What are the stages of chronic heart failure (CHF). Types of heart failure. Physical activity mode

Depending on the severity of symptoms, there are three degrees of severity of chronic heart failure:

• 1st degree - compensated (mild);
• 2nd degree - subcompensated (moderate), it, in turn, is divided into degrees 2a and 2b;
• 3rd degree - decompensated irreversible (severe).

First degree of chronic heart failure

The main symptoms of chronic heart failure of the first degree are fatigue, irritability, poor sleep. With significant physical exertion or prolonged conversation, shortness of breath appears (especially often after a heavy meal). Increased heart rate, especially after exercise. Upon examination and auscultation, the doctor detects symptoms characteristic of heart disease leading to the development of heart failure, but they are often mildly expressed.

After proper treatment, the patient’s condition quickly normalizes, and the symptoms of heart failure disappear.

Second degree

The second degree of chronic heart failure is divided into degrees 2a and 2b.

With degree 2a, shortness of breath occurs even with slight physical exertion. Patients complain of insomnia, loss of appetite, rather strong heartbeat, heaviness in the right hypochondrium. Data objective examination similar to those in the first stage, but all pathological abnormalities are expressed to a much greater extent.

As in the first stage, after treatment the patient’s condition normalizes and almost complete compensation occurs.

At grade 2b, the patient’s condition is much more severe. Shortness of breath periodically occurs even at rest, the abdomen is swollen, the liver is enlarged and painful, severe pain in the right hypochondrium, and regular sleep disturbances are troubling. Swelling of the legs and cyanosis of the skin appear. The pulse reaches 100 beats per minute even at rest. Sometimes chest pain and hemoptysis occur. However, it is still possible to achieve full compensation, in some cases even for many months.

Third degree of chronic heart failure

At this stage of the disease, the patient’s condition is serious, shortness of breath is constantly tormented, swelling spreads to the entire body, accompanied by cyanosis of the skin and mucous membranes, sometimes with a yellowish tint. When coughing, bloody sputum is often produced. Moist rales can be heard well in the lungs. pulse is frequent and weak. Arrhythmias often occur.

Heart failure of the third degree, unlike the second, is irreversible. Improvement in the condition with proper treatment is possible, but it is short-term. At this stage, severe irreversible disorders develop both in the heart and in other organs, affecting the nervous system. Drowsiness and depression alternate with periods of insomnia, mental agitation and confusion. The addition of a bacterial infection at this stage almost always leads to a sad outcome.

Thus, when treating chronic heart failure, it is very important to prevent the development of the pathological process to the third stage, at which modern medicine is unable to cope with the increase in irreversible changes in the body.

Mitral valve insufficiency grades 1, 2, 3: causes, diagnosis and treatment

Causes

All causes of the development of mitral valve insufficiency are divided into those that appeared during the formation of organs (congenital) and acquired. The latter include:

Among the congenital changes are:

The causes of the defect may be associated with congenital changes, hereditary pathology, or be a consequence of acquired diseases.

Classification

The leading factor in the pathogenesis of mitral valve insufficiency is reverse blood flow, or regurgitation. Considering the volume of counterflow, there are several degrees of mitral regurgitation:

According to the clinical course, mitral valve insufficiency can be acute or chronic. The first type of pathology is usually associated with sudden changes, for example, rupture or ischemia of the papillary muscles during inferior myocardial infarction. The chronic course is characterized by a gradual increase in failure against the background of a sluggish process, for example, with the gradual transformation of the heart with dilated cardiomyopathy or with rheumatic disease.

Symptoms

Symptoms of mitral valve insufficiency in a compensated state may be absent or appear only during intense exercise. Subsequently, during the chronic course of the disease, transformation of the left ventricle gradually occurs, since it bears a large load. This condition leads to expansion of its cavity and thickening of the walls (hypertrophy). First, there is insufficiency of blood flow in the small circle, and then in the large circle. In case of secondary right ventricular failure, it is possible to identify:

With the acute development of mitral regurgitation, the heart chambers do not have time to adapt to new hemodynamic conditions, so the symptoms of left ventricular failure come first.

Heart failure classification and clinical manifestations.

In practical medicine, heart failure has several classifications. They are distinguished by the form of the process, the localization of the pathology and the degree of development of the disease. In any case, heart failure is clinical syndrome, developing as a result of insufficient “pumping” function of the myocardium, which leads to the inability of the heart to fully meet the energy needs of the body.

According to the course, chronic and acute forms of heart failure are distinguished.

Chronic heart failure.

This form of heart failure is most often a complication and consequence of some cardiovascular disease. It is the most common and often occurs asymptomatically. long time. Any heart disease ultimately leads to a decrease in its contractile function. Typically, chronic heart failure develops against the background of myocardial infarction, ischemic heart disease, cardiomyopathy, arterial hypertension or heart valve defects.

As statistics show, it is untreated heart failure that most often becomes the cause of death in patients with heart disease.

Acute heart failure.

Acute heart failure is considered to be suddenly rapidly abruptly evolving process- from several days to several hours. Typically, this condition appears against the background of an underlying disease, which will not always be heart disease or during exacerbation of chronic heart failure, as well as when the body is poisoned with cardiotropic poisons (organophosphorus insecticides, quinine, cardiac glycosides, and so on).

Acute heart failure is the most dangerous form syndrome, which is characterized by a sharp decrease in the contractile function of the myocardium or when blood stagnates in various organs.

Based on localization, right ventricular and left ventricular heart failure are distinguished.

With right ventricular failure, there is stagnation of blood in the systemic circulation due to damage and/or excessive load on the right side of the heart. This type syndrome is usually typical for constrictive pericarditis, tricuspid or mitral valve defects, myocarditis of various etiologies, severe ischemic heart disease, congestive cardiomyopathy, and also as a complication of left ventricular failure.

Right ventricular heart failure is manifested by the following symptoms:

- Swelling of the neck veins,

- acrocyanosis (blueness of the fingers, chin, ears, tip of the nose)

- increased venous pressure,

- swelling of varying degrees, ranging from evening swelling of the legs to ascites, hydrothorax and hydropericarditis.

- enlarged liver, sometimes with pain in the right hypochondrium.

Left ventricular heart failure characterized by stagnation of blood in the pulmonary circulation, which leads to impaired cerebral and/or coronary circulation. Occurs when there is overload and/or damage to the right heart. This form of the syndrome is usually a complication of myocardial infarction. hypertension. myocarditis. aortic heart defects, left ventricular aneurysm and other lesions of the left calf of cardio-vascular system.

Characteristic symptoms of left ventricular heart failure:

- when cerebral circulation is impaired, dizziness, fainting, and darkening of the eyes are characteristic;

- when coronary circulation is impaired, angina pectoris develops with all its symptoms;

- severe form of left ventricular heart failure is manifested by pulmonary edema or cardiac asthma;

- in some cases, disorders of the coronary and cerebral circulation and, accordingly, symptoms may also be combined.

Dystrophic form of heart failure.

This is the final stage of right ventricular failure. It is manifested by the appearance of cachexia, that is, exhaustion of the entire body and dystrophic changes in the skin, which manifest themselves in unnatural skin shine, thinning, smoothness of the pattern and excessive sagging. In severe cases, the process reaches anasarca, that is, total swelling of the body cavities and skin. A disturbance occurs in the body water-salt balance. A blood test shows a decrease in albumin levels.

In some cases, left and right ventricular failure occurs simultaneously. This usually occurs with myocarditis, when right ventricular failure becomes a complication of untreated left ventricular failure. Or in case of poisoning with cardiotropic poisons.

According to the stages of development, heart failure is divided according to the classification of V.Kh. Vasilenko and N.D. Strazhesko into the following groups:

Preclinical stage. At this stage, patients do not feel any special changes in their condition and are detected exclusively when testing with certain devices under load.

I the initial stage is manifested by tachycardia, shortness of breath and fatigue, but all this only under a certain load.

II stage is characterized by stagnation in tissues and organs, which are accompanied by the development of reversible dysfunctions in them. There are substages here:

IIA stage - not sharp pronounced signs stagnation, occurring only in the large or only in the pulmonary circulation.

IIB stadia - pronounced edema in two circles of blood circulation and obvious hemodynamic disturbances.

III stage - Symptoms of heart failure IIB are accompanied by signs of morphological irreversible changes in various organs due to prolonged hypoxia and protein degeneration, as well as the development of sclerosis in their tissues (liver cirrhosis, pulmonary hemosiderosis, and so on).

There is also a classification by the New York Heart Association (NYHA), which divides the degrees of development of heart failure based solely on the principle of functional assessment of the severity of the patient’s condition. At the same time, hemodynamic and morphological changes in both circulation circles are not specified. In practical cardiology, this classification is the most convenient.

I FC— There is no restriction on a person’s physical activity; shortness of breath occurs when rising above the third floor.

II FC- slight limitation of activity, palpitations, shortness of breath, fatigue and other manifestations occur exclusively during physical activity of the usual type or more.

III FC— Symptoms appear with the slightest physical activity, which leads to a significant decrease in activity. At rest clinical manifestations not visible.

IV FC— Symptoms of heart failure appear even in the still state and increase with the slightest physical exertion.

When formulating a diagnosis, it is best to use the last two classifications, as they complement each other. Moreover, it is better to indicate first according to V.Kh. Vasilenko and N.D. Strazhesko, and next in brackets according to NYHA.

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Causes of CHF development, risk factors

The main cause of this pathology is a noticeable decrease in the filling of the heart with blood, as a result of which the ejection of fluid from the artery will also be reduced.

Because of this disorder, a decrease in EF (that is, cardiac ejection fraction) occurs. In a healthy adult at rest, the EF should be 4.5–5 l/min. This amount of blood is sufficient to properly supply the body with oxygen.

Sometimes heart failure occurs as a result of damage to the myocardium or other structures of this organ.

Often the cause of the pathology is cardiac causes or an increased need of body tissues for oxygen.

The main cardiac factors are:

1. Serious violations. For example, heart attack, ischemic heart disease and inflammation of the heart muscle. Due to necrosis or tissue damage, the muscle loses its elasticity and is not able to contract fully.
2. Heart defects or injuries. As a result of such changes, the heart is unable to provide normal blood supply.
3. Dilation, as well as hypertrophic cardiomyopathy, leading to a decrease in muscle elasticity.

Heart failure occurs due to stress, bad habits or as a result of heavy physical labor.

Often, a chronic type of disease can be triggered by improper use of medications.

This reaction occurs to antiarrhythmic drugs or NSAIDs.

Classification of pathology and symptoms of CHF 2 degrees

Heart failure is conventionally divided into several stages, each of which has its own characteristics:

Depending on the severity of CHF, it is customary to classify it into 4 FCs (functional class):

1. If a person has FC I, he is able to tolerate physical activity normally, but the result of heavy exertion will be shortness of breath and fatigue.
2. In FC II, the patient's activity will be moderately limited.
3. In FC III, habitual activity is noticeably limited due to pronounced symptoms.
4. With IV FC it will no longer be possible to carry out the necessary load without pain, and signs of pathology appear even at rest.

Features of the second degree of CHF

In grade 1A, symptoms are mild, mainly due to increased stress. The result of this is left ventricular failure (the left side of the heart is affected). The patient's left cardiac border will be displaced, asthma attacks will occur, and the liver will change size (enlarge).

If the right parts of the heart are affected, signs of stagnation of blood circulation (in the systemic circle) are noticeable. The result of this is acrocyanosis, ascites and tachycardia. All boundaries of the heart expand. When CHF is in the second degree - 2B, significant disturbances are noticeable, because two circles (large and small) experience a lack of blood circulation.

The patient complains of shortness of breath, rapid heartbeat, and weakness. The person cannot lie on his back and develops orthopnea. In addition, the boundaries of the heart expand, the liver enlarges, and sometimes extrasystole appears.

How to treat CHF

Heart failure must be treated promptly to prevent further deterioration of the patient's condition. However, in addition to high-quality drug therapy, and sometimes surgical intervention, diet is recommended. In addition, it is necessary to take care of rational physical activity, as well as psychological rehabilitation.

