Chronic Heart Failure (CHF): Classification, Causes, Symptoms and General Treatment Principles
The basis of such a disease as chronic heart failure (CHF), the classification of which is presented in this article, is a decrease in the functionality of the heart. This process is triggered by pathological damage to the muscles, as well as an imbalance of the systems that affect the cardiovascular system.
What degrees of damage are marked by cardiologists with CHF? The classification of the disease was approved at the All-Union Congress of Therapists in 1935. It is based on the functional and morphological principles for assessing the dynamics of the clinical manifestations of the disease. It was compiled by cardiologists N. D. Strazhesko and V. Kh. Vasilenko with the participation of G. F. Lang.Subsequently, it was supplemented by scientists N. M. Mukharlyamov and L. I. Olbinskaya.
So how is CHF subdivided? The classification involves 4 stages:
- NC 1 - is the initial stage. Signs of chronic heart failure 1 degree manifest in shortness of breath, asthenia, tachycardia only during exercise.
- NC 2A - signs of moderate. Stagnation is observed in one circle of blood circulation. Swelling of the legs is not intestinal.
- NK 2B - signs of the disease are expressed sharply, gross hemodynamic disturbances are noted, and stagnation in the small and large circulation is clearly manifested. Edema are massive.
- NC 3 - dystrophic stage. Extremely gross hemodynamic disturbances and irreversible processes in tissues and organs are noted.
Despite the fact that the classification of chronic heart failure by N. D. Strazhesko and V. Kh. Vasilenko is quite convenient for determining biventricular (total) chronic pathology, it cannot be used to assess the degree of development of right ventricular failure, which is inherent in an isolated character.
Classification of chronic heart failure,proposed by the New York Heart Association (NYHA) in 1964, built on the principle of the prevalence of the process and hemodynamic disturbances in the large and small circle of blood circulation.
What gradation did American scientists give to a disease like CHF? Classification (functional classes) implies the degree of tolerance to exercise by the patient.
It is accepted to subdivide four classes:
- CHF 1 degree - the patient is physically active. Normal loads do not cause such manifestations as shortness of breath, tachycardia, angiotic pain, nausea.
- CHF 2 degrees - limitation of physical activity is moderate. The patient is comfortably at rest, but under load, he becomes ill. He experiences asthenia, tachycardia, shortness of breath, and angiotic pain.
- CHF grade 3 - limitation of physical activity is pronounced. The patient experiences comfort only at rest. Slight physical exertion leads to nausea, weakness, shortness of breath and heart palpitations.
- Grade 4 CHF - any slight exercise causes instant discomfort. Symptoms of heart failure and angina can also be detected at rest.
Classification of CHF by NYHA is simple and convenient.It is recommended for use by the International and European Society of Cardiology.
Causes of pathology
CHF (classification given in this article) can be caused by the following pathological processes:
- damage to the heart muscle;
- ischemia (impaired blood flow);
- myocardial infarction, involving the death of the heart muscle due to circulatory disorders;
- ischemia without myocardial infarction;
- high blood pressure;
- the presence of cardiomyopathy;
- changes in muscle structure due to the negative effects of certain drugs (for example, drugs used in oncology, as well as for the treatment of cardiac arrhythmias);
- the presence of endocrine pathologies;
- adrenal dysfunction;
- lack of certain vitamins and minerals in the body;
- the presence of infiltrative pathologies;
- HIV infection;
- the presence of renal failure;
- atrial fibrillation;
- heart block;
- presence of congenital heart defects;
- dry constrictive or sticky pericarditis;
- drinking alcohol.
Preclinical chronic dream has mild symptoms. Slow blood circulation provokes a moderate oxygen starvation of all organs and tissues.
As the disease progresses, the following symptoms appear:
- shortness of breath on exertion;
Insufficient oxygen supply to the fingers and toes causes their coloring to a grayish-bluish tint. In medicine, this condition is called "cyanosis". A low level of cardiac output causes a decrease in blood volume, which enters the arterial bed, as well as stagnation in the venous bed. This causes swelling. Legs suffer first. Also marked pain in the right hypochondrium, which is provoked by the overflow of blood veins of the liver.
