Heart failure

Heart failureHEART FAILURE (HF) is a pathological condition caused by failure of the heart as a pump that provides adequate circulation. Manifestation and a consequence of pathological conditions that affect the myocardium or hindering the work of the heart: coronary heart disease, heart disease, hypertension, diffuse lung disease, myocarditis, myocardial degeneration (including thyroid, sports and others), myocardiopathy (including alcohol) and other Heart failure acute or actual acute or acute manifestations of chronic CH. Cm. also Cardiac asthma, pulmonary edema. About the pathogenesis and acute SN see also below in the description of chronic CH. Heart failure chronic. The pathogenesis. The consequence and manifestation of SN is the increase or decrease of the blood supply, blood flow and / or pressure in one or other of the Central and peripheral parts of the circulation. These changes occur not only as a direct mechanical consequence of a failure of the pump function of the heart, but also as a result of the inadequacy of adaptive reactions. Such reactions include the and bradycardia, changes in peripheral vascular and pulmonary resistance, centralization of blood circulation and other forms of redistribution of blood, fluid retention, sodium, hypertrophy and expansion of the private chambers of the heart and other Disorders of hemodynamics in turn lead to pathological changes in the heart and blood vessels, and other organs and systems and are accompanied by disorders that limit the life activity of the patient and, ultimately, threatening his life. Symptoms within different for different forms and stages of CH. Clinical forms: 1. Congestive left ventricular failure characteristic of the mitral valve, for severe forms of coronary artery disease especially in patients with arterial hypertension. Increased pressure in the pulmonary veins contributes to the filling of the left ventricle and maintaining adequate cardiac output. At the same time, congestive changes in the lungs impair the respiratory function and are a major factor aggravating the patient's condition in this form of CH. Symptoms: dyspnea, orthopnea, signs of stagnation in the lungs auscultation (dry rales below the shoulder blades, migratory moist rales) and x-ray, cardiac asthma and pulmonary edema, secondary pulmonary hypertension, tachycardia. 2. Left ventricular failure ejection characteristic of aortic lesions (see), ischemic heart disease, arterial hypertension. Symptoms: cerebral circulation insufficiency (dizziness, blackout, fainting), coronary insufficiency, sphygmographic and echocardiographic priznaki low emissions. In severe cases, possible breathing of Cheyne - Stokes equations, alternating pulse (rarely), presistolic gallop rhythm (IV pathological tone), clinical manifestations of congestive left ventricular failure. In the terminal phase can join right ventricular failure. 3. Stagnant right ventricular nadostatochnost characteristic of mitral and tricuspid blemish, constrictive pericarditis. Usually attached to congestive left ventricular failure. Symptoms: swelling of the neck veins, high venous pressure, acrocyanosis, enlarged liver, subikterichnost, swelling, abdominal and peripheral. 4. Right ventricular failure ejection characteristic of pulmonary artery stenosis, pulmonary hypertension. Diagnosed and mostly radiographically (depleted peripheral pulmonary vascular pattern). You can discover other signs of this form: shortness of breath when a specific threshold level of physical activity, right ventricular hypertrophy - palpation, then and ECG signs of type "load pressure" (high wave I and the reduction of the T wave in the right chest leads). In severe cases, the grey colour of the skin. 5. Dystrophic form. Typically, end-stage right heart failure. Options: a) capactitance; b) swollen dystrophic and degenerative skin changes (thinning, Shine, smoothness of the picture laxity), edema is common or limited mobile, hypoalbuminemia, in the most pronounced cases of anasarca;) necorrigiruemaya salt depletion. In some cases there are changes in the heart (cardiomegaly, acromegalia, atrial fibrillation), that allows to speak about the "Central" form CH. As a special form with specific mechanisms of circulatory disorders and manifestations consider SN when "blue" birth defects with insufficient blood flow in a small circle and nesmejana or over - large, and pulmonary heart, thyrotoxicosis, anemia, arteriovenous fistula, liver cirrhosis, and arrhythmogenic CH. In patients with childhood may develop "passive adaptation" (small body weight and growth, poor physical development, sharply reduced physical activity, infantilism). These forms of SN are found in various combinations, it is often possible to select a lead form. Stage of development and the severity of congestive HF. Of the many signs of a SN listed in the description of one stage or another, you want to highlight a few, each of which is sufficient to determine the specific stage. Stage I: subjective symptoms of HF at moderate or greater exertion. Stage IIA: 1). expressed subjective symptoms of HF at low utilization; 2). the orthopnea; 3). asthma; 4). x-ray, in some cases - and electrocardiographic signs of secondary pulmonary hypertension; 5). re edema; 6). re-enlargement of the liver; 7). cardiomegaly without other symptoms of this stage; 8). atrial fibrillation without other symptoms of this stage.

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