Causes and treatment of left ventricular heart failure. Left-deceiving deficiency (i50.1) with acute left-detection deficiency preference gives

A picture of cardiac asthma develops, an acute increase in volume in a small circulation circle is occurring, stagnation develops. It happens connected with a sharp weakening of the contractile work of the left sections of the heart with sufficient work of the right.

Causes: Myocardial infarction, acute coronary failure, heart defects (mitral stenosis, aortic vices), high hypertension (often with acute glomerulonephritis, IBS, infection with acute lung edema.

In mitral stenosis, there are no signs of left ventricular CH, but it happens a heart asthma (in the narrowed atrioventricular hole does not have time to leave the blood during the diastology, a purely mechanical obstacle arises in the conditions of increased work of the right ventricle).

The permeability of pulmonary capillaries increases, the lymphatic drainage is disrupted - the liquid part of the blood is hesitating in the alveoli and into the lumen of small bronchi, as a result of which the respiratory surface of the lungs is reduced, shortness of breath decreases, bronchospasm may join. If the attack is delayed, there is a sharp hypoxia of fabrics, including the pulmonary, increases the flow of the liquid part of the blood in the alveoli, foaming occurs, the respiratory surface is sharply reduced - it is a lung swelling.

Clinic

The attack of cardiac asthma appears most often at night, the patient wakes up from the attack of choking. Dyspnea more often inspiratory type. With bronchospasm, exhalation may be difficult. The fear of death, fright on the face, the patient jumps, sits down, the complexion of Earth-gray, breathing frequent, to 4 ° C. Under the edema of the lungs, the bubbling breathing, the allocation of scarlet sputum. Objectively arrhythmia and tachycardia, in the lungs hard breathing, an abundance of wet wheezes.

Acute referee

It is often connected with the pulmonary artery embolism. A suffocation appears, the cervical veins swell quickly, the dilatation of the right ventricle happens, a hearty push appears, the systolic noise of the sternum is often listened to the left, the liver increases. In the occurrence of CH, long-term diseases are played (heart defects, decompensation in these vices is partly associated with atherosclerotic lesion of the heart).

Violations of rhythm (extrasystole) and conductivity also play a major role. The prevention of CH has a tremendous value, especially in patients with cardiovascular diseases. There is a moderate restriction of physical exertion and training with the backup capabilities of myocardium.

Treatment:

It is important to treat the underlying disease that led to the development of CH. The treatment depends on the stage: I and II-A stage are treated outpatient, II-b and III stage are treated in the hospital.

1) Peace - first of all. The feature of the bed regime is a semi-dyed position, in which the venous return to the heart decreases, its operation is reduced.

2) diet - the restriction of salt and water (up to 1 l in day). Showing an easy-friendly rich in full-fledged proteins, vitamins and potassium products: potatoes, tomatoes, cabbage, spinach, smoking, raisins.

3) Employment:

I st. - exemption from severe physical work,

II Art. - Disability.

4) Timely recognition and treatment of the underlying disease: thyrotoxicosis, rheumatism, arrhythmia - provocateurs CH.

Medical therapy

1. Preparations that improve myocardial metabolism. Cardiac glycosides:

a) direct action on myocardial metabolism directly: frees calcium ions, increases ATP-AZA activity - direct cardiotonic effect, slows down the flow of potassium ions;

b) an honorable action through Vagus: Tachycardia decreases on the sinus unit - the conduct of the AV - slows down, transfers the tachistolic shape of fliccific arrhythmia into bradyistolic. But heart glycosides and their dangers: close therapeutic and toxic doses, during treatment it is necessary to take into account extremely different sensitivity to these drugs, especially in old people. Cardiac glycosides are capable of cumulating in the body.

Principles of treatment of glycosides

Treatment to start as soon as possible, especially shown glycosides with hemodynamic CH. First give a saturacing dose, then supporting. There are various saturation schemes:

a) rapid saturation (digitalization) - a goning dose is given over one day;

b) moderately fast - dose is given within 3-4 days;

c) Slow degitals - saturation lead slowly, gradually, without limit.

The optimal technique is moderately fast.

Timely overdose prevention is needed: Careful control over the pulse, especially in the first 5 days, good ECG control. Ensuring energy resources, a normal potassium balance. A rational approach to the choice of the drug is needed: stanfantine O, O5% and Corglon O, O6%, high-speed drugs are cumulative, only in / s is introduced; Digoxin O, Ltd.25, 6O% Suction in the intestine, Digitoxin Oh, OOOO1 has 1OO% absorption, celainide O, LLC25, 4o% suction.

Contraindications:

a) The emergence of CH against the background of bradycardia. A drug Teluzil It turns out the action not through Vagus, but directly on the heart - it can be used in bradycardia.

b) ventricular forms of arrhythmias (paroxysmal ventricular tachycardia, etc.), as there may be ventricular ashistolia.

c) Atrioventricular blockades, especially incomplete block.

Side effects from the use of glycosides

Stomatricular arrhythmias: extrasystole, ventricular fibrillation, paroxysmal tachycardia. Different blockades, especially atrophiventricular. Target disorders: nausea, vomiting, diarrhea, bad appetite. From the CNS: Headache, Weakness.

2. Preparations of potassium: Potassium chloride 1O% of 1 tbsp. spoon * 3 times a day; Panangin 1 Dragee * 3 times a day, asparks (Pangin's analogue) 1 dragee * 3 times a day.

3. Vitamins: Cocarboxylase 1OO ML / day. per / m; B-6 1% 1, o / m; Nicotine Acid Oh, O5.

4. Anabolic tools: potassium orotat o, 5 * 3 r. a day per hour before meals; nebrol, spectabolic 5% 1, o / m 1 time per week.

5. Potassium-saving diuretics: Veroshpiriron 1OO mg / day.

6. Khormon 1, o / m

7. Diuretki.: Laziks 2, O / B, Hypothiazide 5O mg, Uzhgeit Oh, O5.

8. Preparations aimed at improving heart work:

a) reducing venous return to the right heart: nitroglycerin o, ll5; nitrosorbit o, o1; Susta o, 64 mg expand venules, increasing their container.

b) Reducing peripheral resistance: Aprescin and Nitroprusside Nada - expand the arterioles in chronic CH. Apply carefully! With acute sn, enter into / c.

