Targeting leg fatigue in heart failure — ScienceDaily

Doctors should not only treat the heart muscle in chronic heart failure patients, but also their leg muscles through exercise, say researchers in a major new study.

Heart failure causes breathlessness and fatigue that severely limits normal daily activities such as walking. The University of Leeds research team has, for the first time, shown that leg muscle dysfunction is related to the severity of symptoms in heart failure patients. These findings suggest that daily activity in patients with severe heart failure may not simply be limited by the failing heart, but also by an impairment in the leg muscles themselves.

In a series of experiments with chronic heart failure patients, the research team measured responses of the heart, lungs and leg muscles following a moderate exercise warm-up. Using a near-infrared laser to measure the oxygenation of the leg muscles, they found that warm-up exercise increased the activity of skeletal muscle enzymes that control energy production. However, this adaptation was less in patients with the most severe symptoms, showing that the heart failure condition had a negative impact on the normal function of the leg muscles.

Dr Harry Rossiter, of the University’s Faculty of Biological Sciences says: “Many chronic heart failure patients complain of leg fatigue during exercise and this can prevent them from being active. Our study shows that by warming up properly, patients can improve the oxygenation and performance of their leg muscles, which is beneficial in promoting exercise tolerance.”

“When your muscles don’t use oxygen well, it causes an uncomfortable burning sensation during activity,” says Dr Klaus Witte, the Leeds General Infirmary Cardiologist on the research team. “The effect of a warm up is to direct oxygen to the places that are going to need it, and make the muscles ready to use it when you start exercising.”

Dr Rossiter says the next stage of this research will be to see whether training of the skeletal muscles can improve long-term overall outcomes for patients with chronic heart failure, and to discover more about the pathological changes in the leg muscles that may be a contributing factor in limiting exercise.

“Our main message is that exercise is safe and beneficial in patients with heart failure. By warming up the leg muscles properly, the exercise can be more comfortable and sustained for longer — affording great benefits for these patients,” he says.

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Materials provided by University of Leeds. Note: Content may be edited for style and length.

Using Clonidine to Improve Leg Weakness in People With Heart Failure – Full Text View

Heart failure is a common condition, affecting approximately 5 million people in the United States. People with heart failure are encouraged to exercise and lose weight. However, many people with heart failure develop weakness in their leg muscles, which can make exercise difficult. Increased sympathetic nerve activity, which involves the nerves that carry adrenaline, also occurs in people with heart failure. It is possible that the increased sympathetic nerve activity may actually cause the leg muscle weakness. Clonidine, a medication used to treat high blood pressure, has been found to decrease sympathetic nerve activity. This study will further examine the connection between leg weakness and sympathetic nerve activity. It will also evaluate the effectiveness of clonidine at decreasing leg weakness in people with heart failure. Results from this study may explain why some people with heart failure are unable to exercise and may help to identify ways in which leg strength can be increased.

This study will enroll people with heart failure. Participants will be randomly assigned to wear either a clonidine patch or a placebo patch for 3 months. Participants will wear the patch on their upper arm, and they will replace the patch each week. At study visits at baseline and Month 3, participants will undergo the following procedures:

• Sympathetic nerve activity recording, which will record nerve activity in the lower leg, using small electrodes inserted through the skin
• Muscle biopsy, in which a small piece of muscle tissue will be obtained from participants’ legs
• Heart rate and blood pressure measurements
• Arterial baroreceptor measurements, in which the nerves in the body that respond to changes in blood pressure will be examined while participants receive different medications to increase and decrease their blood pressure
• Echocardiography to obtain images of the heart
• Magnetic resonance scan of the leg
• Passive exercise procedure, in which study researchers will conduct an arm exercise with participants

There will be no follow-up visits.

Symptoms, Causes, Treatment, Types, Stages

Heart failure affects nearly 6 million Americans. Roughly 670,000 people are diagnosed with heart failure each year. It’s the main reason people older than 65 go into the hospital.

What Is Heart Failure?

Heart failure doesn’t mean the heart has stopped working. Rather, it means that the heart works less efficiently than normal. Due to various possible causes, blood moves through the heart and body at a slower rate, and pressure in the heart increases. As a result, the heart can’t  pump enough oxygen and nutrients to meet the body’s needs.

The chambers of the heart may respond by stretching to hold more blood to pump through the body or by becoming stiff and thickened. This helps to keep the blood moving, but the heart muscle walls may eventually weaken and become unable to pump as efficiently. The kidneys may respond by causing the body to retain fluid (water) and salt. If fluid builds up in the arms, legs, ankles, feet, lungs, or other organs, the body becomes congested. Congestive heart failure is the term used to describe the condition.

What Causes Heart Failure?

Heart failure is caused by many conditions that damage the heart muscle, including:

• Coronary artery disease. Coronary artery disease (CAD), a disease of the arteries that supply blood and oxygen to the heart, causes decreased blood flow to the heart muscle. If the arteries become blocked or severely narrowed, the heart becomes starved for oxygen and nutrients.
• Heart attack. A heart attack happens when a coronary artery becomes suddenly blocked, stopping the flow of blood to the heart muscle. A heart attack damages the heart muscle, resulting in a scarred area that doesn’t work the way it should.
• Cardiomyopathy. Damage to the heart muscle from causes other than artery or blood flow problems, such as from infections or alcohol or drug abuse.
• Conditions that overwork the heart. Conditions including high blood pressure, valve disease, thyroid disease, kidney disease, diabetes, or heart defects present at birth can all cause heart failure. In addition, heart failure can happen when several diseases or conditions are present at once.

What Are the Symptoms of Heart Failure?

You may not have any symptoms of heart failure, or the symptoms may be mild to severe. Symptoms can be constant or can come and go. The symptoms can include:

• Congested lungs. Fluid backup in the lungs can cause shortness of breath with exercise or difficulty breathing at rest or when lying flat in bed. Lung congestion can also cause a dry, hacking cough or wheezing.
• Fluid and water retention. Less blood to your kidneys causes fluid and water retention, resulting in swollen ankles, legs, abdomen (called edema), and weight gain. Symptoms may cause an increased need to urinate during the night. Bloating in your stomach may cause a loss of appetite or nausea.
• Dizziness, fatigue, and weakness. Less blood to your major organs and muscles makes you feel tired and weak. Less blood to the brain can cause dizziness or confusion.
• Rapid or irregular heartbeats. The heart beats faster to pump enough blood to the body. This can cause a rapid or irregular heartbeat.

If you have heart failure, you may have one or all of these symptoms or you may have none of them. They may or may not indicate a weakened heart.

What Are the Types of Heart Failure?

Systolic dysfunction (or systolic heart failure) happens when the heart muscle doesn’t contract with enough force, so there is less oxygen-rich blood pumped throughout the body.

Diastolic dysfunction (or diastolic heart failure) happens when the heart contracts normally, but the ventricles don’t relax properly or are stiff, and less blood enters the heart during normal filling.

A calculation done during an echocardiogram, called the ejection fraction (EF), is used to measure how well your heart pumps with each beat to help determine if systolic or diastolic dysfunction is present. Your doctor can discuss which condition you have.

How Is Heart Failure Diagnosed?

Your doctor will ask you many questions about your symptoms and medical history. You’ll be asked about any conditions you have that may cause heart failure (such as coronary artery disease, angina, diabetes, heart valve disease, and high blood pressure). You’ll be asked if you smoke, take drugs, drink alcohol (and how much you drink), and about what drugs you take.

You’ll also get a complete physical exam. Your doctor will listen to your heart and look for signs of heart failure as well as other illnesses that may have caused your heart muscle to weaken or stiffen.

Your doctor may also order other tests to determine the cause and severity of your heart failure. These include:

• Blood tests. Blood tests are used to evaluate kidney and thyroid function as well as to check cholesterol levels and the presence of anemia. Anemia is a blood condition that happens when there is not enough hemoglobin (the substance in red blood cells that enables the blood to transport oxygen through the body) in your blood.
• B-type natriuretic peptide (BNP) blood test. BNP is a substance secreted from the heart in response to changes in blood pressure that happen when heart failure develops or worsens. BNP blood levels increase when heart failure symptoms worsen, and decrease when the heart failure condition is stable. The BNP level in a person with heart failure — even someone whose condition is stable — may be higher than in a person with normal heart function. BNP levels do not necessarily correlate with the severity of heart failure.
• Chest X-ray. A chest X-ray shows the size of your heart and whether there is fluid build-up around the heart and lungs.
• Echocardiogram. This test is an ultrasound which shows the heart’s movement, structure, and function.
• Ejection fraction (EF) is used to measure how well your heart pumps with each beat to determine if systolic dysfunction or heart failure with preserved left ventricular function is present. Your doctor can discuss which condition you have.
• Electrocardiogram (EKG or ECG). An EKG records the electrical impulses traveling through the heart.
• Cardiac catheterization. This invasive procedure helps determine whether coronary artery disease is a cause of congestive heart failure.
• Stress Test. Noninvasive stress tests provide information about the likelihood of coronary artery disease.

