Heart failure (HF) is a disease caused by the abnormal function of heart pumping blood, which causes the heart unable to meet the basic metabolic needs of the whole body.Common causes includemiocardial infarction、Cardiomyopathy、myocarditisEtc.The high incidence population includes the elderly over 70 years old, whose incidence rate exceeds 10%, and the 5-year mortality rate can reach 50%.Heart failure can be divided intoLeft heart failure、Right heart failureAnd heart failure.
The main symptoms of heart failure include dyspnea, limited mobility and fluid retention.When the condition worsens, symptoms such as pulmonary congestion, shortness of breath, chest tightness, edema of both lower limbs, fatigue and dizziness may occur.
Treatments for heart failure includemedication, use of cardiac resynchronization therapy (CRT) and implant typeimplantable cardioverter defibrillator (ICD).Normal living habits and diet control are also very important in the treatment process.
In addition, according to the current research, the prevalence of heart failure is closely related to age, and its 5-year mortality rate is as high as 50%.
The human heart is like a large pump, which sends oxygenated blood through arteries to various oxygen consuming organs in the body, and then uses up oxygen free blood from various organs to send it back to the heart through veins, and then pumps it to the lungs to supplement oxygen.
This work is just like the conveyor in the brewery in summer. Empty beer bottles are continuously transported to the beer canning workshop for canning, and then the bottled beer bottles are sent out of the brewery for fresh beer.
We can understand that the right center is a conveyor that transports empty bottles to the loading workshop, while the left center is a conveyor that transports full beer bottles to the outside of the factory.
Left heart failure is like sending beer bottles out of the factory. The conveyor is not functioning well. The beer bottles filled the beer filling workshop, that is, our lungs are full. Therefore, left heart failure is mostly manifested by symptoms related to pulmonary congestion.
The simple right heart failure is equivalent to the poor function of the conveyor that transports empty bottles to the canning workshop. Many empty bottles cannot enter the canning workshop to fill beer. As a result, the empty bottles of beer drunk in various shops outside are piled up and cannot be filled. In our bodies, it is also manifested as congestion in the systemic circulation (limbs, liver, kidney, brain, etc.).
Of course, whether it is left heart failure or right heart failure, it will gradually cause damage to the other half of the heart function. If not controlled in time, it may lead to more serious heart failure, endangering life.
Classification according to acute and chronic heart failure
Can be divided intoChronic heart failureAnd acute heart failure.Chronic heart failure develops slowly, often accompanied by cardiac enlargement or hypertrophy;Acute heart failure often occurs in acute and severe myocardial damageArrhythmiaEtc.
Classification according to left ventricular ejection fraction
According to the left ventricular ejection fraction (LVEF) obtained by color Doppler echocardiography, heart failure can be divided into heart failure with reduced ejection fraction (HFrEF, LVEF<40%), heart failure with preserved ejection fraction (HFpEF, LVEF ≥ 50%) and heart failure with middle range ejection fraction (HFmrEF, LVEF 40%~49%).
pathogeny
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Various factors causing myocardial injury（miocardial infarction、Cardiomyopathy、myocarditis), leading to impairment of ventricular systolic and diastolic function and heart pumping capacity, which can lead to heart failure.
Myocardial damage caused by metabolic diseases (diabetes, hyperthyroidism), systemic invasive diseases (myocardial amyloidosis), connective tissue diseases, myocardial toxic drug damage, etc.
Cardiac overload
It mainly refers to the diseases that can lead to the overload of the heart. These diseases can make the heart and myocardium meet the needs of the heart to pump blood by changing its own structure, but this is not a long-term solution. The compensatory capacity of the heart is limited for a long time. After exceeding a certain limit, the myocardial structure and function will lose their compensatory capacity, and then heart failure will occur.
Heart failure is the terminal stage of heart disease. Understanding the inducing factors can reduce the acute incidence of heart failure.
Infection: Respiratory infection is the most common, which can aggravate pulmonary congestion.
Arrhythmias: atrial fibrillation is common, and various types of fast arrhythmia, serious slow arrhythmia, etc.
Increased blood volume of the whole body: too much and too fast infusion, high salt diet, etc.
Excessive physical exertion or emotional excitement: late pregnancychildbirth, rage, etc.
Improper treatment: inappropriate withdrawal of diuretics, antihypertensive drugs, etc.
