Inability of the heart to assume its function of pump and propulsion of blood to meet the metabolic needs of the organization. Heart failure is the result of most cardiac pathologies, it is common and serious, because its mortality is estimated at 50% at 5 years.

Etiologies:
Heart failure (or ventricular) may be secondary to left:

  • Hypertension by chronic increase of afterload with left ventricular hypertrophy
  • A valvular (narrowing or aortic insufficiency or mitral)
  • Ischemic heart disease (reduction or stoppage of blood flow in one or more arteries of the heart),
  • Hypertensive cardiomyopathy, toxic, or deficiency (beri beri)
  • Obstructive cardiomyopathy
  • Myocarditis (myocarditis, inflammatory rheumatic or Chagas disease, common in South America)
  • Arrhythmias,
  • Profound anemia
  • Hyperthyroidism
  • Ischemic by coronary atherosclerosis

Heart failure (or ventricular) is right most often follows:

  • Left heart failure + + +
  • Pulmonary hypertension, itself caused by a lung disease (chronic bronchitis, emphysema, pulmonary embolism)
  • CHD
  • Mitral stenosis
  • Chronic lung disease

Chronic heart failure:
Often a consequence of hypertension in the small or large circulation, during which the heart muscle to pump against the increased pressure in the vessels. The ventricle must provide more work.

The muscle fibers are modified, they become longer and thicker. It develops an enlarged heart muscle.

The ejection capacity of the heart is diminished. The excessive volume of blood that remains in the heart is dilated ventricles.

Symptoms and Signs:

Left heart failure:

  1. Fatigue due to lower systemic flow
  2. Dyspnea at rest and
  3. Supine Dyspnea: one of the best signs of the evolution of IC is the increase in the number of pillows, changing the position of his body, increases the patient’s superior vena cava in venous return and thus pre load.
  4. Cyanosis
  5. Tachycardia, reflex acceleration of heart rate due to adrenergic hyperstimulation
  6. Arrhythmias
  7. Acute pulmonary edema, brutal and revealing
  8. Sometimes, signs of cerebral in cerebral blood flow decline with confusion, insomnia, anxiety


In right heart failure, there creating an overpressure in the venous system. It follows:

  • Dependent edema of the lower limbs
  • Engorgement jugular
  • Cyanosis
  • Hepatomegaly and Splenomegaly (The venous territory touches the cellar, which increases the volume of the liver and spleen)
  • Loss of appetite, nausea (for gastric reflux into the veins)
  • + / – Inflammation of the gastric mucosa
  • Insomnia
  • Nocturia
  • Ascites

Diagnosis:
According to the clinic:
By ECG to detect a possible etiology (myocardial infarction).

Chest radiography: It showed an increase in volume of the heart (cardiomegaly) and possible signs of lung overload.

Echocardiography: Assessing the size and function of the ventricles and diagnosed with valvular.

Other possible tests: cardiac catheterization, myocardial scintigraphy, CT …

Treatments:

  • Treat symptoms and cause.
  • Bed rest in a sitting position
  • Diet low in salt, limit the amount of drink
  • Avoid heavy meals
  • Smoking cessation
  • Avoid prolonged exposure to cold
  • Limit physical exertion
  • Weight Control
  • Diuretics to reduce blood volume and water retention
  • Improving the performance of the heart pump, trying to restore to normal myocardial contractility (inotropic agents)
  • Reduction of cardiac load by reducing either the venous return (preload) or the resistance to ejection (afterload) (vasodilators)
  • Digitalis in some cases (cardio tonics): they increase the contractility of the heart
  • Calcium antagonists or inhibitors of converting enzyme (ACE) for dilation of arteries, decrease hypertension
  • Necessary surgery for the treatment of the cause (valvular disease, ischemic heart disease …)
  • Transplantation as a last resort, in patients under 65 years if the heart failure can be improved by other methods.
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