Other tests may be ordered, depending on your condition.

Is There a Treatment for Heart Failure?

There are more treatment options available for heart failure than ever before. Tight control over your medications and lifestyle, coupled with careful monitoring, are the first steps. As the condition progresses, doctors specializing in the treatment of heart failure can offer more advanced treatment options.

The goals of treating heart failure are to try to keep it from getting worse (lowering the risk of death and the need for hospitalization), to ease symptoms, and to improve quality of life.

Some common types of medicines used to treat it are:

• ACE inhibitors (angiotensin-converting enzyme inhibitors)
• Aldosterone antagonists
• ARBs (angiotensin II receptor blockers)
• ARNIs (angiotensin receptor-neprilysin inhibitors)
• Beta-blockers
• Blood vessel dilators
• Digoxin
• Calcium channel blockers
• Diuretics
• Heart pump medications
• Potassium or magnesium
• Selective sinus node inhibitors
• Soluble guanylate cyclase (sGC) stimulator

Your doctor may also recommend a program called cardiac rehabilitation to help you exercise safely and keep up a heart-healthy lifestyle. It usually includes workouts that are designed just for you, education, and tips to lower your chance of heart trouble, like quitting smoking or changing your diet.

Cardiac rehab also offers emotional support. You can meet people like you who can help you stay on track.

Stages of Heart Failure

In 2001, the American Heart Association (AHA) and American College of Cardiology (ACC) described the “Stages of Heart Failure.” These stages, which were updated in 2005, will help you understand that heart failure is often a progressive condition and can worsen over time. They will also help you understand why a new medication was added to your treatment plan and may help you understand why lifestyle changes and other treatments are needed.

The stages classified by the AHA and ACC are different than the New York Heart Association (NYHA) clinical classifications of heart failure that rank patients as class I-II-III-IV, according to the degree of symptoms or functional limits. Ask your doctor what stage of heart failure you are in.

Check the table below to see if your therapy matches what the AHA and ACC recommend. Note that you cannot go backward in stage, only forward.

The table below outlines a basic plan of care that may or may not apply to you, based on the cause of your heart failure and your special needs. Ask your doctor to explain therapies that are listed if you do not understand why you are or are not receiving them.

Stage	Definition of Stage	Usual Treatments
Stage A	People at high risk of developing heart failure (pre-heart failure), including people with: High blood pressure Diabetes Coronary artery disease Metabolic syndrome History of cardiotoxic drug therapy History of alcohol abuse History of rheumatic fever Family history of cardiomyopathy	Exercise regularly. Quit smoking. Treat high blood pressure. Treat lipid disorders. Discontinue alcohol or illegal drug use. An angiotensin converting enzyme inhibitor (ACE inhibitor) or an angiotensin II receptor blocker (ARB) is prescribed if you have coronary artery disease, diabetes, high blood pressure, or other vascular or cardiac conditions. Beta blockers may be prescribed if you have high blood pressure or if you’ve had a previous heart attack.
Stage B	People diagnosed with systolic left ventricular dysfunction but who have never had symptoms of heart failure (pre-heart failure), including people with: Prior heart attack Valve disease Cardiomyopathy The diagnosis is usually made when an ejection fraction of less than 40% is found during an echocardiogram test.	Treatment methods above for Stage A apply All patients should take an angiotensin converting enzyme inhibitor (ACE inhibitors) or angiotensin II receptor blocker (ARB) Beta-blockers should be prescribed for patients after a heart attack Surgery options for coronary artery repair and valve repair or replacement (as appropriate) should be discussed If appropriate, surgery options should be discussed for patients who have had a heart attack.
Stage C	Patients with known systolic heart failure and current or prior symptoms. Most common symptoms include: Shortness of breath Fatigue Reduced ability to exercise	Treatment methods above for Stage A apply All patients should take an angiotensin converting enzyme inhibitor (ACE inhibitors) and beta-blockers African-American patients may be prescribed a hydralazine/nitrate combination if symptoms persist Diuretics (water pills) and digoxin may be prescribed if symptoms persist An aldosterone inhibitor may be prescribed when symptoms remain severe with other therapies Restrict dietary sodium (salt) Monitor weight Restrict fluids (as appropriate) Drugs that worsen the condition should be discontinued As appropriate, cardiac resynchronization therapy (biventricular pacemaker) may be recommended An implantable cardiac defibrillator (ICD) may be recommended
Stage D	Patients with systolic heart failure and presence of advanced symptoms after receiving optimum medical care.	Treatment methods for Stages A, B & C apply Patient should be evaluated to determine if the following treatments are available options: heart transplant, ventricular assist devices, surgery options, research therapies, continuous infusion of intravenous inotropic drugs and end-of-life (palliative or hospice) care

The New York Heart Association (NYHA) clinical classifications of heart failure rank people as class I-II-III-IV, according to the degree of symptoms or functional limits. You can ask your doctor if you want to know what stage of heart failure you’re in.

• Class I: Physical activity is not affected, and you have no unusual fatigue, shortness of breath, palpitations, or pain during normal activities.
• Class II: Slight limitations on normal activities. You may have mild fatigue, shortness of breath, palpitations, or pain during normal activities; no symptoms at rest.
• Class III: Marked limitation on normal activities. You have fatigue, shortness of breath, palpitations, or pain during less than normal activities; no symptoms at rest.
• Class IV: You’re uncomfortable even at rest. Discomfort gets worse with any physical activity.

How Can I Prevent Further Heart Damage?

In an effort to prevent further heart damage:

What Medications Should I Avoid if I Have Heart Failure?

There are several different types of medications that are best avoided in those with heart failure including:

• Nonsteroidal anti-inflammatory medications such as Motrin or Aleve. For relief of aches, pains, or fever take Tylenol instead.
• Some antiarrhythmic agents
• Most calcium channel blockers (if you have systolic heart failure)
• Some nutritional supplements, such as salt substitutes, and growth hormone therapies
• Antacids that contain sodium (salt)
• Decongestants such as Sudafed

If you’re taking any of these drugs, discuss them with your doctor.

It’s important to know the names of your medications, what they’re used for, and how often and at what times you take them. Keep a list of your medications and bring them with you to each of your doctor visits. Never stop taking your medications without discussing it with your doctor. Even if you have no symptoms, your medications decrease the work of your heart so that it can pump more effectively.

How Can I Improve My Quality of Life With Heart Failure?

There are several things you can do to improve your quality of life if you have heart failure. Among them:

• Eat a healthy diet. Limit your consumption of sodium (salt) to less than 1,500 milligrams (1 1/2 grams) each day. Eat foods high in fiber. Limit foods high in trans fat, cholesterol, and sugar. Reduce total daily intake of calories to lose weight if necessary.
• Exercise regularly. A regular cardiovascular exercise program, prescribed by your doctor, will help improve your strength and make you feel better. It may also decrease heart failure progression.
• Don’t overdo it. Plan your activities and include rest periods during the day. Certain activities, such as pushing or pulling heavy objects and shoveling may worsen heart failure and its symptoms.
• Prevent respiratory infections. Ask your doctor about flu and pneumonia vaccines.
• Take your medications as prescribed. Do not stop taking them without first contacting your doctor.
• Get emotional or psychological support if needed. Heart failure can be difficult for your whole family. If you have questions, ask your doctor or nurse. If you need emotional support, social workers, psychologists, clergy, and heart failure support groups are a phone call away. Ask your doctor or nurse to point you in the right direction.

Can Surgery Be Used to Treat Heart Failure?

In heart failure, surgery may sometimes prevent further damage to the heart and improve the heart’s function. Procedures used include:

• Coronary artery bypass grafting surgery. The most common surgery for heart failure caused by coronary artery disease is bypass surgery. Although surgery is more risky for people with heart failure, new strategies before, during, and after surgery have reduced the risks and improved outcomes.
• Heart valve surgery. Diseased heart valves can be treated both surgically (traditional heart valve surgery) and non-surgically (balloon valvuloplasty).
• Implantable left ventricular assist device (LVAD). The LVAD is known as the “bridge to transplantation” for patients who haven’t responded to other treatments and are hospitalized with severe systolic heart failure. This device helps your heart pump blood throughout your body. It allows you to be mobile, sometimes returning home to await a heart transplant. It may also be used as destination therapy for long-term support in patients who are not eligible for transplant.
• Heart transplant. A heart transplant is considered when heart failure is so severe that it doesn’t respond to all other therapies, but the person’s health is otherwise good.