The most effective drugs for CHF are beta-blockers, special ACE inhibitors, cardiac glycosides, etc. In addition to basic drugs, sometimes there is a need for additional (statins and anticoagulants) and auxiliary drugs.

Electrophysiological treatment methods should be highlighted. It is required if drug therapy did not bring the desired result. The operation of implanting an electrical pacemaker, the use of certain types of heart stimulation, etc. have proven themselves well.

In the most severe cases heart failure requires heart transplantation or implantation of artificial ventricles.

Complex therapy for CHF must necessarily include proper nutrition. In order to prevent disability and get rid of pathology, it is important to limit the amount of salt consumed, and in case of severe swelling, do not drink a lot of liquid. It is preferable to focus on high-calorie foods that contain many vitamins and protein.

In the treatment of CHF 2 FC 2, physical activity is indicated. However, it is necessary to correctly determine the most appropriate level of exercise for the patient. A special walking test will help you with this.

Daily brisk walking improves the patient's exercise tolerance and the effectiveness of therapy. After stopping treatment, it is recommended to make rational exercise part of everyday life.

Timely diagnosed CHF will help prevent its development before terminal III stages. This pathology primarily affects older people, so if unusual symptoms occur, it is recommended to promptly seek qualified medical advice.

vseoserdce.ru

Definition of disease

Millions of people around the world suffer from heart failure today. The number of such patients increases year by year. What is heart failure and how to deal with it?

From a school biology course we know that our body directly depends on the work of a pump called the “heart”. Throughout our lives, it continuously works to deliver blood enriched with oxygen and nutrients to every cell of the body. When cell nutrition is sufficient, the body functions normally.

In heart failure, a weakened heart is unable to supply the cells with the required amount of blood. Fatigue and shortness of breath develop. Any manipulation, even something as simple as climbing stairs, walking or carrying groceries, is difficult for the body.

At the initial stage of development, heart failure leads to enlargement of the heart chambers. Thus, the heart pumps out more blood. Increasing load leads to enlargement of the heart muscle. This allows the heart to pump more blood out. However, over time, these measures do not help - the heart “gets tired”, its capabilities are depleted.

The body as a whole also tries to compensate for the lack of blood using all possible methods. Blood vessels constrict to maintain blood pressure to compensate for the weakness of the heart muscle. The body diverts blood from less important organs and tissues to maintain blood circulation in the most vital organs - the heart and brain.

These temporary measures may temporarily mask the problem called heart failure, but will not solve it. Eventually, the heart will be unable to meet the body's needs and the person will experience fatigue, breathing problems, etc. alarming symptoms– tips for the need to visit a cardiologist.

The body's compensatory mechanisms explain why some people may not realize the severity of their condition when heart failure is on the horizon. This, by the way, is an excellent argument in favor of being regularly examined by a doctor.

Causes

Now we need to understand how heart failure occurs and what causes contribute to the progression of the disease. Most often, heart failure occurs against the background various diseases of cardio-vascular system. The most common of them is a narrowing of the arteries that deliver oxygen to the heart muscle. Vascular diseases occur in youth, and often remain without proper attention. With age, congestive heart failure may develop against their background.

Heart failure syndrome can aggravate the course of almost all diseases of the heart and blood vessels. But his main “partners” are arterial hypertension and coronary heart disease (or a combination of these diseases). Cardiologists often note in their practice that cardiovascular failure can occur with heart attacks and angina pectoris.

Among the reasons contributing to the development of such a formidable disease as heart failure are: changes in the structure of the heart valves, diseases thyroid gland(hyperthyroidism), infectious lesions of the heart muscle (myocarditis).

Heart failure in children can manifest itself as a complication of many infectious diseases:

- diphtheria, - scarlet fever, - polyarthritis, - polio, - pneumonia, - tonsillitis, - influenza and others.

As you can see, there are no “frivolous” infections. Almost any, in the absence of qualified treatment, can lead to serious heart complications.

Chronic heart failure can be caused by alcohol and drug addiction, excessive physical activity and even a sedentary lifestyle.

Recently, a study was conducted in the United States on the causes of sudden death of taxi drivers. It turned out that prolonged sitting in a car causes a slowdown in blood flow, the formation of blood clots and, as a result, heart failure.

During pregnancy, women with various vascular or cardiac pathologies may develop severe heart failure due to increased load on the heart.

Heart failure often occurs in people suffering from diabetes and diseases of the endocrine system in general. In short, anything that overloads the blood vessels and heart can lead to disease. Exacerbation of the disease is caused by (in addition to physical stress): poor nutrition, lack of vitamins, poisoning, stress.

Types of heart failure

According to the duration of development, heart failure is divided into two forms:

Acute heart failure, which 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 failure mitral and aortic valves. Chronic heart failure (as opposed to acute heart failure) forms slowly and develops over weeks, months or even years. Chronic heart failure can be caused by diseases such as heart disease, hypertension, chronic respiratory failure, prolonged anemia.

In turn, chronic heart failure is divided according to the severity into three degrees (classification by Vasilenko V.Kh. and Strazhesko N.D., proposed in 1935):

Heart failure 1st degree - initial hidden circulatory failure. It manifests itself in the form of shortness of breath, palpitations, and excessive fatigue. With rest, these symptoms disappear. Heart failure of the 2nd degree is characterized by the appearance of cardiovascular disorders at rest. If the patient experiences severe circulatory disorders, persistent changes in metabolism and irreversible changes in the structure of organs and tissues, then grade 3 heart failure occurs.

Today, a different classification has been adopted in the world (proposed by the New York Heart Association (NYHA)). In accordance with it, all patients diagnosed with heart failure fall into one of four categories, depending on the limitations of their physical activity:

Class 1. Physical activity is not limited and the patient’s quality of life is not affected. Class 2. Moderate restrictions on physical activity and no discomfort during rest. Class 3. Marked decrease in performance, however, symptoms disappear during rest. Class 4. Complete or partial loss of performance. Heart failure, accompanied by chest pain, manifests itself even at rest.

Depending on the affected area there are:

Left ventricular heart failure - develops as a result of overload of the left ventricle. For example, due to narrowing of the aorta. Also, this type of failure can occur due to a decrease in the contractile function of the heart muscle. This can occur during myocardial infarction. Right ventricular heart failure - develops when the right ventricle is overloaded (for example, with pulmonary hypertension). In cases where there is simultaneous overload of the right and left ventricles, mixed heart failure develops

Symptoms of the disease

How does heart failure manifest? Symptoms of the disease depend not only on the stage of heart failure, but also on which part of the heart is unable to cope with its work.

People who experience any of the symptoms associated with heart failure, even if they are mild, should see a doctor as soon as possible. When making a diagnosis, it is important to monitor symptoms and report any sudden changes. Main signs of heart failure:

Shortness of breath or difficulty breathing is one of the most common symptoms. When the heart begins to fail, it can no longer cope with the blood entering it. In this case, stagnation and overflow of the blood vessels of the lungs occurs, which interferes with normal breathing. On early stages, shortness of breath in heart failure occurs during physical exertion or other activities. As the condition worsens, shortness of breath may be bothersome even at rest or sleep. Chronic cough with heart failure is also not uncommon. Fluid accumulation in the lungs causes persistent cough and noisy wheezing. In this case, it may stand out sticky sputum sometimes mixed with blood. Fatigue and increased fatigue. As heart failure progresses, the heart is unable to pump the amount of blood needed to meet all of the body's needs. To compensate for this, blood is diverted from less important areas, including limbs, in favor of the heart and brain. As a result, people with heart failure often feel weak (particularly in the arms and legs), tired, and have difficulty performing normal daily activities. Cardiopalmus. By increasing the rate of contractions, the heart tries to compensate for its weakness and inability to adequately pump blood throughout the body. Edema in heart failure usually appears in the later stages of the disease. Congestion in the blood vessels and decreased blood flow to the kidneys leads to salt and water retention in the body. As a result of this, edema develops. The swelling is located mainly on the ankles and legs, symmetrically. Swelling of the legs due to heart failure increases slowly over weeks or months. The swelling is dense, leaving a hole when pressed. Abdominal edema or ascites in heart failure is accompanied by an enlarged liver and indicates a further deterioration in blood circulation.

Diagnostics

Heart failure is one of those diseases, in the diagnosis of which it is not just any one proven method that is important, but a combination of diagnostic methods.

The significance of symptoms and clinical manifestations is extremely high. They help the cardiologist suspect heart failure syndrome in a patient. Remember: heart failure detected in time is a prognosis for a long life.

In addition to the complaints described above, the sounds made by the chest can tell an experienced doctor a lot about the presence and degree of heart failure. Since in patients with progressive heart failure, along with increased breathing, its nature may also change.

Using a stethoscope, the doctor can hear various wheezing sounds in the lungs and determine whether the fluid is only in the lung tissue or has already accumulated in the pleural cavity.

Characteristic noises caused by disruption of the heart valves and increased heart rate may also indicate heart failure of varying degrees.

X-ray examination of organs chest allows you to identify fluid stagnation in the lungs and an increase in the shadow of the heart (signs of left-sided heart failure).

Modern instrumental diagnostics heart failure allows us to definitively establish concomitant changes in the heart and determine the extent of its damage. In this case, well-known electrocardiography and echocardiography are used, as well as new methods of diagnostic imaging: radioisotope angiocardiography and coronary cardiography.

Treatment and emergency care

Once the diagnosis is made, the question arises: how to treat heart failure? Treatment options depend on the cause of heart failure, its type, severity, and how well your body can compensate for it.

Acute heart failure

Emergency treatment for heart failure can save lives. Remember: acute heart failure develops very quickly. With lightning-fast flow, death can occur within two to three minutes. Acute heart failure is an extremely serious pathology; the patient should be hospitalized in the intensive care unit without delay.

Both the patients themselves and their relatives should know the symptoms of a disease such as heart failure in order to provide timely assistance at the pre-medical stage. Acute heart failure is manifested by a rapid increase in shortness of breath, wheezing, rapid breathing appears, the skin turns blue, and blood pressure rises. Subsequently, foamy, sometimes pinkish-colored sputum appears on the patient’s lips, which indicates an increase in pulmonary edema.

First aid for heart failure: Call an ambulance immediately. Try to reassure the patient - anxiety can aggravate his condition. Provide unobstructed access to oxygen (open windows). Before the doctors arrive, bring the patient to a semi-sitting position. This will ensure blood flow from the lungs to the lower extremities. After 10 minutes, apply tourniquets to the thigh area to reduce the volume of circulating blood.

Give the patient 1-2 tablets of nitroglycerin under the tongue. The drug must be given every ten minutes, with mandatory measurement of blood pressure.

In case of cardiac arrest, be sure to start artificial massage hearts, without waiting for the ambulance to arrive. All further treatment measures should be carried out only by qualified medical personnel in a cardiac intensive care unit.

Chronic heart failure

Treatment of chronic heart failure is long-term and requires the patient to tirelessly monitor the condition of the body.

Medications for heart failure are selected individually, taking into account the stage of the disease and the condition of the body as a whole. Self-medication for this pathology is unacceptable.

How and what to take for heart failure should be decided only by a qualified cardiologist. What does drug treatment for heart failure include?

ACE inhibitors. The primary goal is to lower blood pressure. For these purposes, ACE inhibitors (enalapril, lisinopril and captopril) are most often used. These drugs dilate blood vessels, thereby reducing blood pressure in heart failure, improving blood circulation and reducing the load on the heart. Another group of drugs are beta blockers (carvedilol, metoprolol and bisoprolol). This class of drugs not only slows the heart rate and lowers blood pressure, but also normalizes the heart rhythm. Diuretics. Treatment of edema in heart failure - at least important task. As the disease progresses, congestion in the lungs can develop extremely quickly. Pulmonary edema in heart failure is one of the most serious complications, often leading to death. However, we should not forget that diuretics for heart failure, along with water, remove potassium and magnesium from the body. A lack of these microelements can seriously worsen the patient's condition. Therefore, when taking diuretics, it is imperative to compensate for the lack of these substances in the body. With the aim of rapid removal diuretics (Lasix, indapamide, bumetanide) are used to remove fluid from the body and reduce the load on the heart. In severe cases, to enhance the effect, the doctor may prescribe several drugs at once. Glycosides. When treating patients with heart failure, it is extremely important to restore myocardial contractility. For these purposes, drugs called cardiac glycosides (digoxin, corglycon, strophanthin) are used. Once in the body, they increase the force of contractions of the heart muscle and slow down the heartbeat. Cardiac glycosides are highly effective drugs for the treatment of heart failure. However, they must be used with great caution, under the supervision of a doctor.

