Q: What is chronic heart failure?
A: Chronic heart failure is a group of common clinical syndromes in which various causes lead to structural or/and functional abnormalities of the heart that impair the ejection or filling capacity of the ventricles. Patients present with weakness and/or dyspnea and limited mobility, while fluid is stored in the lungs, extremities and other organs, causing the body to become congested and edematous. Congestive heart failure is the medical term used to describe this state.
Q: What are the common causes of heart failure?
A: All heart diseases can lead to damage to the structure and function of the heart, eventually leading to the development of heart failure.
1. Coronary heart disease is by far the most important cause of chronic heart failure, of which, post-myocardial infarction is the most common. Some patients do not have a clear history of heart attack.
2, Various diseases that lead to increased cardiac load, such as hypertension, valvular disease, congenital heart disease, lung, pulmonary vascular disease, etc.
3, idiopathic or specific cardiomyopathy, such as dilated cardiomyopathy, alcoholic cardiomyopathy, pregnancy, metabolic disease, etc.
Q: What are the symptoms of chronic heart failure?
A: The symptoms of chronic heart failure are related to the state of cardiac function and the adaptability of the body, but are not always consistent. The main symptoms include.
1. Shortness of breath, shortness of breath, and dry cough due to pulmonary stasis, which may occur initially after activity, or in severe cases at rest, in bed, and unable to lie down. It can also manifest as paroxysmal nocturnal dyspnea, and often requires sitting up to relieve the breathlessness after waking up from suffocation. Pulmonary edema is the most severe form of pulmonary stasis, and blood-red foamy sputum may be coughed up.
2. Fluid retention is caused by a decrease in blood flow through the kidneys, resulting in stasis in the body circulation and increased venous pressure causing tissue edema, such as the extremities, gastrointestinal and abdominal cavities. Patients may feel less urine, weight gain, lack of appetite, poor appetite, etc.
3.Vertigo, weakness and frailty are mainly due to the lack of effective perfusion of tissues and organs (head, muscles, etc.).
4, arrhythmia may be a reflection of the heart disease itself. A rapid heart rate is often a reflex of a failing heart. Tachycardia is also often a predisposing factor for cardiac failure.
Q: How is chronic heart failure classified?
A: Clinically, it is classified into systolic insufficiency and diastolic insufficiency according to the ejection fraction of the ventricles. Systolic insufficiency refers to the reduced ejection capacity of the heart, while diastolic function refers to the heart’s ability to relax and recover, which directly affects blood return. Cardiac capacity systolic insufficiency is characterized by a reduced ejection fraction and the usual dilatation of the ventricular chambers. The vast majority of patients with systolic insufficiency are always accompanied by signs and symptoms of diastolic insufficiency. Both systolic and diastolic insufficiency are most common in the left heart. Prolonged left heart insufficiency results in changes in right heart function due to structural and functional changes in the pulmonary vasculature, resulting in total cardiac insufficiency. Pure right heart insufficiency is seen mainly in pulmonary disease, pulmonary vascular disease and, rarely, restrictive cardiomyopathy. Clinically, if not specifically stated, cardiac insufficiency usually refers to left ventricular systolic insufficiency.
Q: Can heart failure occur even with normal or no significant abnormal systolic function?
A: Yes, as already mentioned, chronic heart failure is divided into systolic and diastolic chronic heart failure. In fact, the vast majority of patients with systolic chronic heart failure report that the pathological process is a reflection of diastolic abnormalities, and objective evaluation confirms the existence of diastolic abnormalities. However, chronic heart failure with predominantly diastolic abnormalities is not necessarily associated with systolic abnormalities. In the past, we have only paid too much attention to systolic chronic heart failure. Diastolic filling abnormalities have been one of the hot elements of clinical work. The diagnostic parameters of its abnormality are very common, but we have not paid sufficient attention to the symptoms it causes and limited to some cardiomyopathies before we made the diagnosis of cardiac insufficiency. Diastolic abnormalities result in symptoms of congestion. Dyspnea and shortness of breath are the most common symptoms. Rales in the lungs and even life-threatening pulmonary edema.
Q: How is chronic heart failure diagnosed?