Heart Failure Treatment Is a Team Effort

Heart failure management is a team effort, and you are the key player on the team. Your heart doctor will prescribe your medications and manage other medical problems. Other team members — including nurses, dietitians, pharmacists, exercise specialists, and social workers — will help you achieve success. But it is up to YOU to take your medications, make dietary changes, live a healthy lifestyle, keep your follow-up appointments, and be an active member of the team.

If you notice anything unusual, don’t wait until your next appointment to discuss it with your doctor. Call them right away if you have:

• Unexplained weight gain (more than 2 pounds in a day or 5 pounds in a week)
• Swelling in your ankles, feet, legs, or belly that gets worse
• Shortness of breath that gets worse or happens more often, especially if you wake up feeling that way
• Bloating with a loss of appetite or nausea
• Extreme fatigue or more trouble finishing your daily activities
• A lung infection or a cough that gets worse
• Fast heart rate (above 100 beats per minute, or a rate noted by your doctor)
• New irregular heartbeat
• Chest pain or discomfort during activity that gets better if you rest
• Trouble breathing during regular activities or at rest
• Changes in how you sleep, like having a hard time sleeping or feeling the need to sleep a lot more than usual
• Less of a need to pee
• Restlessness, confusion
• Constant dizziness or light-headedness

Nausea or poor appetite

When Should I Get Emergency Care?

Go to the ER or call 911 if you have:

• New, unexplained, and severe chest pain that comes with shortness of breath, sweating, nausea, or weakness
• Fast heart rate (more than 120-150 beats per minute, or a rate noted by your doctor), especially if you are short of breath
• Shortness of breath that doesn’t get better if you rest
• Sudden weakness, or you can’t move your arms or legs
• Sudden, severe headache
• Fainting spells

What Is the Outlook for People With Heart Failure?

With the right care, heart failure may not stop you from doing the things you enjoy. Your prognosis or outlook for the future will depend on how well your heart muscle is functioning, your symptoms, and how well you respond to and follow your treatment plan.

Everyone with a long-term illness, such as heart failure, should discuss their desires for extended medical care with their doctor and family. An “advance directive” or “living will” is one way to let everyone know your wishes. A living will expresses your desires about the use of medical treatments to prolong your life. This document is prepared while you are fully competent in case you are unable to make these decisions at a later time.

Heart Failure: Less Common Symptoms

Topic Overview

While there are certain symptoms that people with heart failure experience more commonly, there are many other symptoms that heart failure can cause. These symptoms are typically less common because they often result from more severe heart failure, when the body can no longer compensate properly for the failing heart.

The first table summarizes congestive symptoms that result from fluid leaking into the lungs and the rest of the body. The second table summarizes symptoms that occur because the heart can no longer pump enough blood to meet the body’s needs, which causes poor blood circulation. After the tables is a more detailed explanation of each symptom.

Tell your doctor if you experience any of these less common symptoms.

How does heart failure make the arms, legs, hands, and feet feel cold? People with heart failure may find that they often feel cold in their arms, hands, feet, and legs (the extremities). This happens because the body is circulating most of the available blood to the brain and other vital organs to compensate for the failing heart’s inability to pump enough blood to the entire body. As a result, the extremities get less blood, and without blood to warm them, these parts of your body feel cold.

These symptoms usually occur only in people with chronic, severe heart failure. If your extremities suddenly become cold and clammy, and other symptoms of heart failure, such as fluid buildup (edema), mental confusion, or decreased urine, are becoming worse, you may be going into shock. Shock develops when the amount of blood your heart is pumping becomes critically low. If you experience signs of shock, you will need immediate medical attention.

What happens when the brain doesn’t get enough blood? When the body can no longer compensate adequately for the failing heart, blood circulation to the brain will start to drop. Without enough blood, the brain does not function well, resulting in lightheadedness and/or mental confusion.

Lightheadedness is a sensation of dizziness or mild disorientation. People with heart failure may also experience lightheadedness as a side effect of certain medications.

When blood flow to the brain becomes critically low, people with heart failure may experience an inability to think clearly. Specifically, they may have problems with their memory or with understanding language. This can be particularly dangerous because it can prevent people with severe symptoms from being able to report them to their doctor.

Mental confusion resulting from heart failure means that the amount of blood the heart is pumping is critically low. Typically, this level of impairment occurs in people who are already hospitalized with heart failure. If this is not the case, someone with heart failure who experiences mental confusion needs to see a doctor immediately.

What causes impotence in men who have heart failure? Some men with heart failure cannot achieve an erection (impotence). The specific cause of this impotence can vary. In some cases it results from low blood flow to the genitals caused by the failing heart. In other cases, it can happen as a result of the buildup of plaque (atherosclerosis) in the arteries that supply blood to the genitals. Atherosclerosis in the arteries that supply blood to the heart (coronary artery disease) is often what causes heart failure in men who experience impotence.

Also, impotence can be the result of depression or other psychological factors related to heart failure. Certain medicines used to treat heart failure may also cause impotence.

Heart Failure Warning Signs | South Texas Health System Heart

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Signs of Worsening Heart Failure

While some signs and symptoms of heart failure may not be an emergency, they can worsen if you do not take action immediately. If you have any of the following symptoms, call your doctor or healthcare provider and let them know:

• Shortness of breath
• Feeling dizzy or lightheaded
• Weight gain of three or more pounds in one day
• Weight gain of five pounds in one week
• Unusual swelling in the legs, feet, hands, or abdomen
• A persistent cough or chest congestion (the cough may be dry or hacking)
• Increasing fatigue or a sudden decrease in your ability to do normal activities
• A loss of appetite or nausea
• A feeling of fullness or bloating in your stomach
• Confusion or restlessness

These symptoms may be early signs that fluid is building up and your heart failure is getting worse. If you have these symptoms, let your doctor or nurse know as quickly as possible. Be careful about showering or getting into hot water, which may result in dizziness and lightheadedness as a result of lowered blood pressure. When bathing or showering, try lukewarm water instead. Make sure the water is not more warm than your body temperature.

When to call 911 for Heart Failure

Call 911 if you experience the following symptoms:

• Chest discomfort or pain that lasts more than 15 minutes (that is not relieved with rest or nitroglycerin)
• Severe or persistent shortness of breath
• Fainting or passing out
• A fast or irregular heartbeat, palpitations or a racing heart that does not go away
• A need to sleep sitting up on more pillows than usual
• Frothy or pink tinged sputum when coughing

If you need a non-emergency referral to a cardiologist affiliated with South Texas Health System Heart, call the South Texas Health System Reserve and Learn line at 

800-879-1033.

Heart failure – overview Information | Mount Sinai

Allen LA, Stevenson LW. Management of patients with cardiovascular disease approaching end of life. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 31.

Felker GM, Teerlink JR. Diagnosis and management of acute heart failure. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 24.

Forman DE, Sanderson BK, Josephson RA, Raikhelkar J, Bittner V; American College of Cardiology’s Prevention of Cardiovascular Disease Section. Heart failure as a newly approved diagnosis for cardiac rehabilitation: challenges and opportunities. J Am Coll Cardiol. 2015;65(24):2652-2659. PMID: 26088305 pubmed.ncbi.nlm.nih.gov/26088305/.

Mann DL. Management of heart failure patients with reduced ejection fraction. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 25.

Yancy CW, Jessup M, Bozkurt B, et al. 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation. 2017;136(6):e137-e161. PMID: 28455343 pubmed.ncbi.nlm.nih.gov/28455343/.

Zile MR, Litwin SE. Heart failure with a preserved ejection fraction. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 26.

Last reviewed on: 7/30/2020

Reviewed by: Thomas S. Metkus, MD, Assistant Professor of Medicine and Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Symptoms of Heart Disease | Healthy Heart

Atherosclerotic Disease¹
Generally, atherosclerotic disease refers to conditions that involve narrowed, blocked or stiffened blood vessels, usually due to blood clots or the build up of plaque that can lead to a heart attack, chest pain, stroke or leg pain with walking. Symptoms of atherosclerotic disease depend on which blood vessels are affected and may include:

• Chest pain (angina)
• Shortness of breath
• Sudden numbness or weakness of the leg, arm or face (stroke)
• Sudden dizziness, difficulty walking or difficulty speaking
• Pain or coldness in your legs or arms (caused by the narrowing of the blood vessels in those parts of your body)

Abnormal Heartbeats

An abnormal heartbeat, or heart arrhythmia, means your heart is beating too quickly, too slowly or with an irregular rhythm. Symptoms of heart arrhythmia may include:

• A fluttering or thumping in your chest
• A slow or racing heartbeat
• Chest pain
• Shortness of breath
• Fainting or dizziness
• Lightheadedness

Cardiomyopathy²

Cardiomyopathy refers to diseases of the heart muscle. There are many causes of cardiomyopathy, including high blood pressure, infections and diabetes. In some cases, cardiomyopathy can be due to a gene you inherit from your parents. Cardiomyopathy may make the heart muscle become enlarged, thick or stiff. Or, the heart muscle can become stretched and thin.