If drug treatment for heart failure does not have the desired effect or the patient has heart defects that affect the course of the disease, the doctor may suggest surgery.

Diet for heart failure

Treatment and prevention of heart failure begins with diet. Nutrition for heart failure should be high in calories, easily digestible and adjusted in relation to daily intake liquids and salts. The most suitable diet is fractional (5-6 times a day). Strong tea, coffee, and chocolate must be excluded from the diet. It is strongly recommended not to eat spicy foods or smoked foods. Alcohol in heart failure is strictly contraindicated!

The amount of salt is usually no more than 3-4 grams. per day. If the patient's condition worsens and swelling increases, cardiologists may recommend the patient a salt-free diet.

The diet for heart failure also includes reasonable restriction of fluid intake. Typically, daily water consumption is limited to 1200-1500 ml. per day, including all liquid dishes (soups, teas, jelly, etc.).

- raisins, - dried apricots, - nuts, - buckwheat and oatmeal, - baked potatoes, - Brussels sprouts, - bananas, - peaches, - veal, etc.

Potassium is especially necessary for patients taking diuretics and cardiac glycosides.

For heart failure light form, especially at an early stage, it is enough to change your lifestyle and diet. In many cases, this helps to completely get rid of swelling, shortness of breath, normalize weight and, thereby, remove excess stress from the heart.

Folk remedies

Folk remedies for heart failure have found wide application; even many eminent cardiologists use them in their practice.

Long-term development and chronic course diseases makes it possible to use natural and herbal medicines. Here are some of the most popular folk recipes to treat this disease.

If you or your family are diagnosed with heart failure, elecampane will help. In early spring or late autumn, dig up the roots of the elecampane. Wash, cut and dry in the oven. To prepare the medicine you will need a decoction of oats. To do this, pour half a glass of unrefined grains into 0.5 liters. water and bring to a boil over low heat. Then take a third of a glass of elecampane roots and pour the resulting decoction. Bring this mixture to a boil again and leave for two hours. Then strain and add two tablespoons of honey. The resulting product must be taken half a glass before meals, three times a day, for two weeks. Heart failure can be cured if you use the following recipe: 2 tbsp. l. Chop green or dry bean pods and pour in 750 ml. water. Bring to a boil and cook for five minutes. Then take 1 tsp. crushed motherwort leaves, hawthorn leaves or flowers, lemon balm, mint, lily of the valley leaves or flowers. Pour into boiling water with beans. Boil for another three minutes. Leave for four hours, then strain. Store the resulting broth in the refrigerator. A single dose of the medicine is 4 tbsp. l. Each time before taking, you must add 20 drops of Zelenin to the composition. Take 3 times a day 20 minutes before meals. The following helps with heart pain: folk method: Take 0.5 kg. ripe hawthorn fruits, rinse and pour 1 liter. water. Simmer over low heat for 20 minutes. Strain, add 2/3 cup sugar and the same amount of honey. Mix thoroughly. Take 2 tbsp daily for a month. before eating. Store the composition in the refrigerator. Use the healing properties of viburnum and heart failure will leave you. The healing effects of viburnum berries were known to our ancestors even in ancient times. Viburnum is eaten both fresh and frozen. You can make a tincture from viburnum. To do this, take a tablespoon of viburnum and mash it so that the berries release juice. Add a tablespoon of honey and pour a glass of boiling water. Then leave for an hour. Take the medicine half a glass twice a day for a month. Take a break. Carry out this treatment 4 times a year. You can make jam (or jam) from viburnum and fill pies with it. This delicacy is an excellent means of preventing heart failure. Take 3 parts of yarrow herb and one each of lemon balm leaves and valerian root. Pour a tablespoon of the resulting mixture into 0.5 liters. cold water and leave for 3 hours. Then boil and strain after cooling. Take a glass of infusion daily. If swelling occurs, rub 0.5 kg. raw pumpkin pulp and eat this amount daily. You can drink pumpkin juice - 0.5 liters. in a day. Grated potatoes, which must be peeled first, will also relieve swelling. It is used in the form of compresses on the swollen area. Secure the potatoes with a cloth. Keep the compress for twenty minutes. 2 tbsp. l. Spruce needles and birch leaves, previously crushed, pour 2 glasses of water. Bring the mixture to a boil and cook for 20 minutes over low heat. When the broth has cooled, strain. Take 4 times a day, 30 minutes before meals, one-fourth of a glass. The course of treatment is two months. Here is another proven recipe for heart failure: crushed steelhead roots, birch leaves, flax-seed in a ratio of 3:3:4. Pour the resulting mixture with a glass of boiling water. Let it brew for half an hour. Take 25 g. three times a day, half an hour before meals. The course of treatment is not limited. For the treatment of myocardial dystrophy, chronic heart failure, arrhythmia, the following remedy can be used. Take 10 ml. the following alcohol tinctures: lily of the valley, foxglove, arnica, mix with tinctures of hawthorn leaves and flowers (20 ml each). Take the composition 3 times a day before meals, 30 drops. Since this remedy is potent, consultation with a doctor before treatment is required.

mir-biblii.ru

Why does the heart weaken?

With a variety of cardiac pathologies, too much blood may flow to the heart, it may be weak or have difficulty pumping blood against increased pressure in the vessels (see also causes of heart pain). In any of these cases, the underlying disease may be complicated by heart failure, the main causes of which are worth talking about.

Myocardial causes

They are associated with direct weakness of the heart muscle as a result of:

• inflammation (myocarditis)
• necrosis (acute myocardial infarction)
• dilation of the heart cavities (dilated myocardiopathy)
• muscle wasting (myocardial dystrophy)
• disorders of myocardial nutrition (ischemic disease, atherosclerosis of coronary vessels, diabetes).

Among the reasons:

• compression of the heart by inflammatory effusion in the cardiac sac (pericarditis)
• blood (for wounds or heart ruptures)
• fibrillation due to electric shock
• atrial fibrillation
• paroxysmal tachycardia
• ventricular fibrillation
• overdose of cardiac glycosides, calcium antagonists, adrenergic blockers
• alcoholic myocardiopathy

Volume overload also leads to symptoms of heart failure

It is based on the deterioration of blood flow conditions with an increase in venous return to the heart with heart valve insufficiency, heart septal defects, hypervolemia, polycythemia, or resistance of blood flow to cardiac output with arterial hypertension, congenital and acquired (rheumatic) heart defects with stenosis of valves and large vessels, constrictive myocardiopathy. Overload can also occur with pulmonary embolism, pneumonia, obstructive pulmonary diseases and bronchial asthma.

Combined variants develop with weakness of the heart muscle and increasing load on the heart, for example, with complex heart defects (tetralogy of Fallot)

How quickly does the problem develop?

Depending on how quickly the symptoms of heart failure increase, they speak of acute or chronic variants.

• Acute heart failure worsens over several hours or even minutes. It is preceded by various cardiac accidents: acute myocardial infarction, pulmonary embolism. In this case, the left or right ventricle of the heart may be involved in the pathological process.
• Chronic heart failure is the result of long-term illnesses. It progresses gradually and becomes more severe from minimal manifestations to severe multiple organ failure. It can develop in one of the blood circulation circles.

Acute left ventricular failure

Acute left ventricular failure is a situation that can develop in two ways (cardiac asthma or pulmonary edema). Both of them are characterized by congestion in the vessels of the small (pulmonary) circle.

Their basis is impaired coronary blood flow, which remains less adequate only at the moment of relaxation of the heart muscle (diastole).

At the moment of contraction (systole), blood does not completely enter the aorta, stagnating in the left ventricle. Pressure increases in the left parts of the heart, and the right ones become overfilled with blood, causing pulmonary congestion.

Cardiac asthma

Cardiac asthma is essentially cardiopulmonary failure. Its symptoms may increase gradually:

• The pathology manifests itself in the early stages as shortness of breath. Occurs initially during physical activity, tolerance to which gradually decreases. Dyspnea is inspiratory in nature and with it, unlike bronchial asthma, difficulty breathing. With further development of the process, shortness of breath appears at rest, forcing patients to sleep on higher pillows.
• Shortness of breath then gives way to episodes of suffocation that often accompany nighttime sleep. In this case, the patient has to sit up in bed, take a forced position with his legs lowered from the bed and leaning on his hands to allow the auxiliary respiratory muscles to work.
• Often attacks are combined with fear of death, palpitations and sweating.
• Cough in heart failure - with scanty, difficult to separate sputum. If you look at a person’s face at the time of an attack, you can see the blueness of the nasolabial triangle against the background of pale or grayish skin. There are also frequent breathing movements chest, blueness of fingers. The pulse is often irregular and weak, blood pressure is reduced.

Comparative characteristics of suffocation in cardiac and bronchial asthma

Pulmonary edema

Pulmonary edema is a significant effusion of liquid blood into the lung tissue. Depending on where this fluid ends up, pulmonary edema is divided into interstitial and alveolar. With the first, the effusion occupies the entire lung tissue, with the second - mainly the alveoli, which become clogged with bloody sputum. Pulmonary edema develops at any time of the day or night, like an attack of sudden suffocation. The patient's condition rapidly deteriorates progressively:

• lack of air, shortness of breath increases,
• cyanosis of the limbs and face,
• palpitations, cold sweat
• disturbances of consciousness from motor and speech excitation up to fainting.
• hoarse, bubbling breathing can be heard in the distance.
• with alveolar edema it is released a large number of pink foam.
• if edema develops against the background of a decrease in cardiac output (with myocardial infarction, myocarditis), then there is a risk of developing cardiogenic shock.

Acute right ventricular failure

This is an acute pulmonary heart, which leads to congestion in the systemic circulation. The most likely causes of its occurrence:

• thromboembolism of a large branch of the pulmonary artery
• pneumothorax
• pulmonary atelectasis
• status asthmaticus

This can also complicate myocardial infarction or acute myocarditis. Increased pressure in the pulmonary circulation increases the load on the right ventricle and reduces blood flow to the left side of the heart, which reduces cardiac output. As a result, coronary blood flow suffers and pulmonary ventilation decreases.

With such acute heart failure, the symptoms are as follows:

• The patient begins to experience shortness of breath and a feeling of lack of air.
• His neck veins swell, which is more noticeable when he inhales.
• The face and fingers become blue.
• Next comes pulsation in the epigastrium, enlarged liver and heaviness in the right hypochondrium.
• Pastosity develops, and then swelling of the legs, face and anterior abdominal wall.

How is chronic heart failure classified?

In all cases when heart failure (symptoms and organ disorders) develops slowly, it is said to be chronic form. As symptoms increase, this option is divided into stages. So, according to Vasilenko-Strazhesko there are three of them.

• initial stage
  • I – there are no manifestations of pathology at rest.
  • IA is a preclinical stage, detected only by functional tests.
  • IB – symptoms of heart failure manifest themselves during exercise and disappear completely with rest.

• Stage two
  • II is characterized by the presence of signs of pathology at rest.
  • IIA – stagnation in a large or small circle with moderate manifestations at rest.
  • IIB-disorders are detected in both circulation circles.

• Stage three
  • III – dystrophic changes in organs and tissues against the background of circulatory disorders in both circles.
  • IIIA – Organ disorders are treatable.
  • IIIB- Dystrophic changes are irreversible.

The modern classification of chronic heart failure takes into account exercise tolerance and the prospects of therapy. For this purpose, functional classes are used, which can change with successful therapy.

