patient shares in case of omission of a dose.
- The level of physical activity, sexual activity.
- Avoid alcohol.
- Abstaining from smoking.
- Family members will be informed how to behave in case of sudden death.
Monitoring - monitoring the patient varies depending on clinical circumstances. Initially every two weeks after the patient is stabilized. Tighter control of clinical signs, electrolytes, urea and serum creatinine.
- Digital poisoning.
- Severe electrolyte disturbances.
- Atrial and ventricular arrhythmias.
- Failure mezenteriale traffic.
- Protein enteropathy.
Prognosis and evolution
The treatment results usually are good. Long-term prognosis:
Class II - annual mortality - 10.5%
Class III - 10-20%
Class IV - 20-50%.