In the early stages of the disease, you may not have any symptoms. As cardiomyopathy progresses, the heart weakens and has difficulty pumping blood throughout the body. Symptoms of cardiomyopathy may include:

• Shortness of breath or trouble breathing with physical exertion, or even at rest
• Swelling of the abdomen, legs, ankles, feet and veins of the neck
• Fatigue
• Chest pain, especially after large meals or physical exertion
• Irregular heartbeats that feel too fast, too slow or have an irregular rhythm
• Heart murmurs (extra or unusual sounds during a heartbeat)
• Dizziness, lightheadedness and fainting

Valvular Heart Disease³

Your heart has four valves that open and close to control blood flow: the mitral, pulmonary, aortic and tricuspid valves. In valvular heart disease, one of the heart’s valves is damaged or defective. Depending on which valve isn’t working properly, valvular heart disease symptoms may include:

• Chest pain
• Fatigue
• Shortness of breath
• Irregular heartbeat or heart murmur
• Swollen feet or ankles
• Dizziness or fainting

Talk to Your Doctor⁴

Earlier detection and diagnosis makes heart disease easier to treat. That’s why it’s so important to know the warning signs and talk to your doctor about any symptoms or concerns you may have.

¹National Heart, Lung, and Blood Institute. Atherosclerosis: Signs, Symptoms, and Complications. https://www.nhlbi.nih.gov/health/health-topics/topics/atherosclerosis/signs. Accessed December 12, 2017.
²National Institutes of Health. What Is Cardiomyopathy? http://www.nhlbi.nih.gov/health/health-topics/topics/cm/. Accessed January 1, 2011.
³Mayo Clinic. Heart disease. Symptoms. https://www.mayoclinic.org/diseases-conditions/heart-disease/symptoms-causes/syc-20353118. Accessed January 16, 2013.
⁴Mayo Clinic. Heart attack symptoms: Know what’s a medical emergency. http://www.mayoclinic.org/diseases-conditions/heart-attack/in-depth/heart-attack-symptoms/art-20047744. Accessed July 22, 2011.

Information provided is for general background purposes and is not intended as a substitute for medical diagnosis or treatment by a trained professional. You should always consult your physician about any healthcare questions you may have, especially before trying a new medication, diet, fitness program, or approach to healthcare issues.

Exacerbation of congestive heart failure – Symptoms, diagnosis and treatment

Clinical syndrome of decreased cardiac output, tissue hypoperfusion, increased pulmonary artery pressure and tissue congestion.

Manifested by shortness of breath, decreased exercise tolerance, leg swelling, fatigue and general weakness.

Clinical diagnosis is confirmed by supportive tests such as ECG, chest x-ray, B-natriuretic peptide levels, and echocardiography.When echocardiographic images are suboptimal or an unusual cause of heart failure is suspected, or if specific cardiomyopathies need to be diagnosed, other tests (such as cardiac catheterization with hemodynamic measurements, computed tomography, or cardiac magnetic resonance imaging) are used.

Diuretics and oxygen are the initial treatments for symptoms. Cardiogenic shock may require the administration of vasopressors or mechanical ventilation.

In acute myocardial infarction, early revascularization is necessary.

Root cause or aggravating factors must be identified and treated.

Heart failure is defined clinically as a syndrome in which patients develop symptoms and signs caused by impaired structure and / or function of the heart. [1] Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Eur J Heart Fail. 2016 Aug; 18 (8): 891-975.
http://eurheartj.oxfordjournals.org/content/early/2016/05/19/eurheartj.ehw128

http://www.ncbi.nlm.nih.gov/pubmed/27207191?tool=bestpractice.com
Acute heart failure refers to the rapid onset or worsening of symptoms and / or signs of heart failure that requires immediate evaluation and treatment. [1] Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC).Eur J Heart Fail. 2016 Aug; 18 (8): 891-975.
http://eurheartj.oxfordjournals.org/content/early/2016/05/19/eurheartj.ehw128

http://www.ncbi.nlm.nih.gov/pubmed/27207191?tool=bestpractice.com

Heart failure

Definition

Heart failure (HF) – a pathological condition caused by the failure of the heart as a pump that provides adequate blood circulation.

Etiology and pathogenesis

Manifestation and consequence of pathological conditions affecting the myocardium or impairing the work of the heart: ischemic heart disease, heart defects, arterial hypertension, diffuse lung diseases, myocarditis, myocardial dystrophy (including thyrotoxic, sports, etc.), myocardiopathies (including alcoholic), etc.

Chronic heart failure. Pathogenesis. The consequence and manifestation of HF is a decrease or increase in blood volume, blood flow and / or pressure in certain central and peripheral links of the blood circulation. These changes arise not only as a direct mechanical consequence of a violation of the pumping function of the heart, but also as a result of inadequacy of adaptive reactions. Such reactions include tachy- and bradycardia, changes in peripheral and pulmonary vascular resistance, “centralization” of blood circulation and other forms of redistribution of blood filling, fluid and sodium retention, hypertrophy and expansion of individual chambers of the heart, etc. Hemodynamic disorders, in turn, lead to pathological changes both in the heart and blood vessels, and in other organs and systems and are accompanied by disorders that limit the patient’s life activity and, ultimately, threaten his life.

Clinical picture

Symptoms, the course is not the same for different forms and stages of heart failure. Clinical forms:

1. Congestive left ventricular failure is characteristic of mitral disease, for severe forms of ischemic heart disease – especially in patients with arterial hypertension.Increased pressure in the pulmonary veins helps to fill the left ventricle and maintain a sufficient cardiac output. At the same time, congestive changes in the lungs disrupt the function of external respiration and are the main factor aggravating the patient’s condition with this form of HF. Manifestations: shortness of breath, orthopnea, signs of pulmonary congestion, auscultatory (dry wheezing below the level of the shoulder blades, migrating wet wheezing) and radiological, cardiac asthma and pulmonary edema, secondary pulmonary hypertension, tachycardia.

2. Left ventricular ejection failure is characteristic of aortic disease, coronary artery disease, arterial hypertension. Manifestations: cerebral circulation insufficiency (dizziness, darkening of the eyes, fainting), coronary insufficiency, sphygmographic and echocardiographic signs of low output. In severe cases, Cheyne-Stokes breathing, alternating pulse (rarely), presystolic gallop rhythm (pathological IV tone), clinical manifestations of congestive left ventricular failure are possible.In the terminal stage, right ventricular failure may join.

3. Congestive right ventricular failure is characteristic of mitral and tricuspid defects, constrictive pericarditis. Usually associated with congestive left ventricular failure. Manifestations: swelling of the cervical veins, high venous pressure, acrocyanosis, liver enlargement, subicterity, edema – cavity and peripheral.

4. Right ventricular ejection failure is characteristic of pulmonary artery stenosis, pulmonary hypertension. It is diagnosed and mainly radiographically. Other signs of this form may be detected: shortness of breath at a strictly defined threshold level of physical activity, right ventricular hypertrophy. In especially severe cases, the gray color of the skin.

5. Dystrophic form. As a rule, the terminal stage of right ventricular failure.

Treatment

Regimen and diet: in stage I – observance of the regime of work and rest, moderate physical exercise (but not sports!).In more severe stages, physical activity should be limited, periodically or constantly assigned to bed, half-bed rest. Diet – complete, easily digestible, rich in proteins, vitamins, potassium. With a tendency to fluid retention and with arterial hypertension, a moderate restriction of sodium chloride is shown. With massive edema, a short-term strict salt-free diet may be prescribed. Fasting days are effective, during which a monotonous, easily digestible, sodium chloride-poor food (rice, apple-rice, etc. )days).

Sanatorium treatment is indicated in stages I and IIA, and as an exception – in stage IIIB.

Drug therapy is not the same for different forms, manifestations and origin of HF. It should be carried out against the background of limited physical activity. In chronic heart failure, adequate drug therapy should be constant – its unjustified cancellation often leads to decompensation.

Cardiac glycosides are indicated mainly in congestive heart failure, with atrial fibrillation.According to indications, antiarrhythmic therapy is performed. The patient and his relatives should be familiar with the individual treatment regimen with cardiac glycosides and with the signs of their overdose. The selection of the dosage of cardiac glycosides, as a rule, should be done in a hospital.

Diuretics are indicated for edema, liver enlargement, obvious congestive changes in the lungs, Prescribed in the minimum effective doses, as a rule, against the background of treatment with cardiac glycosides. Massive diuretic therapy is started in bed rest.With pronounced cavity edema (hydrothorax, hydropericardium, but only forcedly – with massive ascites), fluid evacuation can be mechanical (puncture).

Peripheral vasodilators are prescribed in more severe cases with insufficient effectiveness of cardiac glycosides and diuretics in isolation or in conjunction with drugs of these groups.