9. Oxygenotherapy.

Treatment of cardiac asthma

Urgent hospitalization. The patient give a half-time position, reduce the venous refund to the heart. With the very purpose of venous harnesses on the limbs. If there is no cardiogenic shock - bloodletting up to 5oo ml.

Diuretics: Laziks 1%, 2, O-6, O / B; Furosemid Oh, O4. Morphine 1% 1, O (inhibits an excited respiratory center + reduces venous return to heart); Pentamine is 5% to 1 ml, benzenexonium - sharply reduce the tone Voleton, the action of morphine potentiate. With low hell not to apply! Eufillin 2, 4% 1O, o - bronchospasm, Atropine sulfate O, 1% 1, O - in Bradycardia, Stroofantin O, O5% O, 25-O, 5; Talomonal for neuroleptanalgesia, Dimedroll 1% 1, O or Pipolfen (Diprazine) - antihistamines.

The defoamers are inhalation of oxygen moistened with ethyl alcohol. IVL - in severe cases. Electripultic therapy with ventricular flutter.

Fedorov Leonid Grigorievich

Left-deceiving deficiency is a serious pathology that disrupts coronary blood circulation and brain activity. The development of pathology occurs at a, cardiomyopathy and hypertension. Deal is a danger to life and requires urgent help doctors.

Features of pathology

The heart muscle has a pumping function when its work is broken, development occurs. Every year, young people are diagnosed with this problem more and more.

As a result of the disease, the influx of blood to organs and tissues is disturbed, which causes a lack of nutrients and oxygen starvation. For this reason, their work is violated, and serious complications arise.

Insufficiency is right-sided and left-hand.

With left-deceased failure, it is left alternatively left offices of the heart. In the lungs there are stagnant processes, which is expressed in, swelling and attacks.

With this pathology, there is a large-scale damage to the vessels and the weakening of the work of myocardium. The development of this state occurs under the influence of a variety of factors, among which is a sharp infarction, anemia, fever and others.

This state requires urgent treatment, as it can lead to the death of the patient.

Causes of development

The occurrence of acute deficiency of the left ventricle can occur in people of any age. The chances of this increase with other pathologies of the cardiovascular system and after 50 years.

Most often, such a diagnosis is subject to inspiring ischemic disease.

The disease can be caused by pathological processes in the left ventricle or under the influence of external factors.

Cardiological causes of lack of left ventricle are considered diseases in the form:

1. And the next tissue necrosis behind it. The development of the disease occurs with extensive. In this case, the patient is in serious condition and provoke consequences depending on the degree of damage.
2. Myocardians. These are inflammatory processes in the tissues of the heart.
3. Congenital and, which violate the architectonics of the heart.
4. Cleaning arrhythmia, ventricular tachyarhythmias.
5. Hypertensive crisis, in which pressure indicators in the arteries reach high numbers.

Some pathologies of other bodies and systems also contribute to the development of left-delicate insufficiency. The disease may occur in connection with:

1. Thromboembolia. In this case, the pulmonary artery is cleaned with a thrombus in the presence of significant damage to the vessel.
2. Pneumonia.
3. Acute intoxications of various substances.
4. Anemia.
5. Electric current discharge.
6. Asphycia.
7. Heavy injuries of the chest.
8. Pathologies of kidneys, liver in the terminal stage.

There are also certain factors, under the influence of which the likelihood of the development of left-deuded deficiency increases. The disease occurs if a person has a heart pathology, and it is exposed to excessive physical and emotional overloads, visits the baths and saunas, abuses with alcoholic beverages, smokes.

Therefore, it is important to monitor the state of your heart and try to avoid the influence of such factors, since under their impact there is an acute left-sized deficiency.

Classification

Pathology can occur in acute or chronic form.

Outragia left-delicate deficiency is a state that requires urgent care for doctors. In this case, the patient suffers from sudden stagnation of blood in the lungs, it proceeds through the subtle capillaries, it falls into the connective tissue of the organ, and from it in the alveoli, in which air should be in the normal state. If blood gets in them, then normal gas exchange becomes impossible and man suffocates.

Therefore, for an acute form of the disease, the development of first interstitial, and then alveolar.

The development of the chronic stage is gradually. A person may suffer from a problem for years. Its clinical picture is not so pronounced as in the case of an acute form, but the patient often observes the attacks at which the edema is possible.

Therefore, in chronic insufficiency, there is also a risk to the life of the patient in the absence of timely treatment. If you do not conduct supporting therapy, then gradually the heart will stop performing its functions.

Manifestations

All cardiac diseases have a similar clinical picture. Left-deceiving deficiency has symptoms in the form of painful sensations in the region of the heart spreading to the neck, a shovel, left hand. Also observed feverish states and a sharp increase in blood pressure.

The severity of manifestations depends on the size of the focus of damage. In this disease, a person suffers from:

• shortness of shortness of breath;
• dry cough with foamy sputum arising from attacks;
• release of rose foam from oral cavity and nose;
• the need to constantly be in a sitting position;
• wet wheezing during breathing;
• swimming cervical veins.

If congestive processes are developing in a small circulation circle and an acute form of illness occurs:

• sharply begins shortness of breath, turning into an attack of asthma;
• the accumulation of emergency fluid in the tissues of the lungs and edema of the organ;
• a cardiogenic shock occurs, in which the muscles cannot be normally reduced and the blood flow is broken throughout the body.

Outragia left-detective failure is often developing in patients with myocardial infarction, hypertensive disease, heart defects and coronary atherosclerosis.

Such acute heart failure is manifested, primarily in the form of pulmonary edema. Pathogenetic and, depending on the mechanism of development, there are two forms of pulmonary edema.

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Code of the ICD-10

I50.1 Left-deceiving deficiency

Causes of acute left vehicles

Acute cardiac insufficiency with low heart emissions is characterized by small heart-emission and reduced (or normal) arterial pressure. Occreation of left ventricular insufficiency is observed in acute coronary syndrome, mitral and aortic stenosis, myocardits, acute myocardits, acute dysfunction of heart valves, pulmonary artery thromboembolism, heart tamponade, etc. In some cases, the cause of low heart emissions is the insufficient pressure of the filling of the ventricles of the heart.

Outragia left-decent failure with stagnation symptoms in the lungs is most often developed in myocardial dysfunction in chronic diseases, acute ischemia and myocardial infarction, dysfunction of aortic and mitral valves, heart rate disorders, tumors of the left hearts of the heart. Heavy arterial hypertension, a high cardiac release under anemia or thyrotoxicosis, a tumor or brain injury, serve as the main non-reading reasons.