In CHF (the stages are presented above), which occurs in a severe form, all of the above symptoms become more intense. Cyanosis and shortness of breath begin to bother a person even in the absence of physical exertion. The patient is forced to spend all day in a sitting position, as in the lying state shortness of breath becomes more intense.
Hemodynamic disorders cause swelling, which covers the entire lower region of the body. The fluid accumulates in the peritoneum and pleura.
How is the diagnosis made? CHF is determined on the basis of an examination by a cardiologist and additional methods of examination.
The following methods are used:
- Evaluation of the state of the heart based on the data obtained when using the electrocardiogram in various combinations: ECG monitoring during the day and treadmill test.
- The level of contractility and the size of various parts of the heart, as well as the volume of blood thrown into the aorta, can be determined using an echocardiogram.
- Perhaps the implementation of catheterization of the heart. This manipulation involves the introduction of a thin tube through a vein or artery directly into the cavity of the heart. This procedure makes it possible to measure pressure in the chambers of the heart and identify the area of occlusion of the vascular lumens.
How is CHF treated?
The main tools for drug therapy are:
- Angiotensin-converting enzyme (ACE) inhibitors, which make it possible to significantly slow down the progress of pathology.They serve to protect the heart, blood vessels and kidneys, as well as control blood pressure.
- Angiotensin receptor antagonists. They make up a group of tools that provide the full range of necessary enzymes. The drugs are used mostly in case of intolerance to ACE inhibitors. For example, with the appearance of cough.
- Beta-blockers. These drugs block beta-adrenoreceptors in the heart, blood vessels and lungs, help control pressure and correct hemodynamic disturbances. In pathology, beta-blockers are used as an adjunct to ACE inhibitors.
- Antagonists of aldosterone receptors. They are agents with a moderate diuretic effect, which contribute to the retention of potassium in the body. Used in patients with severe heart failure (3rd and 4th functional class), and are also prescribed to patients who have had a myocardial infarction.
- Diuretic drugs that help remove excess salt and fluid from the body. They are used by all patients who have fluid retention.
- Plant-based cardiac glycosides. These remedies increase the strength of the heart muscle.In small doses, their use is justified in the presence of atrial fibrillation (reduction of certain areas of the atria with a very high frequency). Only part of these impulses reach the ventricles.
- Ethyl esters of polyunsaturated fatty acids affect the metabolism and the level of blood clotting. They contribute to an increase in the patient's life, reduce the risk of myocardial infarction and hemorrhage in the brain.
Treatment of CHF is carried out by additional means:
- Statins. These are drugs that reduce the amount of pro-atherogenic lipids in the liver - fats that can be deposited in the walls of blood vessels and narrow their lumen, leading to impaired blood circulation. Usually funds are used in the presence of ischemia (circulatory disorders of the heart arteries).
- Indirect anticoagulants. Means violates the synthesis of blood clots in the liver. They are used for atrial fibrillation or for the prevention of thromboembolism (blockage of blood vessels in a blood clot).
Such drugs are used in special clinical situations that complicate the course of such pathology as chronic insufficiency.
- NitratesThey are used for complex course of the disease.
- Nitric acid salts. They contribute to the expansion of blood vessels and improve blood circulation. They are used in pathological conditions such as angina pectoris (pressing pain behind the sternum due to circulatory disorders in the heart arteries).
- Calcium antagonists. Serve as an obstacle to the penetration of calcium into the cells of the heart. They are used for persistent angina, high blood pressure, which is persistent, pulmonary hypertension, as well as severe heart valve insufficiency.
- Antiarrhythmic drugs. Used for arrhythmias.
- Disaggregant. Funds prevent blood clotting due to a violation of the process of gluing platelets. Typically, drugs are used as a secondary prophylactic for myocardial infarction.
- Non-glycoside inotropic stimulants that increase the strength of the heart.
Electrophysiological methods of treatment
To such methods of therapy include:
- Implantation It involves the installation of pacemakers, contributing to the artificial adjustment of the heart rate.The devices create an electrical impulse and transmit it to the heart muscle.
- Cardiac resynchronization therapy. It also involves the installation of pacemakers.