Others: The original heart disease worsens or other complications occur, such as coronary heart disease patients complicated with myocardial infarction.
symptom
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The performance of early heart failure is generally not obvious, because in the early stage of cardiac function damage, the reserve capacity of the heart will help to compensate for the damage.It is equivalent to that if a colleague in the company gets sick, others will work overtime to help him finish his work and ensure the perfect operation of the company.
If the heart function is further damaged, the application of reserve capacity will eventually reach the limit, and the body will have a series of symptoms.That is to say, if many people in the company are ill and other employees of the company cannot work overtime to complete these jobs, the company will have some problems.
Some patients will have shortness of breath and chest tightness during activities, and some will fall asleepSuffocation、Chest tightness, you need to raise your upper body to sleep.There are also edema, fatigue and dizziness of both lower limbs.The symptoms of heart failure will change with the aggravation of the disease.
Typical symptoms
chronic heart failure
Left heart failure is common and often secondary to right heart failure, that is, it develops into total heart failure.
Left heart failure
dyspnea
The symptoms from mild to severe are: labored dyspnea, that is, dyspnea during heavy physical labor, which can be relieved after rest;Paroxysmal dyspnea at night, that is, sudden suffocation and rapid sitting up at night, which can be relieved after 30 minutes or more;Sit up breathing, that is, the patient will feel difficult breathing when lying on his back for a few minutes, and can only sit up and breathe;In severe cases, acute pulmonary edema may occur, which may be manifested in sudden severe dyspnea, sitting up breathing, accompanied by cough, and often coughing up pink foamy sputum. The patient may also have sweating, irritability, and cyanosis of lips.
Cough, expectoration, hemoptysis
Pulmonary congestionWhen the alveolar and bronchial mucosa are stimulated, the patient may cough, usually with white foamy sputum, and occasionally with bloodshot.
Fatigue, dizziness, palpitation, reduced exercise
Inadequate blood supply to organs and tissues and accelerated heart rate.
Symptoms of oliguria and kidney damage
Oliguria due to decreased renal blood flow may lead to long-term renal function damage.
Right heart failure
Filling and distension of cervical veins: the earliest sign of right heart failure.
Gastrointestinal symptoms: congestion of gastrointestinal tract leads to abdominal distention, anorexia, vomiting, etc.
Dyspnea: the enlargement of the right ventricle affects the relaxation of the left ventricle, which is caused by pulmonary congestion.
Edema: first of all, there is edema in both feet and legs, which gradually spreads upward to the whole body.
Hydrothorax and ascites: caused by congestion of systemic circulation.
Total heart failure
Total heart failure is seen in the late stage of heart disease, and the condition is critical. It can have the clinical manifestations of left and right heart failure at the same time, mainly manifested as the related symptoms of insufficient blood perfusion in various tissues and organs, such as cold limbs, dizziness, oliguria, etc.
For patients who develop from left heart failure to total heart failure, dyspnea may be alleviated, but this does not mean that the condition is improved, but that it is aggravated. Patients and their families should attach great importance to it.
Acute heart failure
Sudden severe dyspnea, forced sitting, sweating, pale complexion, cyanosis of lips, irritability, and continuous cough, pink foam sputum.
Extremely heavy people may be confused.
There may also be a transient increase in blood pressure at the time of onset, and shock may occur if it is not relieved.
Medical treatment
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Indication for medical treatment
When the patient has dyspnea, including shortness of breath and fatigue during activities, and cannot breathe normally when lying on his back, he needs to see a doctor in time.
When the patient has severe dyspnea, cough, and can cough up pink foam sputum, or has a pale face, sweating, tachycardia, etc., it is necessary to immediately call the emergency number and send it to the emergency department for rescue treatment.
According to the patient's medical history, especially the history of heart disease, typical symptoms and signs, it is usually not difficult for doctors to diagnose the disease.For suspected patients, laboratory examination, imaging examination and other auxiliary judgments are available.
Visiting department
Generally, the patient is in the cardiovascular department.In case of acute heart failure symptoms, go to the emergency department for rescue treatment.
