Talking about the standardized treatment of heart failure – written before the first “National Heart Failure Day” Before the first “National Heart Failure Day” on November 26, 2015, it is necessary to talk about the standardized treatment of heart failure. The general public is very familiar with common cardiovascular diseases such as myocardial infarction and stroke, but most people know very little about the concept of heart failure, and the awareness and importance of heart failure are extremely low. So what is heart failure? Heart failure is a complex group of clinical syndromes characterized by impaired ventricular filling or ejection capacity due to any structural or functional abnormality of the heart, and is characterized by dyspnea and malaise (limited activity tolerance), as well as fluid retention (pulmonary stasis and peripheral edema). Heart failure is a serious and terminal stage of various heart diseases with high morbidity and is one of the most important cardiovascular diseases today. In particular, with the onset of winter, temperatures gradually go down, blood pressure gradually goes up in hypertensive patients, and the frequency of myocardial ischemic episodes in patients with coronary artery disease increases markedly, leading to a marked increase in the incidence of heart failure, which is the downstream of these diseases. Recently, the ward has admitted many patients with acute left heart failure and acute coronary syndromes due to sudden rise in blood pressure, heart failure due to myocardial ischemia and infarction. Together with atrial fibrillation, heart failure is one of the two major unsolved cardiovascular battlegrounds. As Brauwald says, “Over the past half century, there have been significant advances in the prevention, diagnosis, and management of cardiovascular disease, with cardiovascular deaths in the developed world reduced by two-thirds, and mortality from ACS, valvular and congenital heart disease, hypertension, and arrhythmias all reduced significantly. Only the field of heart failure is an exception.” Heart failure is the leading cause of hospitalization in the patient population over the age of 65, with a poor long-term prognosis for patients, a 5-year survival rate of less than 50%, and a lethality rate that is 2-3 times higher than that of advanced cancers such as breast and bowel cancers, seriously endangering people’s health. However, I have been receiving consultations from patients all over the country on the websites of “” and “Sina Aiqian Doctor”, and found that many places, hospitals, doctors and patients do not have enough knowledge about heart failure, and the treatment is not standardized, which results in many heart failure patients’ quality of life decreasing significantly and disability rate. The quality of life decreases significantly, and the disability and mortality rates increase significantly. The National Center for Cardiovascular Disease, the Heart Failure Professional Committee of Chinese Physicians Association, and the China Health Promotion Foundation have jointly initiated to designate November 26 as the “National Heart Failure Day” every year, and the theme of the “National Heart Failure Day” in 2015 was The theme of 2015 National Heart Failure Day is “Recognize Heart Failure, Standardize Diagnosis and Treatment”. So how to standardize the treatment of heart failure? (1) The first step is to control the causes of heart failure. In the pre-heart failure stage, it is important to control the risk factors for heart failure, such as controlling blood pressure, actively treating coronary artery disease and controlling blood glucose, losing weight, avoiding alcohol abuse, and controlling rheumatic fever, to avoid the resulting structural changes in the heart. (2) Secondly, it is necessary to recognize the symptoms of heart failure, the most typical symptoms are shortness of breath, fatigue and decreased exercise tolerance after activities, the symptoms gradually aggravate, there will be the inability to lie down at night, forced to sit up and then get better, or nocturnal episodes of dyspnea, and in the early stage of the daytime life and work as usual, the examination in the hospital may not be able to find any problems. Gradual development of the disease, the seriousness of the cough pink foamy sputum, these symptoms are the symptoms of left heart failure. Edema of both lower limbs, fatigue, poor appetite, a lot of chest and abdominal fluid and liver pain and bruising are symptoms of right heart failure. If you experience similar symptoms as above, you must go to the hospital as soon as possible to check whether there is a possibility of heart failure. (The picture below is a classic picture of left heart failure + right heart failure) (3) If you have the above symptoms of heart failure, it is recommended that you go to the hospital to have a cardiac ultrasound, electrocardiogram and chest radiographs checked, as well as blood tests for routine blood counts, liver and kidney function, electrolytes, thyroid function, brain natriuretic peptide, etc., and if you suspect that there is a myocardial infarction, you should also check the ultrasound for Troponin T. The brain natriuretic peptide is a marker that can be used to differentiate cardiac and respiratory dyspnea. Respiratory dyspnea, if brain natriuretic peptide is less than 35ng/L, it does not support heart failure, if brain natriuretic peptide is significantly increased, it strongly suggests heart failure. Cardiac ultrasound allows quantitative analysis of cardiac structure and function, especially the left ventricular end-diastolic internal diameter and left ventricular ejection fraction, which are particularly important. The purpose of these tests is: (a) to confirm the presence of heart failure; (b) to identify the causes of heart failure, and the treatment of the causes is always the most effective and correct treatment plan. Many patients who consult the Internet say that they have “dilated cardiomyopathy heart failure”, but the left ventricular end-diastolic internal diameter and the left ventricular ejection fraction are in the normal range, you can completely exclude dilated cardiomyopathy. However, there are many patients with heart failure who cannot find the cause of their heart failure in various tests, and then clinically consider “dilated cardiomyopathy”. Is there no way out? There is, in fact, a way to standardize anti-failure therapy, as Clyde W. Yancy, chairman of the guideline committee and chairman of the department of cardiology at Northwestern University, said: “If the right treatment is given to the right heart failure patient at the right time in the right way, the risk of death can be reduced very dramatically, perhaps by as much as 50 percent. For every 10 patients given the right treatment, it is likely that at least 1 patient’s life will be saved”. (4) anti-heart failure treatment, every time I answer the question of heart failure, I COPY this paragraph: “anti-heart failure drug treatment, if the patient has symptoms such as chest tightness, shortness of breath and edema, you can use diuretics first, so that chest tightness, shortness of breath and edema symptoms are relieved, and the weight stabilized to achieve “dry weight “Then use angiotensin-converting enzyme inhibitors or angiotensin receptor antagonists, betablockers, and other medications that can improve the prognosis of heart failure, slowly adjusting the dose to the target dose or maximum tolerated dose, and use aldosterone receptor antagonists, usually at a maximum dose of 20 mg once a day.” Why is this passage repeated? Relieve the symptoms of the first is the use of diuretics, but definitely not “infusion therapy”, many consultants, repeatedly emphasized that the heart failure attack to the hospital infusion treatment, do not go to the hospital for no reason infusion to increase the burden on the heart. At the same time, angiotensin-converting enzyme inhibitors are the “cornerstone” of the treatment of heart failure, and must be used unless there are contraindications. Beta-blockers are the only drugs that can reduce the rate of sudden death in heart failure and improve the prognosis of heart failure, not only should be used, but also should be used to the target dose or the maximum tolerated dose, better to use than not to use, and a large dose is better than a small dose. But early use, may impair cardiac function, used to 3 months after the cardiac function significantly improved, this three-month period, the dose increase should be slow, be patient. Another drug to improve the prognosis of heart failure is aldosterone receptor antagonist, domestic spironolactone, in fact, is also a diuretic, the general maximum dose of 20mg a day a piece can be, improve myocardial remodeling, no need to increase the dose. Standardize the treatment of heart failure, at the same time to control the salt and water intake, the amount of out for in, to prevent colds, appropriate exercise, cardiac rehabilitation, let us act!