Mechanical and surgical methods of therapy
- Coronary artery bypass surgery, which involves ensuring blood flow from the aorta to the vessels through the creation of additional pathways.
- Mammary-coronary bypass surgery involves the creation of pathways that facilitate blood flow from the thoracic artery, located inside, to the heart vessels. Usually, such an operation is shown during a deep atherosclerotic process in the heart vessels, during which cholesterol is deposited on their walls.
- Surgical correction of the heart valves is performed with significant stenosis, narrowing or inability to prevent the backflow of blood.
- Wrapping the heart with an elastic mesh-based skeleton is used in the presence of dilated cardiomyopathy. This method of treatment helps to slow down the increase in the size of the heart, helps to optimize the patient's condition, and also increases the level of effectiveness of drug treatment.To confirm the effectiveness of this method requires additional research.
- Heart transplant. The operation is used in the presence of chronic deficiency, which is not amenable to medical treatment.
Related problems with heart transplantation
To a number of related problems in the transplantation of a donor organ should include:
- Not enough donor hearts.
- Rejection of the donor heart.
- The defeat of the vascular system of the transplanted heart.
- The use of auxiliary circulation equipment for blood circulation, as well as artificial ventricles of the heart. These devices are introduced into the body through the surface of the skin and function from batteries attached to the patient's belt. Artificial ventricles pump blood from the left ventricle to the aorta. The volume is 6 liters per minute, which unloads the left ventricle and restores its contractility. It should be noted that the price of the devices is high. They provoke complications of an infectious nature, as well as contribute to the formation of blood clots.
Complications and consequences
CHF, the stages of which are described in this article, can lead to a series of complications.
- sudden death from cardiac arrest;
- failure of the rhythm of the heart and its conduction;
- increase in heart size;
- blood clots;
- provoking liver failure;
- the appearance of cardiac cachexia;
- weight loss;
- thinning of the skin and the appearance of ulcers;
- decreased appetite;
- violation of the process of fat absorption;
- increased metabolism due to increased frequency of the muscles responsible for breathing.
CHF is a disease in which adherence to a strict diet is essential. The diet suggests limiting the use of salt to 3 g per day, and liquids to 1–2 l per day. Consumed foods must contain a sufficient amount of calories, protein, vitamins and be easily digestible.
It is advised to be weighed regularly, as an increase in a person’s weight by 2 kg over 3 days is evidence of a delay in the body fluid. In this case, there is a threat of violation of the mechanisms of decompensation, which causes a deterioration in the patient's well-being.
It is recommended not to completely give up physical exertion. Their volume is calculated individually, depending on the degree of CHF development (the classification describes each). For example, in the presence of myocarditis, the volume of loads should be small.
Preference is given to dynamic loads. Shown running, walking, swimming, cycling.
Not advised to stay in the highlands. Also, the body of a sick person is adversely affected by heat and moisture.
When traveling by plane for more than 2 hours, it is recommended to perform gymnastic exercises or get up every half hour.
Psychological rehabilitation of patients
Psychological rehabilitation involves the provision of medical supervision and the creation of special schools for patients with chronic insufficiency.
The goal of the organizations is to help patients and their families. Relatives and the patient himself receive information about the disease and diet.
For a patient, the types of physical activity appropriate to his condition are selected, useful recommendations are given regarding the regimen of medication, skills of assessing the symptoms of the disease and timely seeking medical help are imparted when the condition worsens.
What are the recommendations for a disease such as chronic heart failure? It is taken to allocate primary prevention with a high risk of pathology, as well as secondary measures to prevent the progress of the disease.
Primary prophylaxis methods
Primary prevention involves streamlining a person’s lifestyle.
- drawing up an appropriate diet;
- selection of physical activity;
- refusal to consume alcoholic beverages and smoking;
- weight normalization.
Secondary prophylaxis involves a set of measures aimed at eliminating existing vascular and heart diseases, as well as preventing the progress of existing CHF.
In hypertension, an optimal combination of drugs is used. They contribute to the normalization of blood pressure indicators and protect the organs that take over the main load.
The implementation of secondary measures involves:
- optimization of blood circulation;
- normalization of lipid metabolism;
- elimination of arrhythmia;
- conducting surgical and drug therapy in the presence of heart disease.