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Outragia left-deceiving default and myocardial infarction

Outragia left university failure is often found with myocardial infarction. It can develop simultaneously with myocardial infarction, but often appears a few days after its development. In the latter case, its occurrence is due to the loss of a significant mass of contractile myocardium.

In early terms, the left-deuded deficiency is often due to the disruption of the diastolic function and can proceed with a normal fraction of emissions. An important role in the development of heart failure plays the development of mitral regurgitation. It can be due to the ischemia of the nobble muscle, damage to the chord of the mitral valve with the lateral and foreground myocardial infarction, the loss of a significant mass of myocardium and / or dilatation of the ventricle.

The development of acute left ventricular failure in the first hours and day in patients with myocardial infarction is characterized by a normal or reduced amount of circulating blood, a moderate decrease in cardiac output, minimal sodium delay and water in the body, transitivity of observed violations.

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How does an acute left-detection deficiency develop?

One of the main pathogenetic moments of the development of left-rude deficiency is an increase in hydrostatic pressure in the venous and capillary departments of a small circulation circle. The accumulation of excess fluid in the pulmonary intersetization leads to a decrease in the elasticity of the lungs. The lungs become more "hard", restrictive disorders appear. Next, the edema fluid is hegan to the alveoli. Alveoli filled with liquid ceases to participate in gas exchange, which leads to ventilation / perfusion in light areas with a reduced ventilation.

Initially, the edema fluid accumulates in the surrounding alveios of tissues and is already then spread along the pulmonary venous trunks and along the pulmonary arterial and bronchial trunks. It is infiltration by the serous fluid of peribroscient and perivascular spaces, which leads to an increase in pulmonary vascular and bronchial resistance, deterioration of the exchange conditions. The liquid can accumulate in bronchioles, which leads to a narrowing of the respiratory tract and is recognized by the emergence of wheezing.

In the left atrium, the blood of non-ventilated alveoli (shunt) is mixed with completely saturated with oxygen blood. This leads to a decrease in the overall arterial partial voltage of oxygen. When the textaceted blood fraction reaches a significant level, hypoxemia state develops.

In the initial stage of acute left left ventricular failure, hypoxia is circulatory and due to "small" cardiac emissions.

With exhaustion of insufficiency to circulatory hypoxia, hypoxic, due to the obturation of the alveoli and tracheobronchial wood with foamy moocroty is joined.

Symptoms of acute left vehicles

Acute lefto-delicate insufficiency includes cardiac asthma, pulmonary edema and shock symptom complex. One of the main pathogenetic moments of its development is an increase in the hydrostatic pressure in the venous and capillary departments of the small cool blood circulation.

Cardial asthma is characterized by the development of the intersectional edema of the lungs. With it, it is infiltration by the serous fluid of peribroscient and perivascular spaces, which leads to an increase in pulmonary vascular and bronchial resistance, deterioration of the metabolism. Further penetration of fluid from the vascular bed into the lumen Alveol leads to the development of alveolar edema of light and severe hypoxemia. In the initial stage of acute left left ventricular failure, hypoxia is circulatory and due to "small" cardiac emissions. With increasing gravity of insufficiency to the circulatory of hypoxia, hypoxic, due to the obturation of the alvetol and the tracheobronchial wood of foamy moocroty is joined.

The clinically attack of cardiac asthma is manifested by the symptoms of severe suffocation. Skin coats are wet and cold. There is a pronounced acricyanosis. Perkkomsos of the lungs reveals a dullness in the lower lungs. Auscultatory breathing noisy, dry dry wheels. Unlike bronchial asthma, the exhalation is not difficult. There is tachycardia, strengthening II tone over the pulmonary artery. Blood pressure can vary widely, central venous pressure is increased.

When progressing heart failure, a picture of the "classic" alveolar edema of the lungs is developing. Over the surface of the lungs appear and quickly increasing the sonorous wipes, drowning the tones of the heart. In the distance heard bubbling, bullous breathing. The frequency of respiratory movements reaches 30-40 per minute. The sputum fills all the tracheoobronchial tree. A cough appears with liquid foam, pink color with a wet.

Cardiac emission is not reduced in the early stages of heart failure due to a compensatory increase in the number of heart abbreviations and a positive reaction of the left ventricle for post-loading. For this period, generally characterized by high filling pressure, low shock volume, tachycardia and a normal moment of blood circulation.

With radiological examination, stadium specific changes in lungs and heart are determined. Fishing fluid compared to air has a greater density for X-rays. Therefore, the swelling of the lungs on radiographs detects itself to the presence of areas of high density, which, with chest radigeniography, is detected earlier than the first clinical signs appear.

An early radiographic sign of pulmonary edema is the amplification of the vascular pattern. Next, fuzzy contours of the vessels can be observed, an increase in the heart shadow sizes, the appearance of Kerly Lines A (long, located in the center of the pulmonary field) and the cerly lines in (short, are located along the periphery). As the edema progressing, infiltration is growing in peribroscial departments, "silhouettes of volatile mouse" or "butterflies" and acinar shadows (sections of consolidation that have a spotted view) appear.

It is extremely important with low heart emissions due to hypovolemia, to find and eliminate its cause (bleeding, excessive dose of diuretic, vasodilators, etc.).

In the intensive therapy of such a state, as an acute left ventricular failure, apply vasodilators, diuretic products, narcotic analgesics, broutine and respiratory support.

How the acute left-rude deficiency develops, the causes of its occurrence - the doctor will answer these questions. The consequence of several heart diseases - heart attacks, defects, hypertensive disease - is the left ventricular failure.

What are the causes of acute left leaves

Its main manifestation is the swelling of the lungs, which is caused by a whole complex of reasons:

1. Low pressure heart ventricles.
2. The appearance of a tumor in the left departments.

There are also the reasons that are incredible. These include a tumor or injury that touched the brain, arterial hypertension in severe, emissions taking place in anemia of varying degrees. The occurrence of left-rich failure, the causes of which are associated with the flow of many diseases and pathologies, becomes a real problem for humans.

This type of disease has some characteristic features:

1. Low level of blood pressure.

The patients affecting the myocarditis of acute form, ordinary myocardits, aortic stenosis, coronary syndrome. But the most frequently acute left-deceased insufficiency amazes people who have undergone myocardial infarction. It usually occurs at one time with it, although it may occur a few days after the start and development of myocardium. This is due to the fact that myocardium loses weight and begins to shrink less.
Sometimes a provoking reason becomes mitral regurgitation, which provoke the following factors:

1. The supreme muscle ischemia begins.
2. There is damage to the chord of valves, especially mitral.
3. Storage dilatation.

