What Is Heart Failure?

Heart failure (heart failure) is referred to as heart failure. Cardiac circulatory disorder syndromes, which are manifested as pulmonary congestion and vena cava congestion. Heart failure is not an independent disease, but an end stage of the development of heart disease. Most of these heart failures start with left heart failure, which first appears as pulmonary circulation congestion.

Basic Information

nickname

Congestive heart failure, cardiac insufficiency, weak heart, systolic heart failure

English name

heart failure

Visiting department

Cardiology

Common symptoms

Difficulty breathing, fatigue, fluid retention

Causes of heart failure

Basic cause

Almost all cardiovascular diseases will eventually lead to heart failure. Myocardial damage caused by any cause such as myocardial infarction, cardiomyopathy, overload of hemodynamics, inflammation, etc., can cause changes in myocardial structure and function, and finally lead to ventricles. Poor pumping and / or filling function.

Predisposing factor

On the basis of basic heart disease, some factors can induce the occurrence of heart failure. Common causes of heart failure are as follows:

(1) Infections such as respiratory infections and rheumatic activities.

(2) Severe arrhythmia, especially tachyarrhythmia such as atrial fibrillation, paroxysmal tachycardia, etc.

(3) Increased heart load Pregnancy, childbirth, excessive and rapid infusions, excessive intake of sodium, etc. lead to increased heart load.

(4) Drug effects, such as digitalis poisoning or inappropriate discontinuation of digitalis.

(5) Improper activity and emotion Excessive physical activity and emotional excitement.

(6) Other diseases such as pulmonary embolism, anemia, and papillary muscle dysfunction.

Heart failure classification

According to the emergence of heart failure, clinical can be divided into acute heart failure and chronic heart failure. According to the site where heart failure occurs, it can be divided into left heart, right heart, and total heart failure. There are also systolic or diastolic heart failure.

Acute heart failure

It refers to acute pulmonary congestion, pulmonary edema, and associated tissue and organ perfusion caused by acute myocardial damage or increased heart load, which causes a sudden decrease in acute cardiac output, increased pulmonary circulation pressure, and increased peripheral circulation resistance. The clinical syndrome of insufficiency and cardiogenic shock is most common in acute left heart failure. Acute heart failure can be exacerbated on the basis of the original chronic heart failure, or it can start suddenly in the heart with normal heart function or in the compensatory period. Most patients with organic cardiovascular disease before the onset of the disease are common in acute myocarditis, generalized myocardial infarction, obstruction of ventricular outflow tract, main pulmonary artery or large branch infarction. It can be expressed as systolic heart failure or diastolic heart failure. Acute heart failure is often life-threatening and must be rescued urgently.

2. chronic heart failure

Refers to a state of persistent heart failure that can stabilize, worsen, or be decompensated. Chronic heart failure is an end stage of heart disease caused by various etiologies, and it is a complex clinical syndrome. The main features are dyspnea, edema, and fatigue, but the above manifestations do not occur simultaneously. Compensated cardiac enlargement or hypertrophy and other compensatory mechanisms are generally involved, often accompanied by congestive pathological changes in organs caused by increased venous pressure, and there may be atrial, ventricular mural thrombosis and venous thrombosis. The causes of chronic heart failure in adults are mainly coronary heart disease, hypertension, valvular disease, and dilated cardiomyopathy.

Clinical manifestations of heart failure

Acute heart failure

(1) Early manifestations Early signs of decreased left ventricular function are fatigue in normal heart function, markedly reduced exercise endurance, and an increase in heart rate of 15-20 beats / min, followed by exertional dyspnea, paroxysmal dyspnea at night, and high pillow sleep Examinations showed enlarged left ventricle, early or middle diastolic galloping, wet rales, dry rales, and wheezing at the bottom of both lungs.

(2) The acute onset of acute pulmonary edema can quickly progress to a critical condition. Sudden severe dyspnea, sitting breath, wheezing, irritability and fear, breathing frequency can reach 30-50 times / min; frequent coughing and a lot of pink foam-like sputum; fast heart rate, constant apex The rhythm of running horses is audible; wet lungs and wheeze are heard in both lungs.