Potassium preparations are prescribed for the treatment of cardiac glycosides, diuretics and steroid hormones. It is most advisable, although not always sufficient, to ensure the need for potassium through an appropriate diet (prunes, dried apricots, apricots, apricot, peach, plum juice with pulp, etc.)).

In the dystrophic stage, albumin, anabolic steroids are administered intravenously.

The need to evacuate fluid from the pleural cavity or pericardial cavity is an indication for urgent hospitalization.

Tranquilizers are prescribed to limit emotional stress.

Prevention

Prevention of heart failure is reduced to the prevention and treatment of the underlying disease, career guidance, employment. Systematic adequate treatment of HF, prevention and vigorous treatment of intercurrent diseases prevents (inhibits) the progression of HF.

The ability to work in the I stage is preserved; hard physical labor is contraindicated; in stage IIA, the ability to work is limited or lost; in IIB it is lost, in stage III patients need constant outside care.

90,000 Myocarditis and postmyocarditis cardiomyopathy. Myocardial dystrophy

The image above shows the formation of a bundle branch block; the appearance of an infarction curve can also be recorded, which leads the diagnostic search to ischemic changes.

Laboratory changes
With myocarditis, both leukocytosis and leukopenia can be observed; possibly an increase in ESR, an increase in sialic acids and C-reactive protein. Dysproteinemia is observed. The amount of class A and G immunoglobulin increases – markers of inflammation. T lymphocytes may be decreased. More than half of patients may have a positive rheumatoid factor. An increase in lipid peroxidation products and a decrease in antioxidant enzymes are also observed, an increase in enzyme activity may occur.It is important to prescribe the patient an analysis to determine the titers of antibodies to myocardium, myosin, actin; if there is any doubt about the diagnosis, a myocardial biopsy should be performed.

Treatment of myocarditis
Discussed hospitalization due to the severity of the general condition, the treatment period is long – up to a month. Compliance with bed rest is mandatory, and anti-inflammatory therapy is also carried out. Antibiotic therapy is considered if the infectious etiology of myocarditis is confirmed: III generation cephalosporins, macrolides and fluoroquinolones are prescribed.If the cause of myocarditis is viral, exogenous interferons, inducers of endogenous interferons (neovir, viferon, courantil) are prescribed. If the cause of myocarditis is a fungal infection, antifungal drugs are prescribed. For pain syndrome, a group of non-steroidal anti-inflammatory drugs is used: a short course so as not to provoke a cardiotoxic effect; considering the use of delagil up to 4-6 months. Hormones and cytostatics are prescribed for severe myocarditis against the background of systemic connective tissue disease, when an infectious cause is excluded.Disaggregants are prescribed from the first day of treatment (courantil, aspirin, trental).

An important point of treatment is metabolic therapy (Riboxin, Cytochrome), when the patient does not have a very pronounced arrhythmia. The patient needs supportive therapy: it is possible to prescribe metabolic drugs with anti-ischemic action (preductal, qudesan, mildronate, mexicor). All metabolic drugs affect oxidative phosphorylation – the production of ATP molecules in mitochondria (cell energy).If oxidative phosphorylation is impaired within the framework of myocarditis, ischemia, toxic effects, in this case, metabolic drugs with anti-ischemic action can solve the problem.
In addition, the patient is prescribed symptomatic therapy, sanitation of foci of chronic infection.
The sanatorium treatment is being discussed, where the treatment of the formed heart failure and vitamin therapy are continued.

Causes of myocardial dystrophies:
1. Alcohol changes in the heart
2.Anemia
3. Insufficient nutrition or obesity (as part of nutritional deficiency or overload)
4. Vitamin deficiency
5. Damage to the liver or kidneys
6. Disorders of certain types of metabolism
7. Endocrine pathology (it is additionally necessary to examine the thyroid gland)
8. Endogenous and exogenous intoxication
9. Physical overstrain
10. Infections
11. Physical effects (trauma, radiation, weightlessness)
12. In case of accumulation and infiltration diseases
13.Hereditary-familial neuromuscular diseases

Morphological changes in myocardial dystrophies (MCD):
Intracellular myocytolysis occurs, contracture damage and coagulation necrosis are observed. The cell is damaged, lysed and disintegrated, which leads to the formation of necrosis.

Stages of ICD
1. Neuro-functional, when there is no necrosis yet and the patient presents with nonspecific complaints.
2. Exchange-structural changes.The patient’s complaints are aggravated, rhythm disturbances become more frequent.
3. Heart failure

Features of ICD
1. Secondary disease with well-pronounced adaptation.
2. Changes in the myocardium at the cellular level.
3. The adaptive-compensatory elements of restoration of the affected structures are well expressed (reversibility of changes in the myocardium).
4. Rarely turns into cardiosclerosis.

Principles of treatment of myocardial dystrophies:
1.Treatment of the underlying disease
2. Regulation of internal homeostasis:
– Electrolyte balance;
– Acid-base balance;
– Elimination of hypoxemia;
– Detoxification.
3. Metabolic therapy.
4. Symptomatic therapy:
– Treatment of arrhythmias.
– Treatment of heart failure.

Alcoholic myocardial dystrophy
– From 8 to 15% of patients with chronic alcoholism die from cardiac disorders;
– 10% of young patients die suddenly;
– 50% of people who abuse alcohol for a long time have clinical signs of damage to the heart and other visceral organs;
– Taking ethyl alcohol in a dose exceeding 90 g per day for five years is accompanied by an increased risk of developing alcoholic CMP.Within three years – the risk of developing atrial fibrillation.

Markers of chronic alcohol intoxication:
– Obesity or underweight
– Coated tongue
– Formation of hypertension
– Sensory disturbance with formation of polyneuropathy
– Dupuytren’s contracture
– Muscular atrophy
– Hyperhidrosis
– Hepatomegaly
– Hepatomegaly
Conjunctival congestion
– Palmar erythema
– Gynecomastia
– Increase in the number of red blood cells with macrocytosis

A combination of 6 or more signs indicates chronic alcoholism!

Phases of alcoholic myocardial dystrophy
– The asymptomatic stage can be prolonged, an enlarged left ventricle is formed. If the patient has hypertension, diastolic dysfunction develops.
– The phase of severe clinical symptoms, when signs of heart failure form quickly.

Pathogenetic links:
I. Due to the destructive effect of ethanol, there is a direct damaging effect on myocardial cells, the integrity of membranes is disturbed – the activity of K +, Na + pumps decreases; arrhythmias may occur, the interaction of Ca with the membrane of the sarcolemma is disrupted and the ATPase activity of myosin decreases – the contractile function of the myocardium is disrupted, the respiratory function is inhibited, anaerobic glycolysis is activated;

II.The synthesis of contractile protein is inhibited;

III. The electrolyte balance is disturbed;

IV. Sympatho-adrenal activity increases;

V. There are gross disturbances of microcirculation (increased permeability of microvessels, endothelial edema, aneurysmal dilatation and rupture of the walls, vascular thrombosis).

Alcoholic myocardial dystrophy develops faster in persons with a history of alcohol abuse and concomitant pathology (diabetes mellitus, chronic pulmonary pathology, etc.)).

Clinic of alcoholic myocardial dystrophy
1. Pseudoischemic form, when the patient presents complaints from the heart, characteristic of angina pectoris, therefore it is necessary to carry out differential diagnosis between the formed angina pectoris and pseudoischemic form of myocardial dystrophy.

2. Option: arrhythmic form of ischemic heart disease – often manifested by paroxysms of atrial fibrillation, tachycardia, extrasystole.

3. Option: congestive form – when total heart failure develops against the background of dilatation of all cardiac cavities (differentiate with dilated cardiomyopathy).

Peculiarities of alcoholic myocardial dystrophy:
– Relationship with constant alcohol abuse or periodic alcoholic excesses (“domestic” drunkenness, “festive” heart).

– Deterioration of the patient’s condition on the 2nd day after alcoholic excess, which are accompanied by severe autonomic symptoms.

– Positive dynamics in the patient’s condition against the background of detoxification therapy and abstinence from alcohol intake.

– Rapid reverse dynamics of even dilated heart chambers and the disappearance of signs of congestive heart failure if the patient refuses alcohol.

– Violation of the rhythm, often supraventricular.

– Very rare thromboembolic complications.

Treatment for alcoholic myocardial dystrophy
– Avoid alcohol intake (including beer).
– Detoxification therapy (various solutions, berlition, unitiol) – maximum neutralization of the toxin.
– Restoration of electrolyte balance: K +, Mg preparations ²⁺ (Magnerot, Panangin).
– Vitamin therapy, B vitamins in large quantities.
– Metabolic and symptomatic therapy: Essentiale, cocarboxylase, mildronate, mexidol, mexi B6, mexicor, cytoflavin, hepatoprotectors – heptral, ursosan, exhol, hafitol.
– Symptomatic treatment of hypertension: antihypertensive drugs (β-blockers (aritel), Ca antagonists (felotens), ACE inhibitors (fosinap), sartans (angiakand).
– Symptomatic treatment of arrhythmias: antiarrhythmic (β-blockers, combination of quinidine with verapamil).