As soon as the disease begins to develop, in the patient during the first night there is still a normal or easy drop in blood volume in vessels, which circulates in ventricles and heart. Simultaneously with this, cardiac emissions decreases slightly, as other symptoms are developing slightly.

Symptoms of Cardiac Pathology

The development of the disease becomes the development of cardiac asthma, lungs swell, a shock symptom complex occurs.

The pathology begins to appear when the hydrostatic pressure in a small circle of circulation increases. It is asthma that provokes the swelling of the lungs, as a result of which the infiltration of neighboring organs is observed. Therefore, vascular and bronchial resistance increases, metabolic processes are violated. Serous fluid further penetrates into the vessels, reaches the alvetol, because of which the alveolar swelling of the lungs develops, hypoxemia is manifested.

Asthma is provoked by choking syndrome, the skin becomes wet and cold, acricyanosis begins.

In case of failure, the patient develops a noisy breathing, which may be accompanied by a dry nature. In this case, it is not difficult to exhale, although tachycardia interferes with breathing, increase pressure.

If deficiency begins to progress, noisy wheels appear above the surface of the left lung, which drowns the tones of the heart. Breathing becomes a bubble, bullous, the frequency of movements can reach tens of shocks for 1 minute.

As a result, cough appears, during which there is a liquid wet of a foyster and pink character.

After a while, the condition of the lungs and the heart begins to change, which can be detected only with the help of X-ray. Liquid in the pictures will be visible as a large seal. Thanks to which the edema of the lungs appears in the pictures earlier than other symptoms.

Treatment of the disease

The pain is manifested in the heart, and the first sign that is strongly worried about the man, becomes shortness of breath. On her background then other symptoms that require immediate surveys and treatment appear.

The main diagnostic methods often become:

Electrocardiography

1. Conducting X-ray examination, especially heart and vessels.
2. Passing echocardiography and electrocardiography.
3. General examination of the heart.

Having obtained the results of the diagnosis, the doctor prescribes the treatment of acute left vehicles. Therapy has an intense and complex nature, the main goal is to increase the heart rate and significant improvement in tissue nutrition. For this, such treatment methods are applied:

1. Infusion support for ventricular pressure, ensuring their filling.
2. Short-term inotropic support.
3. The use of vasodilators.
4. Analgesics of narcotic content.
5. Respiratory support.
6. Reception of diuretics.

But such therapy is assigned, the code of the survey is available. Also often have to assist an emergency nature, which complicates the receipt of a clear understanding of what pressure exists in the ventricles. For this purpose, when patients have no wheezes, intravenous sodium chloride solution is introduced. Infusion should affect within a few minutes if the effect is absent, then the injection is repeated. Cardiac emission can provoke other states, so you need to eliminate stimuli. It can be bleeding, negative effects of drugs.

Medicines must stop pain, eliminate tachycardia, blood clots and blockage, reduce the tone in vessels and arteries.

Reception of drugs occurs according to the developed individual scheme, so it is strictly prohibited to engage in self-examination. This often causes exacerbation of the state, so medicines are accepted under the control of the doctor.

If they do not help, then a surgical operation is prescribed. Most often, it is cardiomioplasty or an implantation of a device that will help improve blood circulation. This process is not easy, but allows you to return health.

Video

Shortness of breath with diseases of the heart and blood vessels

March 3rd, 2011

Outragia left-deceiving deficiency

Dyspnea is more often observed in diseases of cardiovascular and bronchopulmonary systems, less often - with other diseases. Attachments of the chunk are complicated by many diseases of the cardiovascular system, accompanied by the load on the left ventricle of the heart, for example, hypertensive disease, atherosclerotic cardiosclerosis, the aortic patterns of the heart, etc. With these diseases there may be acute left ventricular failure. It is provoked by the load, the deterioration of the coronary blood circulation, an increase in blood pressure, intravenous administration of large amounts of liquid, tachycardia, infection, etc.

Outragia left-deuded failure often occurs at night and manifests itself with cardiac asthma, pulmonary edema.

Cardiac asthma

Cardiac asthma is an inspiratory paroxysm (with a difficult breath) suffocation.

Symptoms. The patient has a feeling of an acute shortage of air, accompanied by fear of death, cough, cold sweat. The face has an afflicted expression, pale, lips of Sonyushna. The cervical veins swell. Dyspnea inspiratory, breathing rapid (up to 30 and more per minute). When coughing, abundant liquid foaming wet is distinguished. If the start preceded the load, then the patient is forced to stop it. If Asthma arises at night, the patient, waking up, sits down, leaning his hands on anything, seeks to approach the open window.

The chest expanded, the on-shifted pits are smoothed. Percussion sound over light boxed shade. When auscultation over the lower lobes lungs are listened to fine and medium-reported wheezes against the background of weakened breathing.

Tachycardia is noted (up to 120-150 beats per minute), often arrhythmia. Elevated at the beginning of the attack arterial pressure in the increase of vascular failure can dramatically decrease. Heart tones are triggered with difficulty because of the abundance of wheezing and noisy breathing.

The transition to the position of sitting with lowered legs (ortopnoe) in some patients significantly improves the state and sometimes stops the attack. But in most cases this is not enough - and intensive therapy is required to prevent the transition of cardiac asthma in the pulmonary edema.

Pulmonary edema

Symptoms. In more severe cases, an acute left-rude deficiency, starting like a cardiac asthma, then quickly progresses and goes into lung swells: the suffocation increases, breathing becomes bubble, the cough is enhanced with the release of serous or bleeding sponge wet. Wet wars in the lungs become more large-caliber and ringing, the region of their listening is distributed to the middle and top departments. Tachycardia is growing. Email swelling requires urgent treatment.

Chronic left vehicles

Gradually, the growing shortness of breath with the usual loads and the tendency to tachycardia are early signs of chronic left vehicles. Chronic left vehicles develop gradually in chronic diseases occurring with a preferential load on the left ventricle, more often - with hypertensive disease and hypertonic syndromes, atherosclerotic cardiosclerosis, diseases of myocardium, aortic heart defects, etc. It is characterized by venous stagnation in the lungs.

