As.prof. N.Z. Yarema
The syndrome of heart failure and vascular insufficiency in diseases of
cardiovascular system
Methods of examination of a heart
Inquiry Inspection Palpation Percussion Auscultation Laboratory and instrumental studies
Patient’s complaints typical for heart diseases
Dyspnea Pain in the heart area Oedema Cough Palpitation Heart intermissions
Points of auscultation
Causes of heart failure
Causes of heart failure (H F): Caused by diseases which affect primary the
myocardium and its metabolism:infections, intoxycations,insufficient of blood supply to the myocardium and its metabolism
HF due to overloading or overstrain of the myocardium: heart defects, arterial hypertension
LV is overloading in presence of obstacles to blood ejection from the ventricle ( narrowing of the aortic orifice, persistent increase in the arterial hypertension)
in diastolic overfilling of the LV (aortic incompetence or mitral insufficiency)
Right ventrical may be overloaded in difficult blood outflow from ventrical due to narrowing of the pulmonary trunk orifice or increase pressure in the lesser circulation
In diastolic overfilling associated with tricuspid or pulmonary valve incompetence
Compensatory mechanism The force of heart contractions increased by
the actions of the vagus nerve Heart rate increases becauses elevated
pressure in the orifice of vena cava Decreases diastolic pressure due to
dilatation of arterioles and capillaries Increases of oxygen utilisation
Clinical symptoms of HF
Dyspnoea (cardiac astma) Cyanosis( acrocyanosis) oedema
Aortal heart configuration
Mitral heart configuration
Classification of the HF
1 st. (initial) – signs of HF due to with physical exercise
2 st. – haemodynamic disorders( congestion in lesser or graeter circulation ) and dysfunction of organs at rest. The work capasity of patients is markedly decreased
A – initial period with mild haemodynamic disorders B – final period with grave haemodynamic disorder 3 st.- terminal dystrophic stage
Classification of HF ( New York)
1 - initial (latent) stage due to with physical exercises
2 – significant stage , congestion in lesser and greater circulation at rest and physical exercises, usual physical exercises causes signs of HF
3 – considerable limitation of physical activity, satisfactory condition at rest
4 - satisfactory condition only at rest
Treatment patients with HF
general recommendation ( diet, habits, limitation of physical activity )
diuretics (furosemide, hypothiaside, inhibitors of ACF (captopril, enalapril,
lisinopril) b- blocers (bisoprolol, carvedilol antagonists of aldosteronum: verospironum digoxynum
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