Takotsubo cardiomyopathy
The patient develops pain; subsequent hospitalization. The ECG pattern is similar to the ECG in patients with myocardial infarction and the clinical picture of acute coronary syndrome. An increase in the content of biomarkers of damage to the heart muscle is observed, but when performing selective cardiography, the absence of significant damage to the coronary arteries is revealed.Takatsubo cardiomyopathy is also called transient apex ballooning syndrome; is presented in the figures below.

Recommendations of doctors – Pavlovsky Infectious Diseases Hospital

Monday,
eight
August
2016

Infectious myocarditis

Myocarditis – focal or widespread inflammation of the heart muscle as a result of various infections, the effects of drugs, toxins or immune processes leading to damage to the cells of the heart tissue and the development of heart failure. It is very difficult to estimate the true prevalence of myocarditis, since in most cases it proceeds without vivid symptoms and usually ends in full recovery. The prevalence of this disease ranges from 1 to 4%, including infectious diseases in 1.7% of cases. According to statistics, people of reproductive age up to 40 years old suffer from myocarditis more often. Women are susceptible to this disease to a greater extent than men, but the male half of the population is subject to more severe forms of myocarditis with severe complications.

Causes of myocarditis and its forms.

All reasons that in one form or another can lead to the formation of inflammation in the heart muscle can be divided into 3 main groups. These are infectious and infectious toxic causes. These include viruses: measles, infectious mononucleosis, adenoviruses, influenza viruses, infectious hepatitis and HIV. They have a direct destructive effect on the cell by introducing it inside, thereby disrupting normal physiological processes.

Of the bacteria that play a role in the development of myocarditis, the following can be distinguished: diphtheria bacillus, mycobacterium tuberculosis, streptococci, meningococci and gonococci. More rare forms: fungal infections (aspergillosis, actinomycosis, candidiasis), parasitic invasions (toxoplasmosis, schistosomiasis, echinococcosis). Allergic group: as a result of exposure to drugs (sulfonamides, cephalosporins, antidepressants), systemic connective tissue diseases. All this activates the body’s immune system into a wrong mechanism, which, in an attempt to suppress inflammation, takes its organs and tissues for a pathogenic object and attacks them.Toxic effects (drugs, alcohol, thyroid disease and diabetes) have a direct effect on the heart muscle, leading to cell death.

Symptoms arising from myocarditis.

Several forms of myocarditis are distinguished along the course, depending on the onset of symptoms and the duration of their existence.

Acute myocarditis is characterized by an acute onset and severity of clinical manifestations. Subacute myocarditis is characterized by a less vivid clinical picture, moderate changes in laboratory tests.Chronic myocarditis is characterized by a long course with periods of exacerbation and complete disappearance of all symptoms. There are also three degrees of severity of myocarditis: mild, medium-severe and severe. The symptoms of myocarditis do not have any specific features, according to which one could say with 100% certainty that this is exactly the pathology. But in most cases, there is a relationship between heart disease and infection or other reasons listed above. The disease most often develops a few days (less often weeks) after a viral infection and in most cases is asymptomatic.Most often (60% of cases), patients begin to feel pain in the region of the heart, which usually comes from near the nipple zone and can spread to the entire chest area. Pains are usually pressing or stabbing in nature, lasting in time and do not depend on physical effort or stress, that is, they can occur at rest. Shortness of breath is the second most common symptom of current myocarditis. Its appearance is associated with a decreasing contractility of the left heart. It usually occurs with severe physical exertion, with a mild form of myocarditis, or even at rest – with moderate and severe forms.Shortness of breath may increase when the patient takes a horizontal position. Heart palpitations are noted by 47.3% of patients with myocarditis. Interruptions in the work of the heart, dizziness and fainting occur as a result of rhythm disturbances and are the root causes of which patients are treated. With a prolonged course of myocarditis, edema in the legs may appear, which are the result of insufficient work of the heart. If you begin to notice any of these symptoms in yourself and, alas, have recently had a viral infection or abuse alcohol and drugs, contact your local doctor.

Diagnostic measures.

You must tell your doctor if you have had a cold, fever, joint or muscle pain, or a skin rash.

It is also necessary to inform whether you are worried about pain in the region of the heart or chest and what this pain is associated with (physical activity, eating or pain occurs at rest). You should definitely be asked whether you have had increased fatigue recently, whether there are nocturnal attacks of suffocation or heart palpitations.Then the doctor will need to look at and listen to you.

From laboratory diagnostic methods in the general blood test, an increase in the number of leukocytes and an acceleration of ESR will be observed. However, these indicators may not be constant and depend on many circumstances. In some patients, in the biochemical blood test, the level of myocardial enzymes (CPK, MV-CPK, LDH) may increase, the degree of increase in which reflects the severity of the inflammatory process in the tissues of the myocardium.

In some controversial situations, in order to identify the cause of myocarditis and in the presence of certain symptoms, it is necessary to conduct an analysis to detect antibodies to cardiotropic viruses, a fourfold increase of which has diagnostic value.

Instrumental diagnostic methods include: electrocardiogram and 24-hour Holter ECG monitoring. Myocarditis can cause abnormalities on the ECG. Various rhythm disturbances may appear, such as sinus tachycardia or bradycardia, and other types. When performing echocardiography in patients with asymptomatic or asymptomatic myocarditis, changes may be absent or may reveal insignificant quantitative changes in blood volume. With a pronounced degree of myocarditis, with the development of heart failure, the contractile ability of the heart and the volume of blood that it ejects decreases.X-ray examination allows you to determine the severity of the enlargement of the heart in volume and signs of congestion of blood in the lungs. In very rare cases and for special indications, a myocardial biopsy is performed. The final diagnosis can be made only after this invasive method.

When making a diagnosis of myocarditis, it is necessary to exclude diseases occurring with secondary heart damage, that is, those diseases that, due to their complications, lead to the development of an inflammatory process in the heart.

For the differential diagnosis of non-rheumatic myocarditis, endocrine, metabolic and general systemic diseases should be excluded as the main cause of damage to the heart muscle. Very often pain in the heart area is mistaken for angina pectoris, I would like to list the main differences. Patients with myocarditis usually indicate a recent infection, patients have predisposing factors for the development of coronary heart disease (smoking, high blood pressure, metabolic disorders), angina pectoris is characterized by a positive effect from taking nitroglycerin.For myocarditis that develops in young children, the possibility of congenital disorders (for example, neuromuscular diseases, endocrine pathology, congenital vascular anomalies) should be taken into account.

For a more detailed analysis of the cause of endocarditis, it is necessary to consult a rheumatologist, ENT doctor, infectious disease specialist, cardiac surgeon.

Treatment of myocarditis.

During treatment, it is necessary to decide several main points: it is necessary to prevent irreversible expansion of the heart chambers, to minimize the risk of developing chronic heart failure.If myocarditis is suspected, all patients should be hospitalized. It is necessary to observe bed rest, the duration of which depends on the degree of myocarditis. In severe cases with a risk of complications, treatment should be carried out in the intensive care unit. It is necessary to follow a diet during treatment and for a long time thereafter, with fluid and salt restriction. Drug treatment in patients with myocarditis should be aimed at eliminating the causative factor and directly treating the symptoms of myocarditis.It is also necessary to correct the immune system and eliminate possible further complications. Since in the overwhelming majority of cases, the cause of myocarditis is a viral infection, it is necessary in the acute period of the disease at the height of the symptoms to conduct antiviral therapy (polyclonal immunoglobulins, interferon alpha, riboverin).

With the development of myocarditis against the background of a bacterial infection, patients are shown the use of antibacterial agents. The antibiotic is prescribed taking into account the underlying disease.It is necessary to sanitize chronic foci of infection, which will have a beneficial effect on the outcome of myocarditis.

Surgical treatment is indicated for patients with persistent rhythm disturbances that do not respond to conventional therapy. They are implanted with an external pacemaker, which, by generating the correct rate of contraction, causes the heart to contract and ensure normal circulation.

After recovery, the frequency of visiting a doctor depends on the form of myocarditis.With focal or mild myocarditis, observation by a cardiologist is indicated once every 6 -12 months. With moderate severity, every 3 months, and with severe severity, re-hospitalization is necessary. It should be remembered that if you have ever had myocarditis, you need to avoid hypothermia, intense physical exertion, reduce the consumption of table salt to 3 grams per day, if shortness of breath and swelling on the legs appears, immediately consult a doctor.

Prevention and prognosis.