• Class I is the absence of restrictions during usual physical activity. Increased exercise may be accompanied by minimal symptoms of shortness of breath.
• Class II involves a slight restriction of physical activity: there are no symptoms at rest, but habitual exercise may be accompanied by shortness of breath or palpitations.
• Class III is the appearance of symptoms with minimal exertion and their absence at rest.
• IV functional class does not allow to withstand even minimum load, symptoms exist even at rest.

Symptoms of chronic heart failure

This type of heart failure is often the outcome of many chronic heart diseases. It occurs according to the right or left ventricular type, and can be total. The mechanisms of its development are similar to acute forms, but are extended over time, due to which oxygen starvation and degeneration of organs and tissues come first.

Insufficiency of the right heart chambers

leads to disturbances in the pulmonary circulation and is manifested by pulmonary symptoms. The first place among patient complaints is:

• shortness of breath, which progresses and reduces quality of life
• there is a need to sleep with your head elevated, and periodically take an orthopneic position (sitting with your arms supported).
• Shortness of breath is gradually accompanied by coughing with the release of a small amount of clear sputum.
• As heart failure progresses, episodes of suffocation may occur.
• Patients are characterized by a grayish-bluish skin color, cyanosis in the area of ​​the nasolabial triangle, hands and feet. The fingers take on the shape of drumsticks. Nails become excessively convex and thickened.

Left ventricular weakness leads to changes in the systemic circuit

• Patients are concerned about palpitations (paroxysmal tachycardia, atrial fibrillation, extrasystoles), weakness and fatigue.
• Edema syndrome appears. Gradually, swelling in heart failure increases, spreading to the legs, anterior abdominal wall, lower back and genitals. Massive swelling is called anasarca.
• First, this is pastiness of the feet and legs and hidden swelling, revealed during weighing.
• Impaired blood flow in the kidneys causes a decrease in the amount of urine excreted, leading to anuria.
• An enlarged liver is a sign of long-term congestive heart failure. Its symptoms are heaviness and pain in the right hypochondrium due to the tension of the edematous liver on its capsule.
• Problems with cerebral circulation lead to sleep disturbances, memory problems, and even thinking and mental disorders.

Comparative features of cardiac and renal edema

	Heart failure	Renal pathologies
Location in early stages	Feet, legs	Eyelids, face
Appearance time	In the afternoon, in the evening	In the morning
Localization at later stages	Legs to hips, lower back, front abdominal wall, genitals	Face, lower back, extensive anasarca type
Slew rate	They grow more slowly and go away worse	Spreads quickly and resolves more easily
Density	Dense swelling	Loose, “watery”
Liver enlargement	Characteristic	Not typical

Treatment for heart failure

Treatment of heart failure is carried out in two directions. Acute forms require emergency care. Chronic variants are subject to planned treatment with correction of decompensations and long-term administration of maintenance dosages of medications (see new research by scientists on the effect of physical activity on the heart).

First aid

Emergency treatment includes prehospital stage carried out by an ambulance or a doctor on an outpatient basis and inpatient treatment.

• Relief of acute left ventricular failure in the form of pulmonary edema begins with placing the patient in a position with the head of the patient elevated. Oxygen inhalations with alcohol vapor are carried out. Lasix and isosorbide dinitrate in 5% glucose are administered intravenously. At oxygen starvation The patient's tissues are transferred to artificial ventilation (the trachea is intubated, having previously administered atropine sulfate, Dormicum, Relanium and ketamine).
• Symptoms of acute right ventricular failure secondary to pulmonary embolism include oxygen therapy, administration of rheopolyglucin and heparin (with stable blood pressure). In case of hypotension, dopamine or adrenaline is administered. If clinical death occurs, cardiopulmonary resuscitation is performed.

Treatment of chronic heart failure

Chronic heart failure requires an integrated approach. Treatment includes not only medications, but also involves a diet with a decrease in fluid (up to 2.5 liters per day) and salt (up to 1 g per day). Therapy is carried out using the following groups of drugs.

• Diuretics

They reduce venous return to the heart and help cope with edema. Preference is given to saluretics (furosemide, lasix, torasemide, indapamide) and potassium-sparing agents (triampur, spironolactone, veroshpiron). Aldosterone antagonists (veroshpiron) are the drug of choice in the treatment of refractory edema.

• ACE inhibitors

They reduce preload and pulmonary congestion, improve renal blood flow and remodel the heart muscle, increasing cardiac output:

— Captopril (Capoten), enalapril (Enap), perindopril (Prestarium), lisinopril (Diroton), fosinopril (Monopril), ramipril (Tritace) are used. This is the main group susceptible to chronic heart failure. Treatment is carried out with minimal maintenance dosages.

— Medium- and long-acting cardiac glycosides: digoxin (cedoxin) and digitoxin (digofton). Cardiac glycosides are most preferable when, against the background atrial fibrillation have heart failure. Treatment of functional classes III and IV also requires their appointment. The drugs increase the force of mytocardial contractions, reduce the frequency of contractions, and reduce the size of the enlarged heart.

• Beta blockers

reduce tachycardia and myocardial oxygen demand. After two weeks of adaptation to the drugs, cardiac output increases. Metoprolol succinate (betaloc ZOK), bisoprolol (concor), nebivolol (nebilet).

Treatment of heart failure is carried out over a long period of time under the supervision of a cardiologist and therapist. By following all the recommendations of specialists, it is possible to compensate for the pathology, maintain quality of life and prevent the development of decompensations.

Classification clinical forms and variations of chronic heart failure is necessary to distinguish between the severity of the patient’s condition and the characteristics of the course of the pathology.

This distinction should simplify the diagnostic procedure and the choice of treatment tactics.

In domestic clinical practice, the classification of CHF according to Vasilenko-Strazhesko and the functional classification of the New York Heart Association are used.

The classification was adopted in 1935 and is still used today with some clarifications and additions. Based on the clinical manifestations of the disease during CHF, three stages are distinguished:

• I. Latent circulatory failure without concomitant hemodynamic disorders. Symptoms of hypoxia appear with unusual or prolonged physical activity. Possible shortness of breath, severe fatigue,... There are two periods A and B.
  

  Stage Ia is a preclinical variant of the course, in which cardiac dysfunction has almost no effect on the patient’s well-being. At instrumental examination an increase in ejection fraction during physical activity is detected. At stage 1b (latent CHF), circulatory failure manifests itself during physical activity and goes away at rest.

• II. In one or both circles of blood circulation, stagnation is expressed that does not go away at rest. Period A (stage 2a, clinically pronounced CHF) is characterized by symptoms of blood stagnation in one of the blood circulation.

  The patient exhibits acrocyanosis, peripheral edema, dry cough and others, depending on the location of the lesion. In period B (stage IIb, severe), the entire circulatory system is involved in pathological changes.

• III. The final stage of the disease with signs of failure of both ventricles. Against the background of venous stagnation, severe hypoxia of organs and tissues appears in both circulation circles. Multiple organ failure develops severe swelling, including ascites, hydrothorax.
  

  Stage 3a is treatable; with adequate complex therapy for CHF, partial restoration of the functions of the affected organs, stabilization of blood circulation and partial elimination of congestion are possible. Stage IIIb is characterized by irreversible changes in metabolism in the affected tissues, accompanied by structural and functional disorders.

The introduction of additional gradations is partly due to the development and implementation of new treatment methods, which significantly increase patients’ chances of improving their quality of life.

Application modern drugs and aggressive treatment methods quite often eliminates the symptoms of CHF, corresponding to stage 2b to the preclinical state.

New York (1, 2, 3, 4 FC)

The functional classification is based on exercise tolerance as an indicator of the severity of circulatory failure. Determining the patient's physical abilities is possible based on a thorough history taking and extremely simple tests. Based on this feature, four functional classes are distinguished:

• I FC. Everyday physical activity does not cause dizziness, shortness of breath or other signs of myocardial dysfunction. occur against the background of unusual or prolonged physical activity.
• II FC. Physical activity is partially limited. Everyday stress causes discomfort in the heart area or anginal pain, attacks of tachycardia, weakness, and shortness of breath. At rest, the state of health returns to normal, the patient feels comfortable.
• III FC. Significant limitation of physical activity. The patient does not experience discomfort at rest, but everyday physical activity becomes unbearable. Weakness, pain in the heart, shortness of breath, attacks of tachycardia are caused by less than usual loads.
• IV FC. Discomfort occurs with minimal physical activity. or others may appear at rest without visible preconditions.

See the table of correspondence between the classifications of CHF according to NYHA and N.D. Strazhesko:

Functional classification is convenient for assessing the dynamics of the patient’s condition during treatment. Since the gradations of severity according to functional criteria and according to Vasilenko-Strazhesko are based on different criteria and do not accurately correlate with each other, when diagnosing, the stage and class according to both systems are indicated.

Here is a video about the classification of chronic heart failure:

The result of diseases of the cardiovascular system in the absence of proper treatment is CHF (chronic cardiac failure). The impetus for the development of pathology is a decrease in myocardial activity. The inability of the heart to provide the body with nutrients and oxygen leads to inhibition of the central nervous system and internal organs.

CHF 1st degree FC 2

CHF is not an independent (separate) disease. This is a symptomatic condition observed in various pathologies. More often, CHF becomes the result of:

• obesity;
• previous myocarditis;
• vitamin deficiency;
• COPD;
• HIV infections;
• cardiac ischemia;
• cardiomyopathy;
• diabetes mellitus;
• heart defects;
• atrial fibrillation;
• arterial hypertension;
• pathologies of the thyroid gland;
• imbalance of the adrenal glands;
• myocardial infarction;
• acute cerebrovascular accident;
• amyloidosis (protein metabolism disorder);
• sarcoidosis (granulomatous disease);
• cachexia (extreme degree of exhaustion of the body);
• long-term use of antitumor drugs.

Risk development of CHF increases with the patient's age; this pathology is more common in men. According to statistics, about 80% of the world's population suffers from heart failure. And the mortality rate is 10-12 times higher than the number deaths from myocardial infarction.

When classifying pathology, the indicators of the organ’s ability to accept venous blood and transmit arterial blood, saturated with oxygen cells, into the circulatory system are taken into account. There are three types of heart failure (HF):

1. HF with preserved left ventricular (LV) ejection fraction (HFpEF) ≥50%. Patients with normal EF typically do not have LV dilatation, but instead often have LV wall thickening and/or left atrial (LA) dilatation as a sign of increased filling pressure.
2. HF with reduced LV systolic function< 40% (СН-нФВ). Поражение миокарда, при котором мышца не справляется с насосной функцией (не способна вытолкнуть определенный объем крови).
3. HF with average LVEF 40-49% (HFmEF). The ejection fraction is not within normal limits, but there is no significant decrease in it.

In 1965, the New York Heart Association (NYHA) developed a classification of heart failure consisting of four groups (functional classes). Russian doctors have a domestic method for dividing CHF into types (Strazhesko/Vasilenko), consisting of three pathology groups.

Unlike their American colleagues, Russian doctors take into account (in addition to the symptoms of the disease) the degree of scarification (impairment) of hemodynamics, metabolism, individual sensitivity to the therapy and other diagnostic indicators.

Russian cardiologists take into account the NYHA classification, therefore, when diagnosing, they indicate the indicators of both methods:

Classification of CHF by functional classes and stages	NYHA (FC)	Strazhesko/Vasilenko (stages)
1/1FC	There are no restrictions on physical activity. Regular exercise stress does not cause shortness of breath, fatigue or heartbeat.	Initial, or latent failure, which manifests itself in the form of shortness of breath and palpitations only with significant physical activity that has not previously caused it. At rest, hemodynamics and organ functions are not impaired, work capacity is slightly reduced.
2A /2FC	Light limitation of physical activity. Comfortable well-being at rest, but normal physical activity causes shortness of breath, fatigue, palpitations.	Signs of circulatory failure at rest are moderate, exercise tolerance is reduced. There are hemodynamic disturbances in the systemic or pulmonary circulation, their severity is moderate.
2B/3FC	Significant limitation of physical activity. Comfortable I feel at rest, but a small load causes shortness of breath, fatigue, palpitations.	Severe signs of heart failure at rest, severe hemodynamic disturbances in both the systemic and pulmonary circulation.
3/4FC	Inability to perform any physical activity without feelings of discomfort. Symptoms may also be present in peace. With any load, the discomfort increases.	Final: diastolic stage with pronounced hemodynamic disturbances, metabolic disorders and reversible changes in the structure of organs and tissues.

