What Are the Congestive Heart Failure Stages?

Heart failure is due to the ventricular pumping or filling function is low, the cardiac output can not meet the needs of the body's metabolism, insufficient blood perfusion of tissues and organs, and the occurrence of pulmonary circulation and / or systemic congestion. Disease, also known as congestive heart failure (CHF). It is characterized by left ventricular hypertrophy or dilatation, leading to neuroendocrine disorders, circulatory abnormalities, and typical clinical symptoms: dyspnea, fluid retention, and fatigue (especially during exercise). During the development of the disease, clinical symptoms may change significantly, and may not be consistent with cardiac function. If left untreated or untreated, the symptoms of cardiac insufficiency will continue to worsen.

Basic Information

English name

congestiveheartfailure

Visiting department

cardiology

Multiple groups

Heart patient

Common symptoms

Dyspnea, fatigue, edema, symptoms of heart disease, worsening heart failure

Causes of congestive heart failure

Most patients have a history of heart disease, and effective treatment of the cause can improve the prognosis of heart failure. Coronary heart disease, hypertension, and senile degenerative heart valve disease are the main causes of elderly patients with heart failure, while rheumatic heart valve disease, dilated cardiomyopathy, and acute severe myocarditis cause young patients with heart failure. Coronary heart disease is the most common cause of systolic heart failure. Active revascularization can prevent the development and worsening of heart failure. Hypertension is a common cause of diastolic (or normal ejection fraction) heart failure. Active control of blood pressure is extremely important, otherwise heart failure progress Faster and induces acute heart failure.

Clinical manifestations of congestive heart failure

Dyspnea and fatigue

Most patients with heart failure seek medical attention due to dyspnea or fatigue due to decreased exercise tolerance. Severe cases also have symptoms under rest conditions, and can also wake up at night.

2. Lower limb edema

Patients may have symptoms of fluid retention, such as leg or abdominal edema, and use this as their first or only symptom. Impairment of exercise tolerance in these patients is gradual.

3. Asymptomatic or other symptoms caused by heart disease or non-heart disease

Examination of acute myocardial infarction, arrhythmia, or other diseases such as thromboembolic diseases of the lungs or the body revealed these patients with enlarged or insufficiency of the heart.

4. Early manifestations of worsening heart failure

The early signs of reduced left ventricular function are: when the original cardiac function is normal, unexplained fatigue or decreased exercise endurance, and an increase in heart rate of 15-20 beats / min. If you continue to develop, you will need to raise your head with a pillow when you sleep, labor dyspnea, and paroxysmal dyspnea at night. On examination, you can see that the left ventricle is enlarged, and the early or mid-diastolic galloping is smelled. Wet snoring, but also dry wheezing and wheezing, suggesting left ventricular dysfunction.

5. Acute pulmonary edema

Sudden onset and rapid development of the condition. Sudden severe shortness of breath, side-by-side breathing, irritability with fear, breathing frequency up to 30-50 beats / min; frequent coughing and a large amount of pink foam-like sputum; auscultation heart rate is fast, often apical Running horse law; wet lungs and wheezing sounds in both lungs.

Congestive heart failure examination

Electrocardiogram

Primary diseases can often be found.

2.X-ray inspection

Pulmonary congestion and pulmonary edema can be seen.

3. Echocardiography

Can understand the structure, function, heart valve status of the heart, the presence of pericardial disease, mechanical complications of acute myocardial infarction, dyskinesia of the wall; LVEF can be measured.

4. Arterial blood gas analysis

Monitor arterial oxygen partial pressure (PaO ₂ ) and carbon dioxide partial pressure (PaCO ₂ ).

5. Laboratory inspection

Including blood routine and blood biochemical tests, such as electrolytes, liver function, kidney function, blood glucose, albumin and high-sensitivity C-reactive protein.

6. Heart failure markers

The accepted and objective indicators for clinical diagnosis of heart failure are increased concentrations of B-type natriuretic peptide (BNP) and N-terminal B-type natriuretic peptide (NT-proBNP).

