As.prof. N.Z. Yarema The syndrome of heart failure and vascular insufficiency in diseases of...

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

Thank you