Relevant inspection
Physical examination
Detailed physical examination is of great significance for the diagnosis of the disease, especially auscultation of the heart and lungs.
laboratory examination
BNP and NT proBNP
They are plasma brain natriuretic peptide (BNP) and N-terminal pro brain natriuretic peptide (NT proBNP).It is mainly used to diagnose heart failure or assess the severity of heart failure. Generally, if the indicators of untreated patients are normal, heart failure can be basically excluded.However, many diseases can cause the index to increase, so the specificity of this test is not high.
troponin
Troponin in patients with severe heart failure may be slightly elevated.In addition, this indicator can also help to determine whether there is an acute coronary syndrome.
Other routine inspection
Including routine blood and urine tests, liver and kidney functions, blood sugar, blood lipids, electrolytes, thyroid function tests, etc.It is mainly used for screening other diseases and evaluating the patient's condition.
Special examination related to heart
electrocardiogram
Routine cardiac examination, but heart failure itself has no specific ECG performance, which can determine whether there is abnormal heartbeat rhythm, whether there is myocardial infarction, etc.
Cardiac catheterization
Insert a catheter from the arm or leg artery to the aorta to measure the arterial pressure of the lower ventricle, and then inject contrast agent to show the condition of the coronary artery and heart.
6-minute walk test
It is mainly applicable to the evaluation of exercise endurance of patients with chronic heart failure, and can also judge the severity of patients with heart failure and treatment effect.
The patient was required to walk in a straight corridor as soon as possible, and the 6-minute walking distance was measured. The patients who were<150m, 150m~450m, and>450m were diagnosed as severe, moderate, and mild heart failure respectively.
It can be confirmed whether there is coronary atherosclerotic heart disease (coronary heart disease).
differential diagnosis
bronchial asthma
"Cardiogenic asthma" in severe left heart failure should be differentiated from bronchial asthma.
Most patients with heart failure have basic organic heart disease. Changes in posture can affect breathing. In severe cases, they can cough pink foamy sputum.
Most patients with bronchial asthma have a history of anaphylaxis in adolescence, can cough white mucus, and the plasma BNP level can assist in differentiation.
Pericardium related diseases
Pericardial effusion, constrictive pericarditis, etc. can compress the heart, block the vena cava return, enlarge the liver, and dilate the jugular vein. It can be diagnosed according to the medical history and echocardiography.
Liver cirrhosis with edema of lower limbs
It can be differentiated from chronic right heart failure. Liver cirrhosis is often accompanied by ascites. Basic signs of heart disease and whether there is jugular vein distension can help to differentiate.
treatment
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For patients with acute heart failure, priority should be given to relieving life threatening symptoms such as severe dyspnea and hypoxia. The treatment goal is to improve symptoms, stabilize hemodynamics, and maintain important organ functions.
For patients with chronic heart failure, the treatment goal is to alleviate clinical symptoms, delay disease progression, improve long-term prognosis, reduce mortality and hospitalization rate, and improve the quality of life of patients as much as possible.
In general, patients with heart failure need to take comprehensive treatment, which mainly includes removing the incentives, treating the causes and symptomatic support. The treatment methods include drugs, cardiac resynchronization therapy (CRT), implantable cardioverter defibrillator (ICD), etc.
Acute treatment
When acute heart failure or acute exacerbation of chronic heart failure occurs, patients may have acute pulmonary edema, shock, syncope or even cardiac arrest, which may threaten their lives.At this time, doctors will give priority to controlling patients' symptoms, protecting patients' important organ functions as far as possible, and improving the prognosis.
First aid measures at home
In case of acute heart failure or sudden aggravation of heart failure, the patient needs to be rescued in time. If not, life may be endangered. The following steps can be referred to for rescue at home:
The rescuer should keep calm, call the emergency number in time and wait for first aid;
Raise the patient's upper trunk (half lying position or high sitting position), with legs sagging;
Give oxygen to the patient immediately if possible;
Cut or open the clothes on the patient's chest to ensure smooth breathing;
Calm the patient;
In case of sudden cardiac arrest, cardiopulmonary resuscitation should be carried out in time.
General treatment
Lifestyle management
Learn about disease management, correctly understand the disease, and maintain emotional stability.
Patients also need to pay special attention to monitoring their weight changes during treatment.
Dietary intake of sodium salt should be limited to prevent water and sodium retention.
Rest and activities
For patients with unstable condition or acute stage, physical activity should be strictly restricted, and they can rest in a high or half lying position, but they should be prevented at the same timeDeep vein thrombosis、Muscular atrophy、BedsoreThe occurrence of, etc.