The peculiarity of chronic heart failure is its hidden manifestations. The pathology develops slowly, without clear manifestations of symptoms. There is a high risk of not detecting heart failure in time.

Doctors often note cases where older people with the first stage of pathology literally go to the terminal level within a couple of years after the diagnosis is made, when therapy in the vast majority of cases is already powerless.

Important. Without proper competent treatment of CHF, the disease provokes the appearance of pulmonary edema, attacks of suffocation and the development of cardiogenic shock (a rapid decrease in myocardial function). There is a high risk of death.

If in the initial stage of CHF (stage 1) the symptoms are difficult to determine, then, starting from the second stage of the disease, the patient is already able to understand that disturbances are occurring in the body. If alarming symptoms appear, especially if they worsen, you should immediately visit a doctor.

Symptoms of second class CHF

When the cameras heart organ stretched and weakened, the heart is not able to fully contract and send blood through the bloodstream. As a result, it accumulates in a large hemodynamic circle. When the accumulated blood encounters the natural flow of the circulation, it “overflows,” returning to the pulmonary vessels.

If a similar situation occurs with a small hemodynamic circle, swelling and shortness of breath develop. Less and less blood enters and exits the heart organ, causing the heart to beat faster. The main distinguishing signs of CHF are shortness of breath, rapid heartbeat (tachycardia) and swelling.

Dyspnea

One of the first and most frequent CHF symptoms. At the first stage of heart failure, attacks of shortness of breath are hardly noticeable, they practically do not happen, and breathing becomes more frequent only with strong physical exertion. As the pathology develops, shortness of breath occurs to the patient even in a state of complete rest.

Many patients are even forced to sleep in a semi-sitting position - cardiac asthma manifests itself especially strongly at night, when it is harder for the heart to cope with stress. A paroxysmal hacking cough develops.

Important. Dyspnea is a specific indicator for diagnosing CHF by type. Dyspnea indicates the patient's functional potential and serves as the basis for disease classification.

Shortness of breath occurs due to problems with blood flow vascular system pulmonary organs (develops in vessels venous stasis). This leads to the development of a dry, hacking cough and swelling of the lungs. In severe situations, cough syndrome and shortness of breath combine into a severe attack of suffocation, which indicates the transition of CHF to the acute stage.

Tachycardia

IN elementary degrees development of CHF, increased heart rate develops only with severe overexertion. With the development of pathology, tachycardia manifests itself constantly and increases even with minor physical effort.

Important. CHF is characterized by a “gallop rhythm,” that is, when listening to the heart rhythm, the heartbeat is clear and fast.

When resting at night, heart rate increases from 120 beats/minute. Such a heart rhythm does not allow the patient to sleep and rest normally. With stage 2 CHF, the pulse returns to normal 10-12 minutes after physical activity. As the disease progresses, the time frame increases.

Swelling

One of the most striking and noticeable signs of CHF is the appearance of peripheral edema. The appearance of edema may indicate the degree of development of the pathology:

1. Beginning of the disease. There is no swelling.
2. CHF from stage 2 B. Swelling covers the area of ​​the lower leg and thighs, spreading to other parts of the body. In bedridden patients, swelling is concentrated in the sacral area. By the evening there is a strong dynamics of the symptom, in the morning the manifestation of the pathology remains.
3. CHF last stage. Severe swelling in the lower back and hips. Possible development of ascites (abdominal dropsy).

Video - Heart failure

Other signs

In addition to tachycardia, swelling and shortness of breath, a number of other signs are observed in patients with CHF. The possibility of their manifestation depends on the condition of the patient’s body. The following symptoms may occur:

• swelling of the jugular veins;
• hair loss (alopecia);
• deformation of the nail plates;
• blueness of the tip of the nose, lips and fingers;
• aching pain stupid character in the area of ​​the right hypochondrium;
• hydrothorax (chest dropsy: accumulation of fluid in the pleural cavities);
• skin problems (pigmentation, trophic changes, ulcers, non-healing wounds);
• disruption of the liver (enlargement of the organ, its compaction, yellowness of the epidermal and mucous tissues).

Another main feature Early stage CHF – pronounced muscle weakness and high fatigue. This symptom develops due to insufficient blood supply to the muscles.

Diagnosis of CHF

At the patient’s first appointment, the doctor conducts an initial examination: listening to the heart and measuring the pulse. An important factor When diagnosing CHF, it is necessary to ask the patient about existing diseases, ongoing courses of therapy and taking medications.

In older people, many conditions and diseases can mimic CHF with similar symptoms:

• shortness of breath is a common occurrence in heart failure, often accompanies lung pathologies that occur with bronchospasms;
• swelling of the legs is provoked by taking amlodipine (a medicine that lowers blood pressure), the swelling disappears after stopping the drug;
• The symptoms of decompensated liver cirrhosis are similar to the manifestations of CHF: yellowness of the skin, swelling, problems with the functioning of the organ.

The likelihood of diagnosing CHF increases if people have rheumatism, angina pectoris, regular increases in blood pressure, heart defects and a history of myocardial infarction.

To establish an accurate verdict, patients are prescribed a number of auxiliary examinations:

• biochemical analysis of blood serum;
• urine examination and diuresis determination per day.

When diagnosing CHF, it is especially important to study the work of the myocardium. The cardiologist gives directions for the following instrumental examinations:

ECG (electrocardiography). A technique for analyzing and graphically recording electric fields generated during cardiac activity. If possible, the cardiologist also conducts an extended examination using the ECG method:

• Holter monitoring, in which the patient wears a cardiac recorder attached to the body throughout the day, the work of the myocardium is carried out continuously;
• phonocardiography for a more accurate determination of heart murmurs and its sounds.

EchoCG (ultrasound of the heart). Effective method diagnostics of cardiac activity, which has no contraindications. This method has high and accurate information content and is considered the leading method for diagnosing cardiac pathologies.

The procedure is painless and takes only 10-15 minutes. The patient is examined in supine position and the use of ultrasonic high-frequency equipment.

CT (computed tomography). Safe method studies of the heart muscle are especially important in early stages of CHF. Cardiac CT reveals pathologies in the early stages of development. The patient undergoes a scan of the heart area for 20-25 minutes. The result is a three-dimensional image of the cardiac organ in different planes and sections.

Cardiologists can also conduct computed tomography using contrast - coronary angiography.

MRI (magnetic resonance imaging). One of the accurate methods for determining the quality of the heart muscle and analyzing the condition of myocardial tissue. As a result of the examination, the doctor receives reliable results about the volume of the heart, the size of the walls of the organ and other values.

Important. MRI is the most expensive research method. This diagnosis is used if the examinations did not provide an accurate picture or if the patient has contraindications to other research methods.

Stress testing also helps determine the degree of CHF in the early stages. The simplest way designed for older people - they are asked to walk at a fast pace for 5-6 minutes. Then the cardiologist measures pulse, pressure and other parameters of cardiac activity.

Treatment of the disease

Therapeutic measures for CHF are aimed at removing excess fluid from the body, normalizing myocardial function and stabilizing blood pressure. Treatment with medications is carried out simultaneously with a diet that limits fluid and salt intake and moderate physical activity.

The following medications are prescribed for the treatment of CHF:

ACE inhibitors. The medicinal group of these drugs significantly reduces the risk of unexpected death from respiratory arrest, slows down the manifestations of CSH and alleviates unpleasant symptoms. The therapeutic result appears after 2-3 days.

ACE inhibitors include: Benazepril, Captopril, Zofenopril, Cilazapril, Enalapril, Lisinopril, Perindopril, Quinapril, Ramipril, Spirapril, Trandolapril and Fosinopril.

Cardiac glycosides. Medicines in this group are aimed at improving myocardial function, stabilizing hemodynamics and reducing the load on the heart muscle. Glycosides slow down the pulse and restore kidney function, having a moderate diuretic effect.

This group of drugs includes: Digoxin, Novodigal, Lanatozid, Dilacor, Korglykon, Cordigit, Tsedigalan, Strophanthin, Digitoxin.

Antiarrhythmic drugs. Medicines in this category lower pulse and blood pressure, preventing the occurrence of arrhythmia. They also significantly reduce the likelihood of cardiac (sudden) death in people with CHF.

Antiarrhythmic drugs include Amiodarone, Quinidine, Lidocaine, Disopyramide, Mexiletine, Flecainide, Etatsizin, Esmolol, Ivabradine, Adenosine, Panangin, Atenolol, Procainamide.

Diuretics. Medicines that reduce the load on the myocardium and relieve swelling. These are Triamterene, Lasix, Diuver, Veroshpiron and Diakarb.

Anticoagulants. Medicines that prevent blood clots and thin the blood. This group of drugs includes: Warfarin, Heparin, Nadroparin, Reviparin, Tinzaparin, Parnaparin, Enoxaparin, Acenocoumarol, Deltaparin, Neodicoumarin.

In case of stage 1 CHF, in addition to drug treatment, the patient is shown spa therapy, regular walks and vitamin therapy. Success in the treatment of CHF largely depends on the participation of the patient himself in the process, his attitude towards his own health and strict compliance with all doctor’s instructions.

Its common form is angina pectoris, which, in turn, also has 4 degrees of severity.

The essence and typology of forms of the disease

The heart, the main muscle of the body, receives nutrition through the supply of oxygen and nutrients through the arteries. The daily requirement may increase if a person performs a certain physical activity. Accordingly, blood flow to the main organ increases.

The coronary and coronary arteries, which “serve” the heart, come from the aorta. If they are not normal, blood flow is disrupted. This means that a certain part of the heart muscle will not receive enough oxygen and the necessary substances for normal functioning.

This failure is called ischemia. If this condition lasts more than 30 minutes, cardiomyocytes in the heart begin to die, which leads to myocardial infarction. The pathology can become more active when the permissible level of physical activity is exceeded and is accompanied by pain.

There are 4 functional classes of the disease (FC). The main criterion for differentiation is the severity of the form and the permissibility of physical activity:

1. FC 1 is a relatively mild degree of the disease, in which moderate exercise is allowed. An attack is possible only in case of extreme physical stress.
2. FC 2 involves restrictions on physical activity. This class includes patients whose angina attack begins after walking 500 m or when climbing stairs to the second floor. In addition, patients are not recommended to walk in cold and windy weather, to be active immediately after waking up from sleep, or to experience emotional stress. All this can also provoke a deterioration in well-being.
3. FC 3 significantly limits a person’s physical activity. An attack can be triggered by walking average speed us and climbing the flight of stairs.
4. FC 4 is the most severe form. This is a disability in which seizures can occur even when at rest.

It is also worth noting that patients with FC 3 disease can usually control their abilities well. They are also able to sense upcoming attacks. This helps to neutralize them in advance and reduce the intensity to nothing.

How the disease develops

Damage to blood vessels can be caused by diabetes mellitus, cholesterol deposits and other reasons, due to which so-called plaques form on the walls of the arteries. They narrow the passage in the blood vessels, preventing normal blood circulation.

An attack of IHD angina pectoris with FC 3 or 4 is most often accompanied by severe pain. But sometimes it can be limited only to severe shortness of breath, cough and weakness. Main hallmark illness: when a crisis occurs, you can always clearly determine the beginning and end.

The pain may spread to an area on the left side of the torso, behind the breastbone. Sometimes it involves the left arm, jaw or shoulder blade. The patient experiences sensations of pressure and compression in the heart area. With FC 3 or 4, pain may also be accompanied by the symptoms already listed above - shortness of breath, cough, etc.