Diagnosis of congestive heart failure

Have a history of basic cardiovascular diseases such as hypertension, coronary heart disease, typical symptoms of dyspnea, fatigue, ankle edema during rest or exercise, tachycardia, enlarged heart cavity, third heart sound, heart murmur, shortness of breath, Typical signs of lung snoring, pleural effusion, increased jugular vein pressure, peripheral edema, and liver enlargement, with echocardiographic abnormalities, enlarged left ventricle, increased left ventricular end-systolic volume, LVEF45%, natriuretic peptide Objective evidence of elevated (BNP / NT-proBNP) levels and abnormalities in cardiac structure or function.

The New York Heart Association NYHA grades the severity of chronic heart failure as: level , no symptoms of heart failure in daily activities; level , symptoms of heart failure in daily activities (dyspnea, fatigue); level , heart failure below daily activities Symptoms: Grade IV, symptoms of heart failure at rest.

Congestive heart failure treatment

Conventional treatment of heart failure is a combination of three types of drugs, diuretics, ACEI (or ARB) and beta blockers. Digoxin is used as a fourth type of combination drugs to further improve symptoms and control heart rate. Aldosterone receptor antagonists are used in patients with severe heart failure.

Cause treatment

Control of hypertension, diabetes and other risk factors, treatment with antiplatelet and statin lipid-lowering drugs, and secondary prevention of coronary heart disease;

2. Improve symptoms

Adjust the use of diuretics, digitalis and nitrates according to the condition;

3. Neuroendocrine inhibitors

It should be gradually increased from a small dose to the target dose or the maximum dose that the patient can tolerate;

4. Drug response monitoring

After the water and sodium retention subsides, the amount of diuretics can be gradually reduced or maintained in small doses. At the same time, hypokalemia can be prevented, and sodium intake (days) can be restricted. The most reliable indicator of diuretic effect and dose adjustment is the daily weight change, which can detect early fluid retention. For patients with decompensation period, the intravenous inotropic drug was changed to digoxin (0.125 mg / d in elderly patients). Heart failure occurs repeatedly. If digoxin is stopped, heart failure will worsen. If symptoms of anorexia, nausea, and vomiting occur, digoxin should be discontinued or the digoxin concentration monitored. Increase ACEI (or ARB) dose every 1 to 2 weeks, pay attention to monitoring serum potassium, blood pressure, and serum creatinine levels. When serum creatinine increases [> 265.2 mol / L (3mg / dl)], hyperkalemia (> 5.5 mmol / L) or hypotension (systolic blood pressure <90mmHg), ACEI (or ARB) should be discontinued. For patients with stable disease, no fluid retention, and heart rate 60 beats / min, increase the amount of -blockers every 2 weeks, heart rate <55 beats / min or accompanied by dizziness, etc., should be reduced.

5. Monitoring frequency

Patients should self-test blood pressure, heart rate, weight and record daily. Follow-up visits every two weeks after discharge from the hospital, observe the changes in symptoms and signs, and conduct a biochemical review of blood, and adjust the type and dose of the drug accordingly. After a stable condition for 3 months, you can return to the clinic once a month.

Congestive heart failure prevention

Patients with chronic heart failure also need to cooperate to improve their compliance.

1. Understand the treatment goals in different periods, follow up regularly, follow the doctor's advice, and take drugs rationally.

2. Understand the basic knowledge of heart failure, and see a doctor promptly if there is a problem: weight gain, lower limb edema, fatigue, decreased exercise tolerance (shortness of breath after exercise), increased heart rate (rest increased 15-20 times / minute), or slow (55 beats / minute), continuous decrease or increase in blood pressure (> 130 / 80mmHg), arrhythmia, etc.

3. According to the condition, master the method of adjusting diuretics.

4. Daily weight measurement, salt, water (<2 liters of liquid per day), smoking cessation, and alcohol limit. Avoid stress, such as fatigue, emotional excitement, and stress. Appropriate exercise, walking 30 minutes a day, insisting on 5 to 6 days a week, and gradually increase the amount. Avoid colds, respiratory infections, and various other infections. The unauthorized use of non-steroidal anti-inflammatory drugs, hormones, and other antiarrhythmic drugs is prohibited.