Myocarditis can develop as a manifestation or complication of any infectious disease (primarily viral), therefore, the prevention of myocarditis is reduced mainly to the prevention of these diseases.It consists in carrying out preventive vaccinations and vaccinations against those infectious agents that directly affect the heart (measles, rubella, influenza, polio, diphtheria). All patients who have had cases of sudden death or the development of heart failure at a young age in the family should undergo a medical examination and an ECG study at least once a year. In addition to the examination, overload work or professional sports should be avoided.

The rule of “three” applies to the prognosis of myocarditis: one third of patients recover, one third develops heart failure, and another third rapidly deteriorates and may be fatal.Therefore, watch your health and do not get sick!

Good results in reducing the number of myocarditis can be achieved only with family education, family prevention, early active detection and early treatment by a cardiologist.

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Heart failure – ProMedicine Ufa

Heart failure is a condition associated with the fact that the heart does not cope with its functions as a pump that ensures normal blood circulation.With heart failure, the heart is not able to pump blood efficiently, and therefore there is a violation of the circulation of oxygen and nutrients in the body, which leads to stagnation of blood. It manifests itself as a result of coronary heart disease, heart defects, arterial hypertension, lung diseases, myocarditis, rheumatism.

Reasons

The reasons for the development of heart failure are associated with prolonged overload of the heart and cardiovascular diseases: ischemic heart disease, hypertension, heart defects.

These diseases weaken the heart and lead to the activation of compensation mechanisms that are aimed at restoring normal blood circulation. For a while, blood circulation improves, but soon the reserve capacity ends and the symptoms of heart failure appear with renewed vigor.

Risk factors for the development of heart failure:

– obesity;
– smoking, alcohol abuse;
– diabetes mellitus;
– hypertension;
– diseases of the pituitary gland and thyroid gland, accompanied by an increase in pressure;
– any heart disease;
– taking medications: antineoplastic, tricyclic antidepressants, glucocorticoid hormones, calcium antagonists.

Symptoms

Heart failure can manifest itself in different symptoms, depending on which part of the heart is most affected. Shortness of breath, arrhythmias, dizziness, darkening of the eyes, fainting, swelling of the cervical veins, pallor of the skin, swelling of the legs and pain in the legs, enlarged liver, ascites (free fluid in the abdominal cavity) may occur. The patient does not tolerate even a little physical activity. In the later stages, complaints arise not only during exertion, but also at rest, the ability to work is completely lost.Due to insufficient blood supply, all organs and systems of the body suffer to one degree or another.

Diagnostics

If heart failure is suspected, the electrolyte and gas composition of blood, acid-base balance, urea, creatinine, cardiospecific enzymes, indicators of protein-carbohydrate metabolism are determined.

ECG for specific changes helps to identify hypertrophy and insufficient blood supply (ischemia) of the myocardium, as well as arrhythmias.On the basis of electrocardiography, various stress tests are widely used using an exercise bike (bicycle ergometry) and a treadmill (treadmill test). Such tests with a gradually increasing level of load make it possible to judge the reserve capabilities of the heart function.

With the help of ultrasound echocardiography, it is possible to establish the cause of heart failure, as well as to assess the pumping function of the myocardium. With the help of MRI of the heart, coronary artery disease, congenital or acquired heart defects, arterial hypertension, etc. are successfully diagnosed.diseases.

Radiography of the lungs and chest organs in heart failure determines congestion in the small circle, cardiomegaly.

Radioisotope ventriculography in patients with heart failure allows a high degree of accuracy to assess the contractility of the ventricles and determine their volumetric capacity.

In severe forms of heart failure, ultrasound of the abdominal cavity, liver, spleen, and pancreas is performed to determine the damage to the internal organs.

Treatment

Treatment of heart failure is aimed, first of all, at improving the quality and increasing the life expectancy of patients, as well as at preventing and / or treating diseases of concomitant diseases. The goal of treatment is to improve hemodynamics, reduce the clinical manifestations of heart failure and increase exercise tolerance.

Treatment of heart failure involves the use of drugs that affect some of the known pathogenetic links of the disease, their use allows you to curb the progression and reduce clinical manifestations.A prerequisite for successful treatment is pathogenetic therapy of the disease.

Targeted treatment of the underlying disease includes:

– myocardial revascularization and optimal antianginal therapy for coronary artery disease;
– normalization of blood pressure in arterial hypertension;
– treatment of thyroid dysfunction, surgical correction of heart defects and the like.

Treatment of acute and chronic heart failure is carried out individually. The selection of drugs depends on the stage of the disease, the severity of the symptoms, and the characteristics of heart damage.Nutrition for heart failure has its own characteristics. Forbidden to eat: strong fish and meat broths, legumes and mushrooms, fresh bread, pastry and puff pastry, pancakes, fatty meats: pork, lamb, goose meat, duck, liver, kidneys, sausages, fatty fish , smoked, salted and canned fish, canned food, fatty and salted cheeses, sorrel, radish, spinach, salted, pickled and pickled vegetables, hot spices: horseradish, mustard, animal and cooking fats, coffee, cocoa, alcoholic beverages.

Heart transplantation is a radical treatment for patients with chronic congestive heart failure. Although there are contraindications, such as old age, systemic diseases with multiple organ lesions, recent thromboembolic complications, etc.

90,000 Causes, provoking factors, signs and treatment of heart failure

Causes of development, symptoms and treatment of heart failure

Heart failure is a pathological condition in which the heart does not provide adequate blood flow, which leads to oxygen starvation and a lack of nutrients in the cells of organs.Chronic cardiovascular failure is a consequence of almost every disease of this system.

Causes of occurrence

Atherosclerosis, hypertension, myocardial infarction, heart defects are the main causes of the development of this disease. Constant narrowing of the blood vessels causes blood flow to slow down. Until a certain moment, the heart independently copes with this problem, learning the rhythm of its contraction. If these pathologies are not treated, the result will be heart failure.

Doctors consider some autoimmune pathologies, food poisoning, and severe infectious diseases to be provoking factors. The causes of heart failure in old age can be diseases of the respiratory system, and problems in the work of the genitourinary system. In the first case, the heart cannot cope with the increased pressure in the pulmonary artery, in the second – with a large amount of fluid in the body, which accumulates due to insufficient functioning of the kidneys.

Symptoms of heart failure

A distinctive feature of the disease under consideration is a gradual increase in the intensity of clinical manifestations. Symptoms of heart failure at the beginning of the development of pathology are practically absent – a person leads a normal life, but with aggressive physical exertion, shortness of breath may appear. If at this moment the pressure in the vessels of the lungs rises, shortness of breath quickly transforms into a cough. As the disease progresses, the following will appear:

• feeling of weakness, malaise, no matter how heavy the load was;
• cough – in case of heart failure, it has a paroxysmal character, may be accompanied by the release of pinkish sputum, which means the presence of blood in it;
• palpitations, anxiety;
• decrease in the amount of urine excreted, urination takes place mainly at night.

Mild heart failure in women in menopause will be accompanied by disturbances in the psycho-emotional background – mood swings, unmotivated irritability, headaches, drowsiness during the day and insomnia at night. If this condition is accompanied by a periodic increase in heart rate and shortness of breath during physical exertion, then you need to be examined by a cardiologist.

The disease in question may be accompanied by uncharacteristic manifestations.For example, if narrowing of the blood vessels and congestion occur in the liver, then the patient will complain of a feeling of heaviness and aching pain in the right hypochondrium. Cough, persistent shortness of breath and chest pain are signs of cardiopulmonary failure.

Therapeutic measures

Treatment of heart failure begins with an examination of the patient. The doctor should get the results:

• ultrasound examination of the heart;
• chest radiographs;
• ECG;
• general blood test.

With appropriate symptoms, ultrasound of the kidneys and liver, general urine analysis can be prescribed as an additional examination.

Therapy can be carried out on an outpatient basis – the patient is registered with a cardiologist, receives medications and periodically undergoes control examinations. The doctor will definitely give clinical recommendations for heart failure:

1. Limit physical activity, give up strength exercises and cardio training, change jobs if necessary.
2. Adjust the diet. Patients with similar problems need to follow a diet that includes avoiding salt, fatty foods and controlling the drinking regime.
3. Need to take medication for shortness of breath in heart failure. They are usually given in short courses and help prevent respiratory problems.
4. Periodically take a course of vitamin therapy. The complexes help restore the work of the heart muscle and normalize the metabolism in it.

It is imperative to take medications that help remove excess fluid from the body and lower blood pressure. Therapy for heart failure is always complex and long-term. Predictions depend on what underlying disease led to the problem in question – if it is treatable, then the restoration of the heart is quite possible.