During an attack, a person usually feels a characteristic pressing pain. It cannot be confused with anything and cannot be overcome if the appropriate drugs are not at hand. Fortunately, the attacks are usually short and often end unexpectedly, at the very peak of frustration. The disease is dangerous, first of all, due to the increased chances of getting a myocardial infarction.

Usually an attack with FC 3 or 4 lasts about 3-5 minutes, but in some patients it can be significantly delayed. In particularly advanced cases or after severe overload, the patient’s pain intensity can be wave-like, ranging from severe to excessive. In this case, you must immediately call an ambulance, since conventional neutralizers are not able to stop the crisis.

It is also worth noting that, depending on the predictability and nature of the attacks, angina in FC 3 or 4 can be stable or unstable:

1. A stable form suggests that the patient can predict the onset of a crisis. He knows for sure that if he does not exceed a certain standard of physical activity, he will be able to avoid pain. In this case, the disease is easy to control. The main thing is to define in advance the limits of what is permitted and calculate your capabilities.
2. In the case of an unstable form, attacks can begin without cause or prerequisites. The insidiousness of the disease is also that conventional medications may not help.

The forms of the disease largely determine the course of diagnosis and treatment that will be prescribed to the patient.

Diagnosis of the disease

Due to the specific clinical picture, diagnosing coronary artery disease angina is not particularly difficult for specialists. A cardiologist can determine the disease based on patient complaints alone. The diagnosis is even more likely if one of the patient’s relatives suffers from similar attacks in forms FC 3 or 4.

To confirm the disease, a series of instrumental examinations is used.

These include:

• electrocardiogram;
• Holter ECG monitoring;
• stress tests;
• Ultrasound of the heart;
• blood chemistry;
• myocardial scintigraphy;
• coronary angiography.

The most common and accessible diagnostic method is an electrocardiogram. To obtain more accurate data, it is recommended to do it directly during an attack.

Holter monitoring involves a series of ECGs, the results of which are recorded throughout the day using a special device. The patient goes about his business as usual. He independently records the monitoring data in a diary.

Ultrasound of the heart can detect disturbances in the functioning of the valve apparatus and myocardial contractions, which usually accompany ischemia of the heart muscle.

A biochemical blood test is used to diagnose the condition of blood vessels. In particular, they are tested for cholesterol and the degree of atherosclerotic lesions, which makes it possible to determine the degree of blood flow intensity.

First aid for a seizure

Angina pectoris is a chronic disease. Therefore, a complete cure is not always possible and only through surgical intervention.

But first of all, the patient and his immediate environment need to learn how to provide first aid during attacks.

Nitroglycerin and drugs based on it are the main means for stopping a crisis. At the first symptoms, the patient needs to put one tablet under the tongue and dissolve it. If the attack is severe, you can give it twice. It is better if the oral cavity is sufficiently moist. The maximum dose, 5 tablets, is taken in extremely severe cases when medical help is not expected.

You can also use a spray instead of tablets. The results of the action of nitroglycerin can be seen within a couple of minutes.

Sometimes they try to stop the attack with validol. This is a grave mistake, since this medicine not only does not help, but can cause serious harm to health.

But those around you can use simple ways to ease the crisis. To do this, it is necessary to stabilize the patient’s condition as much as possible, both physically and morally:

• the person must be allowed to stand for a while and catch his breath if the attack was provoked by intense physical activity;
• if the cause is stress, the patient needs to be reassured;
• it is important to provide the person with a sitting or semi-sitting position, as well as an influx of fresh oxygen;
• the body should be freed from any oppressive objects, including belts, collars, and excess outerwear;
• You can place heating pads with warm water on your feet.

Treatment of the disease

Aspirin should be used for therapeutic purposes. The drug reduces blood viscosity and facilitates its fluidity inside the vessels. For the same purpose, it is recommended to take:

• beta blockers;
• calcium antagonists;
• mixed action antiadrenergic drugs;
• vasodilators.

The course of therapy usually includes sedatives. It is important to understand that treatment must be supervised by a cardiologist. If you have this diagnosis, you should also acquire several useful habits:

1. Always carry a pack of nitroglycerin or spray with you. You can also stock up on medication at work and at home.
2. Before possible physical or emotional overload You need to put a tablet under your tongue in advance.
3. Observe nutritional culture and maintain a routine. The condition of the blood vessels directly depends on this. The more cholesterol is deposited on their walls, the worse the blood flow and nutrition of the heart muscle, and the longer and more intense the attacks will be.
4. Monitor your condition and regularly attend general examinations. This is a must to keep attacks to a minimum. Suffering from obesity, advanced diabetes or other cardiovascular diseases, it is very difficult to get rid of the disease.
5. Move as much as possible. With angina pectoris FC 3, sports and intense walking are prohibited. However, it is acceptable to move slowly, shop on your own, or take a walk. You must first discuss your physical activity norm with a specialist.

From smoking and overeating fatty foods must be refused. If all preventive and therapeutic measures do not help achieve complete recovery, the patient may be recommended invasive intervention. This could be bypass surgery or coronary artery grafting. Such radical treatment is applicable if angina attacks in forms FC 3 or 4 are real threat patient's life.

You should not start a disease that can provoke the parallel development of cardiovascular disorders: tachycardia, severe forms of arrhythmia, heart attack. As a rule, complications progress and lead to disability.

The information on the site is provided for informational purposes only and does not constitute a guide to action. Do not self-medicate. Consult your healthcare provider.

The main thing about angina pectoris III-FC

Angina pectoris or angina pectoris is characterized by the paroxysmal nature of unexpected chest pain due to insufficient blood supply to the myocardium of the heart in an acute form. Thus, the pathological picture of cardiac ischemia (CHD) appears.

• paroxysmal form;
• has a clear time for the onset of the attack and the end and subsidence of the attack;
• certain circumstances and reasons provoke an attack;
• Nitroglycerin helps relieve an attack 2-3 minutes after taking it;
• pain is localized behind the sternum, sometimes radiating to the neck, shoulder, left shoulder blade, heart;
• Characterized by pressing and squeezing pain, less often burning pain;
• high blood pressure;
• pale skin, the presence of perspiration on the face during an attack;
• fluctuating pulse, presence of extrasystole.

Based on the main symptoms and observation by a doctor, a diagnosis of angina pectoris is made. Concomitant ischemic heart disease aggravates the patient's condition. With angina pectoris III-FC, the electrocardiogram changes.

Factors contributing to the occurrence of angina pectoris III-FC:

• fast walking;
• climbing uphill, using stairs;
• gusts of strong headwind;
• emotional stress, both negative and positive.

Classification

Angina has several forms, these are:

• initial, manifested in the sick person for the first time;
• assignment of I-IV functional class to a patient with persistent symptoms illness;
• increasing, angina pectoris.

Constant angina pectoris is diagnosed when attacks of ischemic heart disease last more than 30 days. The nature of the manifestation of symptoms does not change. There is an international Classification of the Cardiovascular Society, which provides four functional classes (FC).

Features of angina pectoris

Sometimes you have to limit physical stress and active actions. The attack begins during a hurried movement on a flat surface, when moving more than 500 m, climbing a mountain, using stairs (starting from the second floor).

The appearance of pain when walking full stomach", in windy and cold weather, after emotional stress, sometimes after waking up from a night's sleep.

The diagnosis of angina pectoris FC III in a patient gives him the legal opportunity to be awarded disability.

Group I lifelong disability is established for patients diagnosed with coronary artery disease with coronary insufficiency of III-IV functional class of angina pectoris.

Medical and social examination, when assigning a disability group, takes into account the person’s health status, based on clinical and functional changes.

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Symptoms and signs of FC III

This form of angina is a clear manifestation of coronary artery disease. With this disease, there is an increased need in the myocardium for an increased volume of oxygen-enriched blood. This becomes difficult due to the narrowing of the coronary artery, leading to cardiac ischemia.

As IHD develops, disorders in the contraction of myocardial muscles intensify, and the picture of biochemical and electrical processes in the heart changes.

The accumulation of energy in cells ends due to the insufficient presence of oxygen in the blood.

Having studied Elena Malysheva’s methods in the treatment of HEART DISEASE, as well as restoration and cleansing of VESSELS, we decided to offer it to your attention.

• onset of pain after generous intake food;
• “warm-up phenomenon” in middle-aged patients;
• duration of pain up to minutes of increasing nature;
• feeling of nausea, vomiting;
• sweating;
• severe shortness of breath, rapid fatigue;
• increased heart rate;
• increased blood pressure.

Diagnostics

A thorough history taking and external examination of the patient begins with an examination of the skin, the patient’s desire to “freeze” in a certain position in order to reduce heart pain.

Excessive sweating, signs of tachycardia, extrasystoles appear, the so-called “gallop” rhythm.

Methods for detecting coronary artery disease, in addition to ECG, include monitoring ECG during the day, bicycle ergometry, tests, and stress echocardiography. Coronary angiography is performed to diagnose coronary artery disease.

The patient, 47 years old, considers herself ill since March 2012. Suddenly, the first signs of angina pectoris appeared: pressing pain in the chest, a persistent feeling of fear, palpitations, fatigue during short work activities.

Consultations with a therapist and cardiologist at the clinic led to the prescription of treatment for coronary artery disease and the emerging atrial fibrillation. Over the next three years, the patient's condition remained satisfactory.

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After this, interruptions in cardiac activity appeared, accompanied by severe pain behind the sternum. Taking nitroglycerin does not stop the attack. A prolonged stressful situation contributed to the occurrence of a heart attack.

Inpatient treatment gave positive results in relieving attacks. But the patient was diagnosed with coronary heart disease, exertional angina, FC-III degree. The documents have been sent to the ITU to determine the disability group.

An attack of pain behind the sternum is present as a symptom for many diseases. Therefore, it is impossible to judge the presence of tense angina only by this sign.

Prognosis and prevention

This disease is chronic and leads to disability. Most often it ends in myocardial infarction and death.

Only systematic treatment and prevention of the disease will help avoid an undesirable outcome.

It is necessary to limit physical activity, avoid emotional outbursts and stressful situations.

Preventive methods include maintaining an appropriate weight, eating plant food, fruits, vegetables. Treat in a timely manner concomitant diseases such as diabetes mellitus, vascular atherosclerosis, heart failure. You should not wait for the final verdict regarding myocardial infarction. It's your job to prevent it.

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Does angina pectoris degree 3 give you disability?

Disability due to hypertension

High blood pressure is commonly referred to in medicine as hypertension. Disability due to hypertension is common, as it is a very dangerous disease that has a complex course and carries many consequences. The disease most often develops in the category of people after 30 years of age. Although every year the disease gets younger. And working conditions are often contraindicated for the benefit of health.

How to get disability for hypertension?

Do they give disability for problems with blood pressure?

Hypertension requires disability, as the disease is quite complex. Working under certain conditions can harm not only yourself, but also those around you. This indicates disability. And in many professions, before starting work duties, it is customary to measure blood pressure in order to avoid its increase and possible consequences. Contraindications in labor activity for hypertension are presented in the table:

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Expertise

To confirm the diagnosis, you need to undergo instrumental examinations.

To receive disability due to hypertension, you must undergo a medical examination and undergo a series of tests in order to confirm the diagnosis. Sometimes the attending physician prescribes, in addition to this, an additional examination. But to obtain disability you need to pass full examination to receive a fully signed bypass sheet. For this you will need:

• Laboratory blood test (determines chemical composition, hemoglobin, etc.).
• Blood sugar test (to detect diabetes).
• Analysis of urine. Determines the condition of the kidneys and urinary system.
• ECG (cardiogram).

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Stages of the disease

Hypertension manifests itself in general weakness, possible nausea, impaired heart function, pain in the back of the head or temples. With arterial hypertension, the pressure has to jump (up/down). The disease manifests itself in different ways, so it is customary to divide it into categories:

• Stage 1 (soft) - from 140/90 to 160/100. There is rapid fatigue.
• Stage 2 (moderate) - from 160/100−180/110. At stage 2, the disease progresses normally with minor damage to internal organs and severe headaches.
• Stage 3 (severe form) - from 180/110 and above. At stage 3, severe development of the disease and disruption of the functioning of internal organs, the risk of stroke and heart attack.

