Description heart failure
Heart failure occurs on average about 2% of the population. Incidence rises from a low occurrence at a young age after values of over 10% in advanced age.
To understand the subject is required at least a minimal knowledge of blood perfusion in a human body. Vasculature is divided into small and large circulation. In a small circulation (pulmonary) blood is oxygenated and large circulation (body) is supplied with oxygenated blood to the entire body. Heart operates as a pump. The left half of the heart pumps the blood from the small blood circulation through the body and right half of the pumped blood returning from the body into the pulmonary circulation. Heart failure refers to a state in which the heart ceases to cope perform its function of a pump. It is not sufficient to pump the blood, and it is therefore sometimes accumulates and on the contrary, I am missing somewhere. This apparently simple definition explains most of the symptoms and complications of heart failure.
For cardiac section that fails is lack of blood (decrease cardiac output). This results in a decrease in arterial (arterial) blood pressure. Blood accumulates before failing section and thereby increasing venous (venous) blood pressure. According to what prevails, it is possible to simplify failure divided to heart failure forward (forward) and heart failure, backward (backward). Both component failure always occur simultaneously, only the ratio of individual patients vary. Similar terms have the meanings systolic dysfunction (inability to deliver a sufficient volume of blood in circulation) and diastolic dysfunction (inability of heart section is enough to meet most often fail their expansion).
Because the right and left half of the heart have different conditions, resulting from a different connection to the small and large blood circulation, may fail separately the left or right side. We therefore, left-sided and right-sided heart failure.
Very important is also divided into acute heart failure and chronic heart failure. Acute heart failure may be newly infiltrated arrhythmias, can build on longer-lasting heart disease, or in terms of acute exacerbation of chronic heart failure. The circulatory system has called. Compensatory mechanisms, when the engagement condition of the patient is adjusted. If not enough, the patient dies. Involvement of compensatory mechanisms help the short run, but the action of the heart in the new conditions is difficult, and later still requires additional compensation. Acute heart failure thus passes in chronic heart failure. Compensatory mechanisms are limited, so one reaches the chronic failure to acute failure and death (decompensation). Sample course of the patient can thus eg. Look: acute myocardial infarction – acute heart failure -zapojení compensatory mechanisms – chronic heart failure – (there may be previous three points several times) – acute heart failure – death.
Prognosis failure is unfavorable. In acute heart failure must be nearly half of patients hospitalized again within a year. Within one year die up to 40% of patients. In chronic heart failure patients die about half in 5-8 years.
Causes of heart failure
The cause of heart failure is often damage to the heart muscle (cardiac section has a reduced ability to download and eject blood), increased connective tissue in the heart wall (scars after myocardial infarction, diseases with increased connective tissue), where the cardiac chambers are unable to expand and to absorb a sufficient amount of blood and last but not least, cardiac arrhythmia, which does not work properly filling or expelling blood.
The acute heart failure is mainly caused by disturbances in the circulatory system. They’re exhausted compensatory mechanisms in chronic heart failure, cardiac arrhythmias, cardiomyopathy, myocardial infarction, aneurysm (dissection) of the aorta, hypertensive crisis (sudden significant increase in blood pressure), cardiac tamponade (drudges heart in its packaging penetration of fluids, such as blood). Other causes are sudden need for high cardiac output (such as sepsis), asthma, acute embolization into the lungs.
The causes of chronic heart failure and its degradation leads preceding acute failure, ischemic heart disease, rheumatic diseases, infectious diseases, metabolic diseases, endocrine disorders, and many risk factors.
Risk factors for heart failure
Risk factors can include almost anything that causes so. Diseases of civilization. They especially stress, alcohol, smoking, poor dietary habits, little exercise etc.
Risk for increased load of the heart muscle is excessive physical or mental stress, anemia(present few red blood cells able to bind oxygen and is necessary to speed up the circulation of blood), excessive drinking (in volume terms imbibed fluids – increases the amount of circulating fluid and the heart must work more), pregnancy, infectious diseases, excessive salting. The big risk is the development of atherosclerosis (hardening of the arteries) and its related factors (cholesterol, diabetes, poor dietary habits, low physical activity, obesity). With atherosclerosis related recurrent myocardial infarction, cerebrovascular accident (CVA) and coronary artery disease who also have a significant influence on the state of the circulatory system. Other risk factors are untreated or untreatable cardiac arrhythmias, damage to the heart valves (narrowing or stenosis of the valve increases the resistance that has in its work cardiac section front flap overcome the inadequacy or insufficiency valve allows return once ejected blood back to the heart section and so adds bulk load).