Symptoms. Dyspnea with chronic left-deuded deficiency occurs with minor loads (stripping, food) or observed even alone. Usually, shortness of breath is intensified in the lying position, so patients prefer a semi-dyed position with naked legs (orthopnee).

In the lungs listened to reinforced vesicular breathing and unvivaous wet shallow wipes in the lower departments. Cough with separation of serous sputum is possible. In the study of the function of external respiration, objective signs of respiratory failure are detected, in particular, a decrease in the life capacity of the lungs and the speed of breath. These indicators can improve after using diuretics, which has some diagnostic value. Radiographic research confirms venous stagnation in the lungs.

Together with a shortness of breath, tachycardia is revealed in patients with chronic left-chelochetically insufficiency. It easily occurs or enhanced when the load is either resistant. Respiratory delay does not affect or does not affect the frequency of rhythm. When listening to the heart above the top, a three-membered rhythm is sometimes revealed due to the gain of IV (atrial) tone (presetolytic gallop).

In patients with chronic left ventricular failure, signs of a significant increase in the left ventricle of the heart are noticeable - strengthening the top shock and the displacement of it to the left and down. The increase in the left ventricle of the heart is confirmed by X-ray and ECG data.

Hypertonic disease

Sunshine attacks associated with acute left-selling deficiency may occur with hypertension. In this case, the attacks of choking differ in short-term. Usually they continue 15-30 minutes and ends spontaneously. The attack occurs during a hypertensive crisis. In the lungs rapidly grow the number of wet wheezes. But the classical picture of the pulmonary edema with the release of foamy sputum in the uncomplicated myocardial infarction cases are not evolving. After the attack of the suffocation in the patient, a gentle diastolic noise of aortic failure can appear, determined with the auscultation of the heart. This noise disappears without a trace after 2-4 days after a hypertensive crisis.

Miocardial defeat

Dyspnea, associated with left-delicate deficiency, is noted in patients with diseases of the heart muscle (myocardial infarction, myocarditis, progressive myocardiopathy).

Long-term attack of suffocation refers to the number of characteristic features vast myocardial infarction. Astmatic state is observed with small repeated heart attacks. Dyspnea, orthopneus and pulmonary edema can develop in a patient even without fresh heart attack with left ventricular aneurysm and extensive post-infarction cardiosclerosis. Nevertheless, each attack of suffocation in such a patient must be regarded as one of the possible consequences of a fresh infarction and to always take research aimed at identifying it. First of all, an electrocardiographic study is carried out to detect changes characteristic of myocardial infarction. The diagnosis of small-scale myocardial lesions becomes more justified if characteristic changes of the ECG after an attack of suffocation are accompanied by an increase in creatinephosphocinate (KFK) activity and an increase in the concentration of protein-carbohydrate complexes in the blood. On the recovered ECG in such cases, you can register the deepening of the teeth T. to detect a new focus of necrosis in myocardium allows radionuclide study using the technetium of pyrophosphate. Echocardiographic research helps to reveal the foci of diskinesia in myocardium with fresh infarction.

Valve lesions of the heart

Attairs of cardiac asthma are often complicated by valve patterns of the heart, especially aortic stenosis. Dyspnea In this case, the vice is first noted only with significant physical tension and is combined with dizziness or stubborn pain. The earliest sign of the upcoming left ventricular failure is often the attacks of painful cough at night. In more severe cases, typical night attacks of paroxysmal suffocation, which can end with edema of the lungs. Typically, the connection of these attacks with physical effort is revealed. They can occur directly during physical exertion or a few hours after its end. Blood pressure during an attack of suffocation during the aortic stenosis is more often elevated, but sometimes it can be reduced or normal.

Sometimes ortopnoe develops. Depending on the severity of the state, it can continue from several hours to several days. In most cases, a pain in the field of heart appears simultaneously with ortopnoe; Its intensity and duration can vary noticeably.

Paroxysmal tachycardia

Dyspnea with ortopnoe, sometimes leading to a pulmonary edema, can develop in patients with paroxysm of hydrodynricular tachycardia and tachyarhythmias. The occurrence of chunk or its absence during tachycardia paroxysm is determined by the relationship of three factors: the initial functional state of the heart, the duration of tachycardia and the heart rate. Tachycardia to 180 heart abbreviations per minute in patients with a healthy heart can continue for one or two weeks, causing only heartbeat complaints. In patients with valve vices of the heart and especially in patients with mitral stenosis, shortness of breath occurs with a much lower frequency of heart abbreviations. The greatest severity is the paroxysms of sucanementaricular tachycardia in children. On 2 — 3 days after the start of tachycardia with a heart rate of 180 per minute, they appear signs of heart failure: cyanosis, rapid breathing, increased levels of lungs, hepatomegaly (liver increase), vomiting. The heart increases.

Dyspnea and orthopneus in paroxysms of tachycardia in people of elderly and senile age are often combined with transient violations of cerebral blood circulation in the view of clogs, violations of violations, sometimes only one

Simultaneously with the suffocation in the elderly patients, pain often arises pain in the field of heart and often moderately increases the activity of aminotransferase in the blood. Such a combination of listed features makes first consider about myocardial infarction as the most likely their reason. The final diagnosis can be made according to the results of observation of the ECG evolution, the activity of the heart fraction of creatinephosphocinate or lactate dehydrogenase, the content of protein-carbohydrate complexes in the blood. Decisive impress data to the analysis of the described changes after each of the previously transferred paroxysms of tachycardia.

Pulmonary vasculitis

Heavier attacks of choking manifests the pulmonary vasculitis (inflammation of small vessels of the lungs) in patients with nodular periaryatite. Dyspnea, periodically turning into severe asthmatic seizures, sometimes occurs in 1 / 2-1 years before the development of other symptoms of nodular periateryitis. At the beginning of the disease, the attacks of the suffocation are coming against the background of a more or less pronounced fever, in the midst of the disease - against the background of other symptoms of the nodule periatery: pain in the abdomen, arterial hypertension, polynevrit. The body temperature even at the beginning of the disease turns out to be elevated. The nodular periaryitis takes place with leukocytosis and an increase in the number of pulp and young neutrophils, as well as with a pronounced acceleration of erythrocyte sedimentation. In nodule, the Periaryitis is noted significant loss of mass, muscular and articular pains. Symptoms of damage to different internal organs are observed. The diagnosis of nodular periaryitis presents great difficulties in connection with the polymorphism of the clinical picture and the absence of pathogenic signs. The diagnosis is based on the taking into account the characteristic clinical manifestations (renal syndrome, arterial hypertension, asymmetric polyneurite, abdominal, heart, pulmonary syndromes, mass loss, fever, etc.) and laboratory data. Skin-muscular biopsy helps to clarify the diagnosis, although the negative results of the morphological study do not exclude nodular periatery.