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How to get a group and classification into groups?

When applying for a specific job or being drafted into the army, you must pass a special commission. They will assess the patient's condition, whether he is able to work or not, and the anticipated working conditions. When disability is given for hypertension of the 2nd degree, this is the 3rd group. A person with hypertension must receive a disability in order to be properly employed. For heart failure with the second degree, the second group is assigned. With 3 degrees, they give disability of 3 groups, in very complex forms of the disease - the second, and in severe cases - the first is possible.

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How to apply for disability?

To confirm incapacity for work due to high blood pressure and to make a disability group, you must submit documents to a medical institution. First, write an application addressed to the head physician to receive disability. And secondly, a medical certificate with a confirmed diagnosis at the place of residence. If this needs to be done in another city, a certificate of medical care at the place of registration is additionally issued. Obtaining disability for hypertension requires examination. Once approved, the group must be reconfirmed annually. The group is not confirmed upon reaching retirement age and in the presence of anatomical defects.

Angina pectoris FC 3 - what is it?

The situation when the blood supply to the myocardium is disrupted due to obstruction of the blood arteries is called coronary disease heart (CHD). Lack of oxygen creates an imbalance between the coronary blood circulation and the metabolic processes of the heart muscle. This condition can create an acute pathology - myocardial infarction, or take on a stable, protracted nature in the form of exacerbation of angina pectoris.

Etiology of angina pectoris, classification

Angina pectoris is a clinical syndrome of manifestations of coronary artery disease. It is not an independent disease, but consists of many symptoms pain. The location is concentrated in the sternum, in the area where the heart is located. In this area, discomfort is felt in the form of squeezing, heaviness, burning, pressure.

Modern medicine, based on the clinical course of the pathology, combines angina into 3 variants, which have their own codes in the system international classification diseases:

1. Stable exertional angina. ICD-10 code: I20.8. Its essence lies in symptoms that manifest themselves stably over a long period of time. The degree of severity, depending on the load on the body, is combined into a functional class:
   1. FC 1, the patient lives well under normal stress. Only severe overloads cause pain
   2. FC 2, physical activity is reduced. An attack can occur from walking up to a kilometer, climbing stairs to the second floor, or simply in cold weather with gusts of wind.
   3. FC 3, severe decrease in physical activity. Walking 100 to 500 meters can cause heart pain.
   4. FC 4, the slightest load and walking within 100 meters causes muscle pain, which can also occur at rest.
2. An unstable type of angina, ICD code -10: I20.0, replaces the existing pathology and has uncharacteristic expressions. It is caused by unexpected reasons, the duration of the attack can be short or extended, and is characterized by the following indicators:
   1. The primary form, which started in a person for the first time and manifests itself in less than a month.
   2. The progressive form consists of an increase in the number, severity, and duration of attacks.
   3. A form of rest occurs during an unpredictable period in a state of relaxation that is not preceded by a physical or stressful situation.
   4. Post-infarction type of angina appears after a rupture of the heart muscle within a period of up to two weeks from the illness.

Any of these conditions is evidence of unstable angina.

1. Vasospastic angina, ICD code -10: I20.1, takes possession of a person as a result of a sharp spasm of blood vessels, which occurs from their blockage. Pain can occur at rest, during sleep, in the cold, and is not always characteristic of ischemic heart disease, but is caused by other ailments:
   1. Stenosis of the aorta and heart valves.
   2. High degree anemia.
   3. Overgrowth of heart tissue – cardiosclerosis.

Causes and symptoms

Having understood the classification of pathology, we can answer in more detail the question of what is angina pectoris FC 3.

Restriction of the patency of the circulatory system as a result of atherosclerosis is the main cause of angina pectoris FC 3. When its decrease is %, an imbalance occurs between the myocardial need for oxygen and its delivery. Clinical picture The disease is manifested by frequent attacks of angina pectoris. The disease is influenced by various factors:

• localization of stenosis;
• length;
• the number of affected vessels.

In addition to atherosclerotic obstruction, the formation of blood clots and spasms of the artery tree cannot be excluded in the pathogenesis. The following factors can act as provocateurs of angina pectoris FC 3:

• obesity;
• smoking;
• significant levels of cholesterol in the blood;
• diabetes;
• severe emotional stress of any direction;
• chronic stress;
• physical inactivity – sedentary lifestyle;
• hypertension;
• rapid blood clotting, promoting the formation of blood clots;

For the reasons listed above, the patient develops angina. But for the development of an attack, provoking factors are needed, among the main influences are physical activity, emotional experiences or unfavorable weather conditions

What is FC 3 in the development of angina pectoris? These are characteristic and common signs of pathology:

• Physical activity becomes limited so as not to provoke an attack of angina.
• The frequency of pain is almost daily. Its companions are tachycardia, shortness of breath, cold sweat, changes in blood pressure, and arrhythmia.
• Nitroglycerin, which is quick to act, is not always effective.
• Remission does not last long, only after a course of hospital therapy.
• During an attack, an ECG will show ischemia and diffuse changes in the myocardium.

• The medical history often includes infarction or chronic cardiac aneurysm;
• There is a symptom of atherosclerosis of the aorta and other arteries;
• Atypical angina without pain, but with shortness of breath, arrhythmia and other symptoms.
• Heart rhythm disturbances.
• Heart failure.
• Hypertension in combination with ischemic heart disease.
• Diagnostics detects pathogenic branches of blood vessels that have a narrowing of up to 75%.

Important! IHD angina pectoris 3 FC is considered by doctors as a disability.

Availability of specific clinical symptoms will assist in diagnosing pathology:

• Tension, burning, constriction in the heart.
• The place of occurrence of symptoms is the left side of the body: sternum, shoulder, shoulder blade, arm, neck. The right half of the body is also possible, which is less common.
• Duration of pain in the range >2 and<15 минут.
• Conditions for development suddenly or at the apogee of activity: walking, climbing a floor, eating plenty of food, overcoming resistance to gusts of wind.
• Options for stopping an attack: refusal of exercise, relieving pain, or a Nitroglycerin tablet.

Stable angina pectoris FC 3 differs from its counterparts in the ability to predict the onset of an attack. The patient is aware of the limitations in physical activity. Therefore, compliance with their norms is the key to the absence of pain. If warning signs appear, you must have Nitroglycerin on hand. Despite the restrictions on workload, the patient is able to care for himself and does not need someone else’s help, as in the case of FC 4.

Diagnostics

A complaint of pain in the sternum, which is the result of specific human actions, has a subjective criterion in making a diagnosis. It is necessary to weed out other ailments that can give such an effect.

Instrumental techniques and laboratory tests will confirm the correct diagnosis of pathology. These include:

• blood biochemistry;
• scintigraphy;
• Ultrasound of the heart;
• stress tests;
• Holter ECG monitoring;
• coronary angiography.

After completing the examination, there will no longer be any questions about what this is in the diagnosis of coronary artery disease: angina pectoris 3 FC.

Treatment, prognosis and prevention

Having determined the diagnosis, appropriate therapy is selected. It consists of systematically taking medications:

• A number of nitrates that can prevent an attack of angina or stop it. The most common is Nitroglycerin.
• Antiplatelet agents to eradicate the formation of blood clots: Clopidogrel, Aspirin.
• Statins. Medicines for cholesterol: Atorvastatin, Cerivastatin, Fluvastatin, Lovastatin, Mevastatin, Pitavastatin, Ppravastatin, Rosuvastatin, Simvastatin.
• ACE inhibitors. They fight arterial hypertension, chronic heart failure (CHF), complicated by angina: “Capoten”, “Enam”, “Privinil”, “Lotensil”, “Monopril” and others.
• β-blockers, divided into groups, are used for CHF and after a heart attack. They should be selected individually and only on the recommendation of a doctor, because they have a detrimental effect on the body without the correct dosage.

In addition to them, drugs with other effects are also used: a structural analogue of gamma-butyrobetaine “Metonate”, metabolic agents “Kapikor”.

Angina can be treated with surgery:

• coronary angioplasty;
• shunting of affected vessels.

If you do not pay attention to the treatment of angina, there is a risk of death due to extensive heart attacks. Regular use of therapeutic therapy is predicted to improve the quality of life, despite the limitation of the patient’s activity.

Effective prevention lies in eliminating risk factors. Diet, weight loss, blood pressure control and everything else that is beneficial to the body is offered. When angina is diagnosed, secondary prevention is carried out. Here you should avoid emotions and stress, relieving tension to a minimum. Do not forget to take Nitroglycerin before physical exertion. Following the advice of your treating cardiologist can increase your life without attacks.

Please note that all information posted on the site is for reference only and

not intended for self-diagnosis and treatment of diseases!

Copying of materials is permitted only with an active link to the source.

To your health

Disability in angina pectoris III FC

and on the return coupon in the line the disease code according to the ICD was written I25. and that's all. The lines of the main disease, concomitant disease and complications are empty.

Information about consultations on the website

The diagnosis itself is:

IHD. Angina pectoris III FC, rhythm disturbances such as paroxysms of atrial fibrillation, tachysystolic variant, supraventricular tachycardia, extrasystole. Complications: CHF 2A 3f. class

Angina pectoris III FC, rhythm disturbances of the type of paroxysms.

usually corresponds to disability group 3 due to: .

Is there a disability group for angina pectoris 2 fc. Husband 4

Medical and social examination

This is not particularly critical (although, of course, you need to fill out all the points).

This information is mainly needed by the clinic for statistical reporting (the quality of filling out this coupon does not in any way affect the prospects for establishing disability).

You need to answer STRICTLY point by point.

Incomplete fulfillment of these requirements significantly complicates consultation on the prospects for establishing disability in your case.

You practically did not complete point No. 5:

5. Number of inpatient treatments over the last 12 months, their duration in days (each separately) and in full (without abbreviations) ALL diagnoses from there - main and accompanying ones.

The diagnosis itself is:

usually corresponds to the 3rd disability group for the reason: “general disease”, for a period of 1 year according to the 1st degree of labor protection. (provided that this pathology is PERSISTENT).

We can talk about the PERSISTENCE of the pathology in cases where the diagnosed diagnoses are not amenable to not only outpatient treatment (diagnoses on a sick leave), but to treatment in a hospital (diagnoses from hospital extracts).

You did not provide the exact number of inpatient treatments over the last 12 months, their duration and all the diagnoses included in them (you did not fully comply with point No. 5 of the requirements).

Therefore, it is difficult for me to assess the persistence of the patient’s pathology.

If (here I am forced to guess) and in hospital extracts EXACTLY the same diagnoses are given (even one number there can be decisive), then in this case the patient could well be diagnosed with the 3rd disability group (taking into account also the accompanying pathology - grade 2 obesity, etc.).

Typically, the ratios of CHF degrees and disability groups are as follows:

For CHF 0, CHF 0-1 and CHF 1 stage. - disability is usually not established.

With CHF 2Ast. - usually - 3rd disability group.

With CHF 2Bst. - usually - 2nd disability group.

With CHF stage 3. - 1st disability group.

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Acute

(right ventricular, left ventricular, biventricular

Chronic

Clinical stages

(stages according to Strazhesko-Vasilenko):

With systolic dysfunction (EF<40%)

with diastrolic dysfunction of the left ventricle (EF>40%)

Functional classes of heart failure (I-IV) NYHA.

1. Classification of chronic heart failure (CHF)

The classification of CHF was proposed in 1935 by N.D. Strazhesko and V.Kh. Vasilenko. According to this classification, there are three stages of CHF:

StageІ – initial, latent circulatory failure, appearing only during physical activity (shortness of breath, palpitations, excessive fatigue). With rest, these phenomena disappear. Hemodynamics are not affected.

Stage P– severe long-term circulatory failure. Hemodynamic disturbances (stagnation in the pulmonary and systemic circulation), dysfunction of organs and metabolism are expressed at rest, and the ability to work is sharply limited.

PA stage – signs of circulatory failure are moderate. Hemodynamic disturbances in only one part of the cardiovascular system (in the pulmonary or systemic circulation).