A: The diagnosis of chronic heart failure cannot be made based on subjective symptoms alone, but combined with medical history, it can be used as an important diagnostic clue for chronic heart failure and one of the important indicators for evaluating the degree of chronic heart failure. Objective examinations, including physical examination, laboratory tests and abnormal laboratory findings are usually the basis for the diagnosis of chronic heart failure. Echocardiography is the most commonly used diagnostic tool. It can provide diagnostic information about heart anatomy and function, and is valuable in the diagnosis, treatment and prognosis evaluation of patients.
Q: How does heart failure occur?
A: How does heart failure begin? Although we rarely have the opportunity to observe the onset of heart failure except in acute myocardial infarction. However, patients undergo a considerable latent period or period of asymptomatic left ventricular dysfunction before obvious signs and symptoms appear, during which some patients may have experienced sudden death. The process of ventricular remodeling is now considered to be an important part of the development of chronic heart failure. Ventricular remodeling refers to abnormal changes in the morphology of the heart under the action of pathogenic factors, usually manifested as dilatation of the ventricular cavity or thickening of the ventricular wall, both remodeling processes. Activation of the neurohumoral system and cytokines play an important role in remodeling. Blocking these activating links, such as ACEI/ARB and β-blockers currently applied, can help to slow down and stop the progression of chronic heart failure.
Q: How is chronic heart failure treated?
A: There are more tools available for the treatment of chronic heart failure than before. Because of the progression of chronic heart failure, specialists who work with chronic heart failure will provide you with more appropriate treatment options. The primary goals of chronic heart failure treatment are to reduce the likelihood of disease progression (and, therefore, the risk of death and hospitalization), to reduce symptoms, and to improve quality of life. Patients should work with their physicians to determine the best course of treatment to develop.
Q: What can be done to prevent further damage to the heart?
A: Quit smoking, achieve and maintain an ideal body weight, control blood pressure, lipids and diabetes, regular physical activity, and abstain from alcohol to actively treat chronic heart failure and its causes.
Q: What drugs should be avoided in chronic heart failure?
A: Some pain relievers such as NSAIDS class, most anti-arrhythmics, most calcium ion antagonists, some supplements and growth hormone therapy, salt-containing antacids and indigestible preparations. If you are applying these drugs you should communicate and talk to your doctor. It is important to be clear about the name, purpose and application of your medication and not to discontinue medical advice without discussing it with your doctor. Even if you don’t have any symptoms, the medications you are taking can be helpful in maintaining and improving the effective work of your heart.
Q: What surgical means are available for heart failure treatment?
A: The goal of surgical treatment is to prevent further damage to the heart and improve its function. The main components include.
1.Ventricular assist device (VAD) that can be placed, usually for short-term supportive therapy for patients with end-stage chronic heart failure awaiting heart transplantation, cardiogenic shock, hemodynamically unstable state but with reversible cardiac function.
Coronary artery bypass grafting is the most common surgical treatment for chronic heart failure, and the removal of ventricular wall tumors that impair the heart’s ability to do work effectively can help improve function and prognosis.
3.Heart valve surgery helps to relieve the treatment of chronic heart failure due to valve disease.
4. Heart transplantation is used in end-stage chronic heart failure.
Q: What is the prognosis for chronic heart failure?
A: By comparing the efforts that have been attempted in the past in the treatment of heart failure. There has never been anything like what has been accomplished in the last 20 years or so with the application of ACEI and beta blockers, including improved rates of symptom improvement, reduced hospitalization and improved survival in chronic heart failure. For most patients, with proper care, chronic heart failure will not significantly prevent them from doing the things they enjoy. His prognosis will depend on the function of the heart, clinical symptoms and responsiveness to reasonable treatment.
There is still no cure for chronic heart failure, the outlook remains bleak, and those lucky enough to receive a heart transplant for advanced heart failure are, after all, in the minority. Therefore, there is still a long way to go in the search for a cure for heart failure. New drugs are constantly being developed, while at the same time making the existing ones more effective. Unfortunately, there are still a significant number of patients who are not receiving the standardized treatment available, as evidenced by the survey of patients with chronic heart failure who are decompensated.
Patients with chronic heart failure should communicate with their physicians and family members about the difficulties and wishes they are experiencing. Chronic heart failure treatment is a team effort, and the patient himself is a key member. The physician writes medical orders and handles other medical issues for you. And the other members of the team, including nurses, nutritionists, pharmacists, exercise instruction specialists and social workers help you succeed.
If you have questions about your condition and treatment, I hope this booklet will help you.