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Heart failure

Symptoms of a disease. Heart failure is a state at which heart cannot provide bodies and fabrics to sufficient, i.e. adequate requirements of an organism, amount of blood. Decrease in sokratitelny (pumping) function of heart is the cornerstone of heart failure. Heart failure is the syndrome complicating many diseases of cardiovascular system, but most often heart failure develops at ischemic heart disease patients and arterial hypertension. Frequency of heart failure in population makes 1,5-2%. Now increase in number of patients with heart failure is observed that is partly caused by the population postareniye. So, heart failure comes to light at 3 — 5% of persons 65 years are more senior and at 10% — 75 years are more senior.

4 functional classes of heart failure are allocated:

I \the patient does not experience restrictions in physical activity; the usual exercise stress does not cause weakness, an asthma and heartbeat.
II \moderate restriction of physical activity; short wind, fatigue, heartbeat develop at a usual exercise stress.
III \there is a considerable restriction of physical activity; patients feel comfortable at rest; short wind, fatigue, heartbeat develop at loading smaller, than usual.
IV \patients are not capable to carry out any loadings; symptoms of heart failure are observed at rest.

Risk factors of heart failure. Arterial hypertension and an ischemic heart disease which combination is observed at 75% of patients with heart failure are the most common causes of heart failure. Among other reasons of heart failure it is necessary to call heart diseases, myocardites, a cardiomyopathy.

It is possible to distinguish the following from the factors promoting deterioration during heart failure and to its progressing:

• Aggravation and/or progressing of a basic disease of heart.

• Accession of other diseases of cardiovascular system, for example, myocardial infarction, infectious endocarditis, disturbances of a cordial rhythm and conductivity, arterial hypertension, etc.

• Accession of diseases of other systems and bodies: infectious diseases of a respiratory organs, a thromboembolism or thromboses in system of a pulmonary artery, diseases of endocrine system, development of anemia.

• Physical overstrain, food disturbances, avitaminosis, intoxications, stressorny situations.

• Administration of drugs with negative inotropic effect (verapamil, diltiazem; Disopyramidum and other antiarrhytmic drugs 1a and 1s of classes).

Medical actions. Treatment of this disease is made only under control of the doctor or in medical institutions.

1. Treatment of a basic disease (anti-hypertensive therapy, anti-anginal and antiarrhytmic therapy, surgical correction of heart disease etc.).
2. Treatment of states (diseases) promoting progressing of heart failure (anemia, infectious diseases, thromboembolisms, etc.).
3. Mode of physical activity.
4. Diet.
5. Drug treatment.
6. Surgical, mechanical and electrophysiologic methods of treatment.
7. Oxygenotherapy.

On the course of heart failure beneficial effect of physical trainings — reduction of clinical displays of heart failure, increase of tolerance to an exercise stress, improvement of quality of life. It is connected with improvement of function of skeletal muscles, microcirculation and with increase in utilization of oxygen fabrics. Physical trainings are recommended to most of patients with the stable course of chronic heart failure; as contraindications to their carrying out serve myocarditis, stenoses of valves, disturbances of a heart rhythm of high gradation, stenocardia attacks at low fraction of emission (fraction of emission) of a left ventricle. The optimum modes of physical trainings are finally not developed, but now there are following standard recommendations. Trainings on the exercise bike or the tredmil, the dosed walking and remedial gymnastics are used. Loading duration on the exercise bike (tredmil), remedial gymnastics or the dosed walking depends on a functional class of the patient. As control serves first of all good tolerance of loadings, heart rate and level of arterial pressure.

For the choice of the mode of physical trainings it is necessary to define initial tolerance to exercise stresses. The test from 6 is for this purpose used by minute walking. The essence of this test consists in determination of distance in meters which there can pass a patient in 6 min. 6 minute test are used also for an assessment of a functional class of heart failure. Sick, capable to pass from 426 to 550 m in 6 min., belong to the I class; from 300 to 425 m - to the II class, from 150 to 300 m - to the III class, and less than 150 m — to the IV class. Physical trainings are not shown to patients with the IV class of heart failure, only breathing exercises are recommended. If the patient passes more than 150 m, but less than 300 m in 6 min., then exercise stresses in the form of the dosed walking are recommended to him. The patient who passed 300 — 500 m carrying out dynamic physical trainings, including on the tredmil is possible.

The main recommendations about a diet of patients with chronic heart failure are restriction of table salt and liquid. What more expressed symptoms of heart failure and developments of stagnation, that more limits salt.

Limited consumption of liquid is necessary only for patients with heavy stages of chronic heart failure in the presence of stagnation symptoms. Increase in body weight of the patient by 2 kg and more for 1 — 3 day testifies to a liquid delay in an organism and risk of development of a decompensation. Even in the absence of stagnation signs the volume of the entered liquid should not exceed 1,5 l a day.

The food of patients with heart failure has to be rather caloric, easily acquired, with the sufficient content of vitamins and protein. There is an opinion that, and especially with a cachexia, so-called nutritive support in a type of nutritious mixes (food additives) is necessary for patients with the reduced body weight (an index of body weight less than 19 kg/sq.m). However now efficiency and expediency of use of food additives for patients with a cachexia against heart failure are not proved.

 
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