For patients with stable condition, they can exercise moderately according to the doctor's advice.
medication
Patients can be treated with the following drugs under the guidance of doctors.
diuretic
Diuretics can reduce the heart burden of patients by increasing urination, which is the basic medicine for heart failure treatment. Long term use of diuretics should be alert to electrolyte disorders.
Angiotensin receptor antagonist (ARB): It has similar effect to ACEI drugs, but is better tolerated by patients. If patients cannot tolerate ACEI drugs, it can be changed to this drug.
Aldosterone receptor antagonist: the addition of ACEI can improve the prognosis.
Angiotensin receptor enkephalase inhibitor (ARNI): can inhibit vasoconstriction and reduce myocardial remodeling.
Beta receptor antagonist
metoprololIt can inhibit sympathetic nerve activity. Long term application can alleviate symptoms, delay disease progression, improve prognosis and reduce mortality.
Positive inotropic agent
Digitalis drugs: can increase myocardial contractility,Hypoxemia、miocardial infarction、Myocardial ischemiaIt is prone to digitalis poisoning.Patients with obstructed blood outflow tract (hypertrophic cardiomyopathy, etc.) should not use it.
Blood stasis and abnormal myocardial contraction can form in heart failurethrombus, easyembolismTherefore, antiplatelet should be applied（aspirinEtc.), anticoagulation（warfarinDrug treatment.
surgical treatment
Cardiac resynchronization therapy (CRT)
It is equivalent to installing an electronic booster pump on the heart. After implantation, the left and right ventricles can pump blood at the same time, so as to improve the blood pumping function of the heart, help patients improve their symptoms, carry out more activities, and extend their life.
Implantable cardioverter defibrillator (ICD)
The main purpose is to prevent the occurrence of abnormal heart rhythm. It can automatically detect whether the heart will have serious abnormal rhythm. If it does, it will automatically conduct electric shock to help correct it. For patients with heart failure, ICD implantation can avoidventricular fibrillationTo improve the long-term prognosis of patients.
heart transplant
The final choice for the treatment of intractable and intractable heart failure is expensive and difficult to find a donor.
TCM treatment
Traditional Chinese medicine treatment should follow the principle of "treatment based on syndrome differentiation". It is necessary to adopt corresponding treatment plans according to individual specific conditions. It is suggested that patients should be treated under the guidance of doctors after seeing a doctor in a regular medical institution.
The basic feature of heart failure in TCM syndromes is the combination of deficiency and excess.This deficiency is qi deficiency, often accompanied byYin deficiency、Yang deficiency；The standard is blood stasis, often accompanied by phlegm, drink, etc., often aggravated in cold and fatigue.
Heart failure is a progressive disease, and the treatment varies in different stages of the disease.In the acute exacerbation period of heart failure, the treatment requires actively strengthening and protecting qi yin or qi yang to cure the root cause, and strengthening the facilitation of water, blood circulation, and phlegm;In the chronic stable phase of heart failure, it is necessary to replenish qi, nourish yin, warm yang and consolidate the root, and then cooperatePromoting blood circulation and removing blood stasis, promoting hydration and resolving phlegm.
prognosis
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Heart failure is a progressive disease and a negative consequence of the development of cardiovascular disease. It has a high mortality rate and poor prognosis. Early detection and early treatment of the basic heart disease of heart failure are of positive significance for delaying the development of disease, improving the quality of life of patients and reducing the mortality rate of heart failure.
complication
When the patient is not treated in time or the curative effect is poor, the heart failure gradually worsens, which can eventually lead to systemic blood circulation abnormalities, insufficient blood supply of peripheral tissues and organs, and then lead to damage and necrosis of organs throughout the body, such as renal function damage and failure,Pulmonary congestion, limb edema, etc.
Daily care
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Generally, patients should sleep in a high occipital position;The heavier ones shall be in semi recumbent position or sitting position.
limitphysical activityPatients with severe heart failure mainly rest in bed;After the improvement of cardiac function, you should get out of bed and exercise properly to avoid lower limb thrombosis andpulmonary infection。
Be sure to quit smoking and drinking and keepMental balanceAnd ensure adequate sleep.
A small number of meals,Low salt dietThe daily salt should not exceed 5g.