If a person suddenly became ill, complains of severe chest pain, begins to choke, then this may indicate the development of acute heart failure.An ambulance team will provide qualified assistance, but the patient’s condition can be alleviated immediately. First aid for acute heart failure:

• the person must sit – it is important that the legs are down;
• a nitroglycerin tablet is placed under his tongue, after 5 minutes a second tablet can be put;
• provide access to fresh air – open windows and doors, unbutton a sick tie, shirt or outerwear.

Prevention of heart failure

The disease in question can be completely prevented, doctors have developed a set of preventive measures:

1. Regularly visit a cardiologist, take ECG readings and get an assessment of the state of your heart and vascular system from a specialist.
2. Correct your own weight, adhere to a diet that restricts salt, alcohol and fatty foods.
3. Monitor blood pressure.With its frequent increase, you need to consult a specialist and undergo treatment for hypertension.
4. Fully treat any internal diseases, since even a banal inflammation of the prostate gland or ovaries can lead to narrowing of blood vessels and heart failure.

For more information about in which case edema can form in congestive heart failure and what to do in case of severe shortness of breath, you can find out on the pages of our website Dobrobut.com.

Related services:
Cardiological Check-up
Complex cardiac surgery (simple)

symptoms, diagnosis, treatment in Irkutsk at the Expert Clinic

Chronic heart failure. The topic, you see, is more than relevant. Especially today, in an age of previously unthinkable speeds and stresses. Natalya Aleksandrovna Shelest, a cardiologist, Clinic Expert, Irkutsk, tells about why and how this pathology arises, how it is diagnosed and treated.

– Natalya Alexandrovna, statistics show that more people die from cardiovascular diseases every year than from any other ailment. Let’s talk about chronic heart failure. What is this disease?

– Chronic heart failure (CHF) is not an independent disease, but a consequence of some kind of disease, a complication of pathologies such as:

• ischemic heart disease;
• arterial hypertension;
• congenital and acquired heart defects;
• postponed myocarditis, cardiomyopathies, tachyarrhythmias (usually atrial fibrillation) or bradyarrhythmias;
• diseases of the bronchopulmonary system (more often it is chronic broncho-obstructive pulmonary disease) or, in some cases, of the endocrine system (more often diabetes mellitus, less often hyperthyroidism), when secondary cardiomyopathy is already forming.

Chronic heart failure is characterized by recurrent episodes of exacerbation – a sudden or, more often, a gradual increase in symptoms.

With this disease, the heart muscle weakens and is no longer able to fully perform its main, pumping function. This leads to disruptions in the supply of oxygen to the body, nutrients.

CHF is divided into two forms: systolic – when the ventricles of the heart do not have enough strength to effectively push the required amount of blood from the heart into the aorta, and diastolic – when, after pushing blood out of the heart, the heart muscles cannot fully relax, the ventricles do not fill with blood in quantity sufficient for further adequate blood supply to organs and tissues.

Also, different degrees of severity of heart failure are distinguished. There is an international classification – from the first to the fourth functional classes:

I functional class – when there is heart disease, but there are no subjective signs of the disease at rest and with any physical activity.

II functional class – there are no signs of the disease at rest, but there is a feeling of discomfort during normal physical activity.

III functional class – there are no signs of the disease at rest, but with minimal physical activity, symptoms of the disease appear, and the person is forced to limit himself in physical activity.

IV functional class – symptoms of the disease are felt even at rest, any physical activity leads to increased symptoms.

Functional classification allows for dynamic assessment of changes in the patient’s condition and the effectiveness of treatment.

– Why does chronic heart failure develop?

– The cause of the development of the diastolic form is most often arterial hypertension. This type of pathology is provoked by ischemic heart disease, hypertrophic and restrictive cardiomyopathies, heart disease in amyloidosis (an abnormal protein called amyloid is deposited in different organs and tissues) and sarcoidosis (damage to various organs and systems, most often the lungs).

Systolic heart failure is most often caused by myocardial infarction – when a part of the heart muscle completely dies, connective tissue forms in its place, as a result of which the contractile function of the heart suffers. Another reason is heart defects (congenital or acquired), chronic pulmonary heart disease (in diseases accompanied by impaired air permeability through the bronchi).

Less commonly, the pathology is caused by toxic damage to the heart muscle – this happens when taking certain medications or alcohol.

– What are the symptoms of chronic heart failure? And can it be asymptomatic?

– Yes, in the early stages, chronic heart failure occurs without symptoms. It all starts with a deterioration in the tolerance of the usual physical activity. A person quickly gets tired, he is worried about shortness of breath. Shortness of breath first appears with significant physical exertion, later – if the disease is not treated – with little effort. And over time, it can bother even at rest, even in sleep (a person feels a lack of air, but as soon as he sits down, the symptom disappears).Usually people feel worse when lying down. Sometimes shortness of breath is accompanied by fits of coughing, in which mucous sputum may even be released.

Heart palpitations are also a symptom of the disease. In the first stages, a person feels it during physical exertion, and later, when the disease begins to progress, at rest.

Chronic heart failure is often accompanied by life-threatening heart rhythm disorders – atrial fibrillation, ventricular tachycardia.In such cases, the provision of medical assistance should be prompt.

Often, chronic heart failure is characterized by edema of the lower extremities. At the very beginning, they appear in the late afternoon in the area of ​​the ankles, feet, and disappear after rest. If untreated, the edema becomes constant during the day and persists for weeks or months. They can spread along the entire length of the legs, to the abdominal wall and lumbar region.

Far-reaching untreated chronic heart failure is accompanied by the appearance of fluid in the lungs (hydrothorax), in the heart (hydropericardium), in the abdominal cavity (ascites).

In addition to these symptoms, appetite may also deteriorate, but the weight may remain the same or even gradually increase due to edema. With an advanced disease, liver dysfunctions begin, protein is not formed properly, which can cause weight loss and the ineffectiveness of taking diuretics.

Strengthening of the symptoms of the disease occurs against the background of infection, anemia, fever, hyperthyroidism, excessive intake of salt, fluids, excessive alcohol consumption, with renal failure, heart rhythm disturbances.But the most important reasons for the development of CHF or decompensation of CHF is the lack of treatment for the underlying disease or non-compliance with the drug therapy regimen for heart failure.

– What does the diagnosis of chronic heart failure include?

– First of all, the collection of information begins: the doctor listens to the patient’s complaints, gets acquainted with the history of his life and illness, finding out what other diseases he suffered before or is suffering now, how the treatment was carried out.This is followed by a full inspection.

Next, the stage of instrumental and laboratory examination begins. A cardiogram, an x-ray of the chest organs, an ultrasound of the heart (otherwise it is called echocardiography), an ultrasound of the abdominal cavity are done. If necessary, studies such as coronary cardiography, radioisotope angiography, gamma scintigraphy may be prescribed.

In addition, biochemical blood tests are carried out. The doctor looks for concomitant ailments – for example, diabetes mellitus, thyroid disease.

Today, it is very important to determine the content of natriuretic peptide: if this indicator is normal, a person definitely does not have chronic heart failure. The same indicator is used to determine the prognosis for CHF.

– Natalya Alexandrovna, how is chronic heart failure treated?

– Depending on the functional class, there are different schemes for the selection of therapy. With a low-symptom course of the disease, we recommend that you first change your lifestyle, but at the same time it is necessary to treat the underlying disease that provoked the appearance of chronic heart failure – for example, the same ischemic heart disease, arterial hypertension.

Be sure to discuss the diet with the patient. First of all, it is necessary to reduce the consumption of table salt: up to 5-6 grams per day at the first stage of the disease, and if the disease is already progressing – up to 3-4 grams or even have to completely abandon salt. We recommend a balanced diet and normalization of weight, as this helps to significantly facilitate the work of the heart and reduce the high level of blood pressure.

The same applies to fluid intake: at the first stage, no more than 2 liters per day, with decompensation of chronic heart failure – up to one and a half to one liters.It is necessary to constantly monitor body weight: if the weight gain is 2 kilograms in two to three days, this indicates a worsening of the course of the disease and requires increased therapy.

And, of course, drugs are used in the treatment of chronic heart failure. Medications may be prescribed to control blood pressure, fluid content in the body, drugs that inhibit changes in the structure of the heart muscle, preventing the progression of heart failure.There are means that can reduce the heart rate at rest, increase its pumping function, improve oxygen access to the heart, and stop life-threatening rhythm disturbances. Many of these drugs require dynamic patient monitoring by a physician.

Physical activity is useful (of course, strictly dosed, depending on the patient’s condition). We also recommend giving up smoking, excessive alcohol consumption.

All patients with heart failure, regardless of its origin, need vaccination against influenza and pneumococcal diseases.

Interviewed by Igor Chichinov

The edition recommends:

Chest pain: is there always a heart?
What is cardiac arrhythmia?
Holter ECG monitoring: what is it and what is it used for?

For information:

Shelest Natalya Alexandrovna

Graduated from the medical faculty of Irkutsk State Medical University in 2000.