BE stage – the end of a long stage. Profound hemodynamic disturbances, which involve the entire cardiovascular system (hemodynamic disturbances in both the systemic and pulmonary circulation).

Stage III – final, dystrophic stage with severe hemodynamic disturbances. Persistent changes in metabolism, irreversible changes in the structure of organs and tissues, complete loss of ability to work.

First stage is detected using a variety of tests with physical activity - using bicycle ergometry. Master's tests, on the treadmill, etc. A decrease in MOS is determined, which is also detected using rheolipocardiography and echocardiography.

Second stage. Symptoms of heart failure become obvious and are detected at rest. Working capacity decreases sharply or patients become unable to work. Stage 2 is divided into two periods: 2a and 2B.

Stage 2A may progress to stage 1B, or even complete hemodynamic compensation may occur. The degree of reversibility of stage 2B is less. In the process of treatment, either a decrease in the symptoms of HF occurs or a temporary transition from stage 2B to stage 2A and only very rarely to stage 1B.

Third stage dystrophic, cirrhotic, cachectic, irreversible, terminal.

Classification of heart failure proposed by the New York Heart Association and recommended by the WHO (nuha, 1964)

According to this classification, there are four classes of heart failure:

Function classI(FCI)	Patients with heart disease that does not limit physical activity. Normal physical activity does not cause fatigue, palpitations, or shortness of breath
Function classII(FCII)	Patients with heart disease that causes slight limitation of physical activity. At rest, patients feel well. Normal exercise causes excessive fatigue, palpitations, shortness of breath, or angina
Function classIII(FCIII)	Patients with heart disease that causes significant limitation of physical activity. At rest, patients feel well. Mild physical activity causes fatigue, palpitations, shortness of breath, or angina
Function classIV(FCIV)	Patients with a heart condition that prevents them from performing even minimal physical activity. Fatigue, palpitations, shortness of breath and attacks of angina pectoris are observed at rest, with any load these symptoms intensify

During treatment, the stage of HF is maintained, and FC changes, indicating the effectiveness of the therapy.

When formulating a diagnosis, it was decided to combine the definition of the stage and functional class of chronic heart failure - for example: coronary artery disease, chronic heart failure stage IIB, FC II; Hypertrophic cardiomyopathy, chronic heart failure stage IIA, FC IV.

Clinical picture

Patients complain of general weakness, decreased or lost ability to work, shortness of breath, palpitations, decreased daily urine output, and swelling.

Dyspnea associated with stagnation of blood in the pulmonary circulation, which prevents sufficient oxygen supply to the blood. In addition, the lungs become rigid, which leads to a decrease in respiratory excursion. The resulting hypoxemia leads to insufficient oxygen supply to organs and tissues, increased accumulation of carbon dioxide and other metabolic products in the blood that irritate the respiratory center. As a result, dyspnoe and tachypnoe occur.

First, shortness of breath occurs during physical exertion, then at rest. It is easier for the patient to breathe in an upright position; in bed, he prefers a position with the head of the bed raised high, and with severe shortness of breath, he takes a sitting position with his legs down (orthopnea position).

With congestion in the lungs, a cough occurs that is dry or produces mucous sputum, sometimes mixed with blood. Congestion in the bronchi can be complicated by the addition of infection and the development of congestive bronchitis with the release of mucopurulent sputum. Percussion A boxy tone of sound is detected above the lungs. Sweating of transudate, which, due to gravity, descends into the lower parts of the lungs, will cause dullness of the percussion sound. Auscultation: Hard breathing is heard above the lungs, and weakened vesicular breathing is heard in the lower parts. In these same sections, small- and medium-bubbling dull moist rales can be heard. Prolonged stagnation in the lower parts of the lungs leads to the development of connective tissue. With such pneumosclerosis, wheezing becomes persistent and very rough (crackling). Due to hypoventilation and stagnation of blood in the lower parts of the lungs against the background of a decrease in the body's defenses, infection easily attaches - the course of the disease is complicated by hypostatic pneumonia.

Changes in the heart: enlarged, the boundaries are shifted to the right or left depending on the insufficiency of the left or right ventricle. With prolonged total heart failure, there may be a significant increase in the size of the heart with displacement of the boundaries in all directions, up to the development of cardiomegaly (cor bovinum). On auscultation, dull tones, gallop rhythm, systolic murmur above the apex of the heart or at the xiphoid process, which occurs due to relative insufficiency of the atrioventricular valves.

A common symptom of HF is tachycardia. It serves as a manifestation of the compensatory mechanism, providing an increase in blood IOC. Tachycardia can occur during physical activity and continues even after it stops. Subsequently it becomes permanent. HELL decreases, diastolic remains normal. Pulse pressure decreases.

Heart failure is characterized by peripheral cyanosis- cyanosis of the lips, earlobes, chin, fingertips. It is associated with insufficient oxygen saturation of the blood, which is intensively absorbed by the tissues with slow blood movement in the periphery. Peripheral cyanosis is “cold” - the limbs and protruding parts of the face are cold.

A typical and early symptom of congestion in the systemic circulation is liver enlargement as CH increases. At first, the liver is swollen, painful, its edge is rounded. With prolonged stagnation, connective tissue grows in the liver (liver fibrosis develops). It becomes dense, painless, and its size decreases after taking diuretics.

In cases of congestion in the systemic circulation, blood overflowXvenous veins The swelling of the neck veins is best seen. Swollen veins in the arms are often visible. Sometimes the veins swell in healthy people when their arms are lowered, but when they raise their arms they collapse. With heart failure, the veins do not collapse even when they are raised above the horizontal level. This indicates an increase in venous pressure. The jugular veins may pulsate, and sometimes a positive venous pulse is observed, synchronous with ventricular systole, which indicates relative tricuspid valve insufficiency.

As a result of slowing blood flow in the kidneys, their water-excretory function decreases. Arises oliguria, which can be of different sizes, but as the disease progresses, daily diuresis decreases to 400-500 ml per day. Observed nocturia- the advantage of night diuresis over daytime, which is associated with improved heart function at night. The relative density of urine increases, congestive proteinuria and microhematuria are detected.

One of the most common symptoms of blood stagnation in the systemic circulation is swelling that is localized in the lower sections, starting from lower extremities. In the initial stages - in the area of ​​the ankles and feet. As heart failure progresses, swelling spreads to the legs and thighs. Then they appear in the subcutaneous tissue of the genitals, abdomen, and back. If the patient spent a lot of time in bed, the early localization of edema is the lower back and sacrum. With large edema, they spread to the subcutaneous tissue of the entire body - anasarca occurs. The head, neck, and the uppermost part of the body remain free from edema. In the initial stages of heart failure, edema appears at the end of the day and disappears by morning. Hidden edema can be judged by an increase in body weight, a decrease in daily diuresis, and nocturia. Cardiac edema is inactive. They change their localization little when the patient's position changes. Dense swelling persists for a long time. They become especially dense on the legs when they develop in areas of connective tissue swelling. As a result of trophic disorders, mainly in the area of ​​the legs, the skin becomes thin, dry, and pigmented. Cracks form in it, and trophic ulcers may occur.

Hydrothorax(sweating into the pleural cavity). Since the pleural vessels belong to both the large (parietal pleura) and small (visceral pleura) circles of blood circulation, hydrothorx can occur when blood stagnates in both one and the second circle of blood circulation. Constricting the lung, and sometimes displacing the mediastinal organs under pressure, it worsens the patient’s condition and increases shortness of breath. The fluid taken by pleural puncture gives indicators characteristic of transudate - relative density less than 1015, protein - less than 30 g/l, negative Rivalta test.

Transudate can also accumulate in the pericardial cavity, constricting the heart and complicating its work (hydropericardium).

When blood stagnates in the stomach and intestines, stagnant gastritis and duodenitis can develop. Patients feel discomfort, heaviness in the stomach, nausea, sometimes vomiting, bloating, loss of appetite, and constipation.

Ascites occurs as a result of the release of transudate from the gastrointestinal tract into the abdominal cavity with increased pressure in the hepatic veins and veins of the portal system. The patient feels heaviness in the abdomen, it is difficult for him to move with a large accumulation of fluid in the abdomen, which pulls the patient’s torso forward. Intra-abdominal pressure increases sharply, as a result of which the diaphragm rises, constricts the lungs, and changes the position of the heart.

Due to hypoxia of the brain, patients experience rapid fatigue , headache, dizziness, sleep disorders(insomnia at night, drowsiness during the day), increased irritability, apathy, depression, sometimes agitation occurs, reaching the point of psychosis.

With long-term heart failure, a disorder of all types of metabolism develops, resulting in weight loss, which turns into cachexia, the so-called cardiac cachexia. In this case, swelling may decrease or disappear. There is a decrease in muscle mass. With severe congestion, the ESR slows down.

Objective clinical signs of CHF

Bilateral peripheral edema;

Hepatomegaly;

Swelling and pulsation of the neck veins, hepatojugular reflux;

Ascites, hydrothorax (bilateral or right-sided);

Listening to bilateral moist rales in the lungs;

Tachypnea;

Tachysystole;

Alternating pulse;

Expansion of the percussion boundaries of the heart;

III (protodiastolic) tone;

IV (presystolic) tone;

Accent of tone II over LA;

Decreased nutritional status of the patient during general examination.

Symptoms most characteristic of:

Left ventricular HF Right ventricular HF

orthopnea (sitting with lowered yoga) - enlarged liver

crepitus - peripheral edema

wheezing - nocturia

bubbling breathing - hydrothorax, ascites

Diagnostics

laboratory: natriuretic peptide level

instrumentalO - radiography and echocardiography.

For congestion in the lungs radiographically an increase in the roots of the lungs, an increase in the pulmonary pattern, and a blurred pattern due to edema of the perivascular tissue are detected.

A very valuable method in the early diagnosis of heart failure is echocardiography and echocardioscopy. Using this method, you can determine the volume of the chambers, the thickness of the walls of the heart, calculate the MO of the blood, the ejection fraction, and the rate of contraction of the circular fibers of the myocardium.

Differential diagnosis necessary when fluid accumulates in the pleural cavity to resolve the issue of hydrothorax or pleurisy. In such cases, it is necessary to pay attention to the localization of the effusion (unilateral or bilateral localization), the upper level of fluid (horizontal - with hydrothorax, Damoiseau line - with pleurisy), the results of the puncture test, etc. The presence of moist fine- and medium-bubble rales in the lungs in some cases, it requires a differential diagnosis between congestion in the lungs and the addition of hypostatic pneumonia.

A large liver may necessitate a differential diagnosis with hepatitis and liver cirrhosis.

Edema syndrome often requires a differential diagnosis with varicose veins, thrombophlebitis, lymphostasis, and benign hydrostatic edema of the feet and legs in elderly people, which are not accompanied by liver enlargement.

Renal edema differs from cardiac edema in localization (cardiac edema is never localized in the upper part of the body and on the face - a characteristic localization of renal edema). Renal edema is soft, mobile, easily displaced, the skin above it is pale, and above the cardiac edema it is bluish.

Flowchronicheart failure

Chronic HF progresses, moving from one stage to another, and this happens at different rates. With regular and proper treatment of the underlying disease and HF itself, it can stop at stage 1 or 2A.

During HF there may be exacerbations. They are caused by various factors - excessive physical or psycho-emotional overload, the occurrence of arrhythmias, in particular, frequent, group, polymorphic extrasystolic arrhythmia, atrial fibrillation; suffered from ARVI, influenza, pneumonia; pregnancy, which creates increased stress on the heart; consumption of significant amounts of alcoholic beverages, large volumes of liquid taken orally or administered intravenously; taking certain medications (drugs of negative) inotropic action - beta-blockers, calcium antagonists of the verapamil group, some antiarrhythmic drugs - etatsizin, procainamide, disopyramide, etc., antidepressants and neuroleptics (aminazine, amitriptyline); drugs that retain sodium and water - non-steroidal anti-inflammatory drugs, as well as hormonal drugs (corticosteroids, estrogens, etc.).