(3) Cardiogenic shock 1) Hypotension For more than 30 minutes, the systolic blood pressure drops below 90 mmHg, or the systolic blood pressure of patients with original hypertension decreases 60 mmHg. 2) Tissue hypoperfusion: skin is cold, pale, and cyanosis with purple streaks; tachycardia is> 110 beats / min; urine output is significantly reduced (<20ml / h), even without urine; disturbance of consciousness, often irritability Anxiety, agitation, anxiety, fear, and dying; systolic blood pressure below 70mmHg may cause suppression symptoms, and gradually develop into consciousness or even coma. 3) Hemodynamic disorder PCWP18mmHg, cardiac excretion index (CI) 36.7ml / s · m (2.2L / min · m). 4) Metabolic acidosis and hypoxemia

2. chronic heart failure

(1) Symptoms and signs of left heart failure Most patients with left heart failure seek medical attention due to decreased exercise tolerance and breathing difficulties or fatigue. These symptoms can occur during rest or exercise. Multiple diseases may be present in the same patient.

Dyspnea is the main symptom of left heart failure, which can be manifested in various forms such as exertional dyspnea, sitting breathing, paroxysmal nocturnal dyspnea and the like. Decreased exercise endurance and fatigue are manifestations of insufficient blood supply to skeletal muscle. Chen-Shi breathing can occur in patients with severe heart failure, suggesting a poor prognosis. Examination of the heart, in addition to the original signs of heart disease, you can also find that the left ventricle is enlarged, the pulse strength is alternated, and auscultation can be heard and lung snoring.

(2) Symptoms and signs of right heart failure are mainly manifested as changes in various organ functions caused by chronic and persistent congestion. Patients may develop abdominal or leg edema, and seek medical treatment based on this as the first or only symptom. Impairment of exercise tolerance is gradually What happens may not get the patient's attention unless the changes in daily life ability are carefully inquired. Examination of the heart, in addition to the original signs of heart disease, can also find the heart enlargement, jugular vein filling, liver enlargement and tenderness, cyanosis, drooping edema and pleural and ascites.

(3) Symptoms and signs of diastolic heart failure Diastolic heart failure refers to the condition that the ventricular systolic function is normal (LVEF> 40% to 50%), and the decrease in ventricular relaxation and compliance reduces the ventricular filling volume and filling pressure Elevation, resulting in congestion of the pulmonary and systemic circulation. The initial symptoms are not obvious. As the disease progresses, there may be decreased exercise tolerance, shortness of breath, and pulmonary edema.

Heart failure check

Electrocardiogram

Can often prompt the primary disease.

2.X-ray inspection

May show pulmonary congestion and pulmonary edema.

3. Echocardiography

You can understand the structure and function of the heart, the status of heart valves, the presence of pericardial disease, mechanical complications of acute myocardial infarction, wall motion disorders, and left ventricular ejection fraction.

4. Arterial blood gas analysis

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

5. Laboratory inspection

Blood routine and blood biochemical tests, such as electrolytes, renal function, blood glucose, albumin, and high-sensitivity C-reactive protein.

6. Heart failure markers

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

7. Myocardial necrosis markers

The markers with high specificity and sensitivity for detecting myocardial damage are cardiac troponin T or I (CTnT or CTnI).

Heart failure diagnosis

According to the patient's history of basic cardiovascular diseases such as coronary heart disease, hypertension, clinical symptoms of dyspnea, fatigue, and lower limb edema during rest or exercise, tachycardia, shortness of breath, lung snoring, pleural effusion, Signs of increased jugular vein pressure, peripheral edema, and liver enlargement, including enlarged heart chambers, third heart sounds, heart murmurs, abnormal echocardiograms, and elevated natriuretic peptide (BNP / NT-proBNP) levels, etc. Evidence that a diagnosis of systolic or diastolic heart failure is characteristic.

Heart failure treatment

Acute heart failure

Once diagnosed, it should be treated according to specifications.