Pulmonary embolism

Dyspnea with the slightest physical tension manifests the onset thrombosis of the main branches of the pulmonary artery in the early stages. OrthopNoe develops later. Cruel suffocity, sharply amplified at the slightest movement of the patient and forcing it soon to go to the state of ortopnoe, is the main diagnostic sign of the cloth thrombosis of the pulmonary artery. Arterial pressure in all cases decreases. 4-5 days after the start of orthopnoe, there are signs of uncontrollabically increasing right-hand deficiencies with hepatomegaly (increase in liver), swelling edema of the subcutaneous fiber of the lower extremities and ascites. Repeated attacks of suffocation in patients with heart failure, thrombophlebitis, cloth thromboendocarditis are usually caused by thromboembolism of small branches of the pulmonary artery.

For the pulmonary artery embolism, the development of cyanosis is characterized at the very beginning of the attack of the suffocation, the emergence of signs of acute insufficiency of the right ventricle or electrocardiographic signs of its acute overload. With the thromboembolism of the pulmonary artery, the attack of suffocation, especially heavy, in the first minutes of the disease always begins suddenly and often among full health. The pulse with a pulmonal artery thromboembolism, from the very beginning sharply participated, blood pressure is lowered. Peripheral signs of shock (cooling limbs, abundant cold sticky sweat) pronounced at the very beginning of the disease. The pain syndrome never dominates the clinical picture of the pulmonary artery thromboembolism. Breast pain occurs sharply and has no typical localization. When examining a patient with a pulmonal artery thrombomembolism, cyanosis, swelling of the cervical veins and pulsation in the second and third intercostals to the left of the sternum are revealed. With auscultation of the heart, reinforcement and splitting of the second tone on the pulmonary artery are detected.

With the thromboembolism of the pulmonary artery, the echocardiogram does not change. Great diagnostic information is given the results of an electrocardiographic study. ECG changes in acute overload of the right ventricular heart during pulmonary artery thromboembolism resemble shifts when the myocardial infarction of the rear wall of the left ventricle, but still have a number of characteristic features, the correct account of which allows you to distinguish these diseases from each other.

The pulmonary artery thromboembolism is often found in patients with elderly and senile age, in bed, in patients of any age with signs of beginning or severe heart failure. The source of embolts often turn out to phlebotrombosis of pelvic organs and lower extremities and cloth blood clots in the cavities of the right heart. The pulmonary artery thromboembolization is found in women of childbearing age, taking oral contraceptives.

Outragia left binding failure.

Diagnostics. Treatment of CH.

Acute heart failure.

Acute vascular failure.

Chronic heart failure.

Acute vascular failure.

Acute heart failure.

Post-infarction cardiosclerosis

The clinical picture consists of the IBS clinic - angina, signs of chronic heart failure, various violations of the rhythm.

This is a group of patients with varying degrees of CHD severity, but in all cases there are signs of myocardial infarction - no earlier than 8 weeks from the beginning of it. Tactics of treatment of such patients depends on clinical manifestations.

Acute heart failure - a sudden decrease in the contractile function of the heart, which leads to disorders of intracardiac hemodynamics, blood circulation in a small and large circulation circle, which can lead to violations of the functions of individual organs. Acute heart failure is two types: Left-deceased, leading to the development of cardiac asthma and lung edema, and referee.

Main reasons : Heavy diffuse myocardits, cardiosclerosis, acute myocardial infarction, severe arterial hypertension, aortic heart defects, mitral stenosis, cardiomyopathy, extremely large physical activity, intravenous infusion of excessively large amounts of liquid.

Basic pathogenetic factors. weakening the work of the left ventricle in satisfactory work of the right ventricle; increase pressure in pulmonary veins, capillaries, arterioles; Improving the permeability of pulmonary capillaries, the heating of the liquid blood in the alveoy, violation of the diffusion of gases, improving platelet aggregation, microelectasis. As a result of these processes, gas exchange in the lungs is disturbed, the content of oxygen in the blood is reduced and the carbon dioxide content increases. Delivery of oxygen to organs and tissues deteriorates, especially sensitive to this is the central nervous system. In patients, the excitability of the respiratory center increases, which leads to the development of shortness of breath, reaching the degree of suffocation. Blood stagnation in the lungs during its progression is accompanied by penetration into the lumen of the alveoli serous fluid, and this is already the edema of the lungs. The coming upcoming left vehicle failure is called cardiac asthma.

Clinical picture of cardiac asthma. The attack of suffocation is usually developing at night. The development of attacks contribute to physical or neuropsychiatric tension. The patient wakes up a sense of lack of air and fear of death. At the same time there appears an adsatory cough, heartbeat. Strong dyspnea makes the patient sit in bed or approach the open window. The patient is excited, catches the air of the mouth.

In case of inspection. The expression of the face is suffering, the position of ortopnoe with navalized legs, the skin is a grayish-pale, covered by sweat drops, acricyanosis, pronounced shortness of breath, neck vans swelling. Breathing up to 30-40 times per minute, rigid, launched scattered dry and wet wives in the posterior lung departments. Here it is possible to dull the percussion sound. Pulse frequent, weak filling, often arrhythmical. The boundaries of the heart in accordance with the main disease are more often expanded to the left. Heart tones are deaf, often - "Rhythm Galopa." Hell first normal, then as cardiac asthma progression is reduced.

Laboratory data is not characteristic. The wet at the stage of pulmonary edema liquid, foam, pink, eosinophils are not detected in it.

Tool data .

ECG - reducing the amplitude of the teeth, the S-T interval, various arrhythmias, changes characteristic of the main disease.

Light radiography - symmetric homogeneous dimming in the central departments (the central form of the "butterfly wings" type); Double-sided diffuse shadows of different intensity (diffuse form).

Urgent Care .

The main urgent events in the heart asthma should include achieving the decision of the main task - to unload the small circle of blood circulation, achieve a reduction in high hydrostatic pressure in its vessels, improve the contractile ability of the heart muscle, increase blood saturation with oxygen.