A risk factor is a cancer and other ongoing diseases especially among the elderly, who suffer from multiple diseases at once (polymorbidity). There is added and the adverse impact of certain drugs on the heart muscle (cardiotoxic unwanted side effects of drugs).
The biggest risk factors include alcohol, abuse drugs or conversely non-use of drugs (elderly, non-therapeutic measures).
A major role is also played a positive family history of cardiovascular problems (confirmed family history of heart disease or blood vessel).
Prevention of heart failure
Prevention is to eliminate as many risk factors and treatment of disease susceptibility. The easiest prevention is lifestyle change toward prevention of atherosclerosis, obesity and high blood pressure, which can make patients themselves. It is also important to avoid stressful situations and devote enough attention to psychological difficulties.
Symptoms of heart failure
Acute heart failure
For right-sided failure is a typical symptom jugular vein distension (increased filling jugular vein, hepatojugulární reflex), which is due to accumulation of blood in front of a failing heart. It is to increase central venous pressure.
For left-sided failure is a typical symptom of dyspnea, orthopnea (shortness of preventing the victim lying, the patient is forced to sit or stand, is typical nightly occurrence) and the cartilage while listening to the lungs. All this is due to accumulation of blood in front of left heart, thus the lungs (congestive failure).
Chronic heart failure
Chronic heart failure show especially symptoms such as shortness of breath, fatigue and typical findings listening to the heart and lungs. The lungs are audible wheeze of cartilage and is present tachypnea (high respiratory rate). Heart hear III and IV heart sound, which is not normally audible.Is present tachycardia (increased heart rate). May be present in cardiac arrhythmias. Usually found hydrothorax (fluid in the pleural cavity or pleural) and ascites (fluid in the abdominal cavity). You can feel an enlarged liver (hepatomegaly) and are visible swelling of the lower extremities.
Treatment of heart failure
Therapy varies according to the origin and severity of heart failure according to the overall condition of the patient.
Acute heart failure
Primarily attempt is made to eliminate the underlying cause, if possible. It is monitored by oxygen saturation (check whether the amount of oxygen in the blood in the right range) and is optionally supported by ventilation. Of the medicaments are used vasodilators, anticoagulants, diuretics, nitrates, dopamine, dobutamine, epinephrine, norepinephrine, cardiac glycosides, in some cases morphine. Drugless treatment includes surgery, the use of mechanical heart support and heart transplantation.
Chronic heart failure
Therapy has a medical component, drugless and lifestyle change. Medical therapy includes mainly ACE inhibitors, diuretics furthermore, ARBs, renin inhibitors, β blockers, anticoagulants, antiplatelet agents, antiarrhythmics. Drugless therapy involves cardiomyoplasty, permanent pacemaker, intra-aortic balloon counterpulsation, a mechanical heart support and heart transplantation.
How can I help myself
The patient can best help themselves by changing lifestyle and changing dietary habits. Patients should limit the amount of consumed salt and fluids. You must be limited to completely eliminate alcohol and smoking. It is suitable for obese patients reduce weight. Very useful is the inclusion of physical activity into the daily routine. It is important to avoid stressful situations, excessive mental and physical stress. It is also not good long-term static loads (e.g. trimming hedge pruners etc.).
Complications of heart failure
Increased fatigue inability to normal daily activities, loss of appetite, depression and other mental disorders, weakness, dizziness, permanent organ damage congestion of blood (especially the lungs, liver) and ischaemia (kidney). The most serious complication is death.
Other names: Cardiac insufficiency, cardiac failure, Heart Silurian, cardiac dysfunction, ventricular dysfunction, systolic dysfunction, diastolic dysfunction, cardiac insufficiency, cardiac insufficiency, cardiac insufficiency, cardiac failure, cardiac failure