(1) The initial treatment is to inhale oxygen through a mask or nasal cannula; morphine, diuretics, cardiotonics, etc. are given intravenously. The patient is placed in a sitting or semi-recumbent position with the legs drooping to reduce venous return in the lower limbs.

(2) Those who are still not relieved should choose to apply vasoactive drugs, such as positive inotropic drugs, vasodilators and vasoconstrictors, according to systolic blood pressure and pulmonary congestion.

(3) Patients with severe illness, continuous lowering of blood pressure (<90mmHg), and even cardiogenic shock should monitor hemodynamics and use intra-aortic balloon counterpulsation, mechanical ventilation support, blood purification, ventricular mechanical assist devices and surgery Various non-drug treatment methods such as surgery.

(4) Dynamic determination of BNP / NT-proBNP can help guide the treatment of acute heart failure, and those whose levels are still high after treatment, suggesting that the prognosis is poor, and treatment should be strengthened; after treatment, its level decreases and the decrease is> 30%, which indicates treatment Effective and good prognosis.

(5) Control and eliminate various incentives, and timely correct underlying cardiovascular disease.

2. chronic heart failure

The treatment of chronic heart failure has changed from short-term hemodynamic / pharmacological measures such as diuresis, cardiac strengthening, and vasodilation to long-term, repairing strategies, mainly neuroendocrine inhibitors, with the goal of changing the biology of the heart that fails. Nature.

(1) Etiological treatment To control hypertension, diabetes and other risk factors, use antiplatelet drugs and statin lipid-modulating drugs for secondary prevention of coronary heart disease. Eliminate the causes of heart failure, control infections, treat arrhythmias, and correct anemia and electrolyte disorders.

(2) Improve symptoms Adjust the dosage of diuretics, nitrates and cardiotonics according to the condition.

(3) Correct use of neuroendocrine inhibitors from small doses to the target dose or the maximum dose that the patient can tolerate.

(4) Monitoring drug response Those with reduced sodium and sodium retention can gradually reduce the diuretic dose or low-dose maintenance treatment, and it is difficult to stop the drug completely at an early stage. Daily weight change is a reliable indicator of diuretic effect and dose adjustment, and early detection of body fluid retention. During diuretic therapy, sodium intake should be limited (<3g / d). Patients using positive inotropic drugs can be changed to digoxin after discharge. Digoxin is discontinued in patients with repeated symptoms of heart failure, which may lead to increased heart failure. If anorexia, nausea, and vomiting occur, digoxin concentration should be measured or the drug should be tentatively discontinued. Angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor antagonist (ARB) increase the dose every 1 to 2 weeks, while monitoring blood pressure, blood creatinine and blood potassium levels, if blood creatinine significantly increases > 265.2mol / L (3mg / dl)], hyperkalemia (> 5.5mmol / L) or symptomatic hypotension (systolic blood pressure <90mmHg) should be stopped ACEI (or ARB). Patients with stable disease, no fluid retention, and heart rate 60 beats / min can gradually increase the dose of -blockers. If the heart rate is <55 beats / min or accompanied by dizziness, the dose should be reduced.

(5) Monitoring frequency Patients should self-test daily weight, blood pressure, heart rate and register. Follow-up visits every two weeks after discharge from the hospital, observe the symptoms and signs and review blood biochemistry, adjust the type and dose of drugs. After a stable condition for 3 months and the drug reaches the optimal dose, follow-up visits are made monthly.

Heart failure daily care

1. General patients should adopt high pillow sleep; heavier patients should adopt semi-recumbent or sitting position.

2. Restrict physical activity. Patients with severe heart failure are mainly bed rest; after cardiac function is improved, they should get out of bed to prevent lower limb thrombosis and lung infection.

3. Be sure to quit smoking and alcohol, maintain a balance of mind, and also ensure adequate sleep.

4. Small meals, low-salt diet, daily salt should not exceed 5 grams.

5. Take medicine according to doctor's advice; prevent respiratory infections; women of childbearing age should do contraception well.