It should be conveniently seated the patient, ensuring the necessary support for his back and hands. With a low blood pressure, the patient's position in bed is half-sidew, and when hypertension is sitting. Inhalation of fresh air is ensured, inhalation of oxygen begins (at the stage of pulmonary edema - through a defoamer - antifomsilane, alcohol).

Nitroglycerin or 1 drop of 1% alcohol solution is given under the tongue 1. Nitroglycerin reduces the pressure in the pulmonary artery and reduces the venous return to the heart, which improves its work (contraindicated with an ads of less than 100 mm Hg. Art.).

The next action under the attack of the suffocation is the use of narcotic analgesics (1 ml of 1% solution of morphine hydrochloride, together with 10 ml of physiological solution or droperidol 0.25% solution of 2.5 ml intravenously). They are used to reduce shortness of breath (oppress the respiratory center), as well as to calm patients, anesthesia, redistribution of blood from a small circle of blood circulation. Narcotic analgesics are contraindicated with rare superficial breathing.

For the potentiation of the actions of narcotic drugs, intramuscularly 1 ml of 1% diploma solution or 1 ml of 1-2% supustine solution is introduced.

Diuretics are shown in normal or high blood pressure. Intravenously 40-160 mg of furosemide (lazix), with low or normal blood pressure - 30-60 mg of prednisolone intramuscularly or intravenously.

With arterial hypertension, a gangliploclocator -Pentamine 5% solution is 1-2 ml together with 10 ml of isotonic sodium solution of chloride intravenously slowly or intramuscularly (a positive effect has 15-20 minutes with intramuscular administration, and with intravenous - already at the moment of administration). More accessible for the Hospiter Eufillin - 2.4% solution is introduced 10 ml intravenously (normalizes hemodynamics in a small circulation circle). It is especially shown in the presence of symptoms of bronchospasm.

Instead of gangliplocker and euphilline, the paramedic can use dibazole 0.5% solution 6-8 ml with 10 ml of isotonic sodium chloride solution intravenously slowly.

During tachycardia - 1 ml of 0.025% solution of stanfantine together with 10 ml of isotonic solution of sodium chloride intravenously slowly (on the background of myocardial infarction - not to enter.) Selection of medications for cardiac asthma, depending on the level of blood pressure.

At the hospital period in situations, when there are no necessary medicines, the imposition of harnesses on the limb (the cup to the edge region) is shown, which contributes to the exception from the circulation of some blood and unloading of a small circle of blood circulation. Every 10-15 minutes, the harnesses are removed and overlap again after the break (the harnesses are superimposed into two limbs). Sometimes it is necessary to produce bloodletting (300-400 ml). A decrease in blood stagnation in the lungs also contributes to a warm mustard bath for legs (to the top of the head of the heads). Venous harnesses and bloodletting can be performed only with normal or increased blood pressure.

When introducing emergency assistance in the attack of cardiac asthma in persons with arterial hypotension, when the use of basic anti-asthma drugs is contraindicated, patients are prescribed and introduced drugs that contribute to the increase in blood pressure and improve the contractile ability of the heart muscle (Cordiamine, caffeine, Meston, prednisone).

After eliminating the attack of cardiac asthma, patients are subject to hospitalization by the "ambulance" machine (preferably - specialized) into the resuscitation department of the cardiac hospital.

Transportation is carried out on a stretcher with a sublime position of the head end. The phenomena of the concomitant collapse is a horizontal position. During transportation, constant monitoring of the patient is carried out and the necessary emergency assistance is provided.

Outragia right-handed heart failure. Outragia, right-hand deficiency, most often occurs at TEL, rarely - with an extensive infarction of the interventricular septum with aneurysm, with spontaneous pneumothorax, total pneumonia, during asthmatic status.

Infebit factors are obesity, polycythemia, age over 50 years and thrombophlebitis of various location. The thrombus, formed in the lower hollow vein, the ear of the right atrium or the right of atrium, can be broken and entered into the pulmonary artery. As a result of mechanical occlusion and spasm of the ICR vessels, pulmonary-vascular resistance is sharply increasing, leading to the overload of the right ventricle and, accordingly, to the acute insufficiency. Soon the left-deuded failure is also joined, and then they talk about total heart failure.

Symptoms of acute worldwide failure. Complaints of shortness of breath, pain in the right hypochondrium, swelling.

Inspection - cyanosis, swollen cervical veins, edema feet. Pulse frequent, weak filling, often arrhythmical. The boundaries of the heart are expanded to the right, tachycardia, systolic noise over a sword-shaped process, amplifying on inhale due to the relative deficiency of the three-risk valve. The liver is enlarged, painful, pressing on the liver causes swelling of the cervical veins (symptom of the besh), the development of ascites is possible.

Laboratory data due to the main disease.

Long-term bed regime leads to a decrease in the efficiency of the functioning of the cardiovascular system, muscle weakness, osteochondrosis, hypostatic pneumonias, thromboembolic complications.

Instrumental research. ECG: increasing the amplitude of the teeth P in II, III, V1- 2 (reloading the right atrium), the deviation of the electrical axis of the heart to the right.

X-ray study - data of the main disease.

Ultrasound of the heart - dilacation of cavities of the right hearts. Measurement of venous pressure - FED rises sharply.

Urgent Care .

Treatment of acute direct arterial deficiency, due to the emblem of the pulmonary artery (TEL), provides first of all, the introduction of heparin (at least 60,000-70,000 units per day) intravenously, oxygen therapy for peeling oxygen mask or nasopharynx catheters, heart glycosides.

Calling the resuscitation team of ambulance and urgent transportation to a specialized medical institution.

Acute vascular insufficiency - a violation of peripheral blood circulation, which is accompanied by a violation of blood supply to organs and tissues. This state occurs as a result of a sudden primary decrease in the blood venture of peripheral vessels and is manifested in the form of fainting, collapse, shock.

Fainting (syncop) - A sudden short-term disorder of consciousness caused by brain hypoxia, accompanied by the weakening of cardiac activity and respiration and their rapid restoration.

Several kinds of fainting are isolated, which indicates a variety of causes of their occurrence.

In patients, three periods are disturbed with syncopal states: pre-corrupt, actually fainting (syncop) and post-distorted.

Pre-corrupt The state is manifested by a feeling of illness, in the eyes in the eyes, ringing in the ears, weakness, dizziness, gentlement, sweating, skin pallion and usually lasts from a few seconds to 1 minute.

Fainting The loss of consciousness is manifested, a sharp decrease in muscle tone, skin pallor, superficial breathing. Furnaces from a few seconds to 1 minute. In exceptional cases, with a relatively long termination of cerebral blood flow, tonic-clonic convulsions are developing, involuntary urination is observed.

Pupils are narrowed (sometimes expanded), do not react to light, there is no corneal reflex. The pulse is weak, barely palpable, rare. Hell is normal or reduced. Heart tones are muffled. Surface breathing, rare. Sometimes fainting is tightened to 10-20 minutes.

Post-combature state. After the restoration of consciousness, gradually the skin acquires usual color, the filling of the pulse is improved, bradycardia disappears, the hell is normalized. The patient does not remember the fainting that happened, usually asks where he and what happened to him. Some patients have weakness, headache or heaviness in the head.

Three main groups of syncopal states are distinguished: neuro-cardiogenic; cardiogenic; Angogenic.

How does the heart failure arise?

Heart failure of the left-deceased Some people consider not such severe pathology. This erroneous conviction is connected with the fact that at the initial stage it is able to proceed asymptomatic and give itself to know when a person is experiencing significant physical and emotional loads. There are groups of risk, most of all predisposed to left-deuded heart failure. If a person suffered a heart attack, the probability is greater that he will begin the heart left ventricular failure.

Those who suffer arrhythmia are also in the risk group. At myocardium, the heart is striking inflammatory processes, destructive changes in the tissues of the organ are a common cause of left vehicles. If a person abuses alcoholic beverages, he must be ready for the fact that his heart will not work normally. Under the influence of substances contained in alcohol, the body is expanded by the cavities where blood is stared. The damage to the heart valve apparatus, stenosis, broken systemic blood flow - all this leads to heart failure.

Acute or chronic form of illness?

In modern medicine, it is customary to distinguish between two forms of left-detective failure:

• sharp;
• chronic.

The manifestation of the acute type of heart failure carries with it a heart asthma, pulmonary swelling, cardiogenic shock. Breathing is disturbed, and the lungs are gradually filled with water. At the same time, the condition of a person when it is in a horizontal position, significantly worsens, because his shortness of breath is enhanced. The symptoms of the attack of acute insufficiency can resemble a cold.

People who suffer from this disease often appear cough. If there is an acute insufficiency, urgent help of the doctor and hospitalization of the patient are required. Each fifth person who was not provided in a timely manner, dies from an acute form of the disease in the first day from the moment of its appearance.

The chronic form of illness develops significantly slower. The first of its signs are associated with stagnation of blood, whose composition is characterized by low oxygen content. In parallel, both disorders in the blood supply to the kidneys begin, the first signs of renal failure appear, because the functioning of the pair body is closely related to the cardiovascular system.

The edema of the limbs is one of the leading signs of heart and renal pathologies. With bowls, the swelling is developing instantly and very specifically. It begins with ankle joint and stop.

Gradually swelling rise above, and as a result they are already observed in the abdomen. Pathology accompanies the emergence of symptoms of hepatic diseases - painful, uncomfortable sensations in the right hypochondrium. They are connected with the progressive multiple liver. It increases significantly in size, and pain occurs as a result of pressure capsule.

The accumulation of fluid in the abdominal cavity is capable of achieving such a level that the sign of the heart disease becomes visually more noticeable. In a person who suffers from left-cheerful heart failure, the belly resembles a frog. In the man's peritoneum can spill up to 15 liters of water. The liquid in the pleural region is also one of the symptoms of heart problems. The accumulation of fluid is accompanied by a violation of the functioning of the respiratory organs. At the same time, symptoms of the delay in the formation of urine and its derivation of the body are observed.

Stages of disease development

Modern medicine distinguishes three stages of heart failure:

• initial;
• middle;
• terminal.

Each of them has its own specific symptoms. At the initial stage, a small shortness of breath appears, not all people pay attention to it, considering it by a consequence of physical overvoltage. The rapid heartbeat is not observed when the body is at rest. But with a significant increase in physical activity, a rapid heartbeat appears. The swelling and permanent shortness of breath (even at rest) are the symptoms of the second stage of the left ventricular heart failure. At the same stage, cyanosis is observed. The third stage of heart failure is considered irreversible. This is due to the fact that the processes occurring in the tissues of the body becomes impossible to completely stop. The therapy of the left-handhold insufficiency on any of its stages is closely related to the struggle with the causes provoked by the disease. Their detection at an early stage of pathology gives the greatest amount of chances to save a person life.

What needs to be taken?

In heart failure therapy, several groups of drugs are used:

• diuretics;
• beta blockers;
• aCE inhibitors;
• glycosides;
• nitrates.

Diuretics simultaneously perform two roles: their use is necessary to improve the work of the kidneys and remove the fluid from the body. The reception of beta-blockers is associated with the need to make the adjustment to the work of heart muscles. These drugs reduce the heart rate, and the load on the muscles of the internal organ, respectively, is reduced. Inhibitors are needed to expand heart cavities and stabilize blood pressure. Increasing the emission fraction is due to the reception of glycosides. They are also a vital medicine for patients who have heart failure accompanied by arrhythmia. Nitrates are necessary to expand the vascular of the internal organ. This group of drugs is widely used to combat acute heart failure.

The chance to save life is

If the cause of insufficiency is a coronary heart attack, the main task for doctors becomes the restoration of arteries. One of the most widely used methods for its implementation is a shining when the artery is expanding due to the introduction into the patient's body a special spring. With damage to the heart valves, the use of purely drug therapy is ineffective - operational intervention and heart valve prosthetics are necessary. To implement this procedure, modern medicine uses donor organs or metal prostheses. When cardiac insufficiency accompanies arrhythmias, with non-efficiency of drug therapy, radio frequency ablation is used. No less effective method is the migation of foci provoking arrhythmia. With cardiopathy, none of the listed operational methods in the patient cannot help. In such cases, the only real chance of saving the life of a person is a heart transplant.

An indispensable condition for the effectiveness of conservative and operational treatment of heart failure is the observance of the diet.

The patient needs to constantly monitor its weight and prevent unnecessary kilograms, obesity. The limited use of salt, water and fats of animal origin is also an indispensable condition, as well as a refusal of strong alcoholic beverages, smoking. Without physical activity, it is impossible to a person, but it will also have to strictly regulate it, but the performance of special exercises of the exercise will help in the struggle against heart failure.