In order to reduce the risk of heart disease and regeneration and support during or after illness, it is worth using the Biofiton Healthy Vessels supplement. Biofiton Healthy Vessels Phytotablets include medicinal plants, the effect of which is aimed at:

  1. NORMAL PRESSURE. Biologically active substances of Hawthorn Flowers, Birch Leaves and Horsetail Aerial Parts improve heart work and regulate blood pressure.
  2. NORMAL BLOOD FLOW. Hawthorn Flowers, Melilot Aerial Parts, Horse Chestnut Seeds, Horsetail Aerial Parts and Buckwheat Flowers have mild action and favorable effect on blood circulation.
  3. NORMAL CHOLESTEROL LEVEL. Active substances of Alder Buckthorn Bark and Peppermint Leaves prevent fatty deposits on vascular walls and maintain normal blood cholesterol level.
  4. STRENGTHENING AND CLEARANCE. Common Periwinkle and Melilot Aerial Parts, Dog Rose Fruits and Cowberry Leaves clean vessels from various deposits, normalizing their elasticity and flexibility.
  5. NORMAL METABOLISM. Hawthorn Flowers, Horse Chestnut Seeds, Dog Rose Fruits and Buckwheat Flowers activate metabolic processes, providing delivery of nutrients to all body cells, thus normalizing the blood flow.

 

Chronic heart failure (Latin insufficientia cordis chronica) – a progressive set of symptoms resulting from a decrease in cardiac output, accompanied by objective evidence of myocardial dysfunction, and responding to treatment for heart failure. The most common cause is coronary heart disease, but it can also be a complication of hypertension, cardiomyopathy, and myocarditis. Traditionally, heart failure is divided into left and right ventricular as well as systolic and diastolic. Acute heart failure is a clinically different syndrome that may or may not develop as a result of decompensation of chronic heart failure that requires different management and treatment. Chronic heart failure is the first cause of hospitalization after the age of 65 in developed countries. Adequately treated in most patients can be controlled, but is still a life-threatening condition with an annual mortality of 10%.

ETIOLOGY
Chronic heart failure is caused by diseases that affect the filling or emptying of the heart chambers. PNS develops in two basic mechanisms:
• impairment of heart contraction
• diastolic impairment.
In most cases, heart failure is associated with left ventricular systolic dysfunction, which is very often (perhaps always) accompanied by impaired diastolic function at rest. In contrast, isolated diastolic heart failure is relatively rare, its incidence increases with age, and is more common in women.
The most important causes of heart failure are:
• myocardial dysfunction
Heart arythmia
• valve defects
• pericardial diseases.
Anemia, renal failure, thyroid dysfunction and medications are rarely a factor in heart failure, but may increase the symptoms].

PATHOPHYSIOLOGY
The pathophysiological mechanisms of heart failure are not well understood. In the pathophysiology of PNS, the participation of activation of many neuroendocrine systems is postulated. Baroreceptor dysfunction may be an important factor. It is believed that the release of cytokines may be responsible for the development of cardiac dysfunction, especially in more advanced cases.

OTHER TERMS RELATED TO HEART FAILURE
1. left ventricular, right ventricular, mixed
2. systolic, diastolic, mixed
3. with a high throw, with a small throw
4. with dominance of ejection disorders (forward), with dominance of filling disorders (backward)
5. mild, moderate, severe

FACTORS LAUNCHING FOR EXPRESSION
• patient not taking medication, failure to follow the doctor’s instructions
• introduction of new medicines or abrupt withdrawal of medicines
• infections
• atrial fibrillation, other cardiac arrhythmias
• hypertensive crisis

SYMPTOMS AND COURSE
Symptoms of chronic heart failure are not characteristic only of this disease entity. Their severity is not dependent on the degree of damage to the left ventricle. Certain factors not primarily related to heart disease – for example, infections, abnormal blood electrolytes, anemia, and hyperthyroidism – may increase the symptoms of failure.
The lack of signs of failure speaks against the diagnosis of PNS, while the lack of symptoms in the physical examination to a lesser extent. Detection of signs suggests diagnosis.

Signs and symptoms of heart failure
• deterioration of exercise tolerance
• shortness of breath, orthopnoë
• cough
• nocturia, oliguria
• swelling
• abdominal pain

Signs and symptoms of heart failure
• pallor of the skin, cooling of the skin, cyanosis
• excessive filling of jugular veins (associated with increased venous pressure), hepatocervical symptom (often absent in severe heart failure)
liver enlargement
• tachycardia (not very specific)
• third heart tone (non-specific symptom of severe heart failure)
• auscultatory crackling over the lung fields (a sign of lung stasis): nonspecific symptom with low prognostic value
• pleural and peritoneal fluid
• Cheyne-Stokes breath

Irregularities in additional tests

ECG
• a normal ECG result should prompt the verification of the primary diagnosis of heart failure (the predictive value of a normal ECG to exclude left ventricular systolic dysfunction is estimated at over 90%)
• atrial fibrillation occurs in up to 40% of patients with heart failure, regardless of its cause
• pathological Q waves or fresh LBBB indicate myocardial infarction as a cause of cardiac impairment

Chest radiograph
heart enlargement (often absent in patients with diastolic dysfunction, e.g. in syndromes such as hypertrophic cardiomyopathy)
• changes in the pulmonary circulation, exudates

Biochemical and hematological tests
Complete blood count
• anemia (a factor exacerbating or causing circulatory failure)

electrolytes
• hyponatraemia
• hypokalemia

Creatinine level
• hypercretinemia

Determination of liver enzymes
• elevated levels of transaminases and LDH

General urine test
• proteinuria (sometimes)

Other
• usually increased levels of natriuretic peptides: BNP and NT-pro-BNP

ECHO heart
• the method of choice for detecting cardiac dysfunction at rest
• allows assessment of the left ventricular ejection fraction (LVEF)
• absence of cardiac dysfunction on echocardiography speaks against the diagnosis of heart failure

Stress echocardiography

Radioisotope angiography

Magnetic resonance imaging

RECOGNITION
Diagnosis of heart failure should be based on the results of physical and physical examination and (correctly selected) additional tests.

DIVISION
NYHA heart failure rates:
• I – there are no changes under normal load
• II – slight changes at normal load, physical capacity is reduced
• III – significantly reduced performance at low load
• IV – resting shortness of breath

TREATMENT

Treatment goals
• prevention or treatment of underlying diseases leading to heart dysfunction and failure
• preventing the progression of heart dysfunction to heart failure
• maintaining or improving the quality of life
• prolonging your life

Non-pharmacological treatment
• reduction of sodium and fluid supply
• weight reduction in obese patients
• improving nutrition in malnourished patients
• reducing alcohol consumption
• absolute smoking ban
• avoiding drugs that increase chronic heart failure (especially nonsteroidal anti-inflammatory drugs)
• annual vaccination against influenza and pneumococcal infections

Pharmacological treatment
Drug treatment has evolved over the years. While until the 70s of the twentieth century striving to improve cardiac contractile function (cardiac glycosides and diuretics were used for this purpose), in the 21st century the emphasis was on reducing peripheral resistance through the use of ACEI, often with the addition of sartans under strict control of potassium levels ( risk of hyperkalemia). In many cases, aldosterone receptor blockers are given instead of sartans. This is called double RAA lock. The use of the triple RAA block (ACEI plus sartans plus aldosterone receptor blockers) is debatable due to the high risk of severe hyperkalemia. The use of nitrates is discussed in the absence of myocardial ischemia. There are indications for their use in the event of elevated left ventricular filling pressure. The use of some calcium channel blockers (verapamil) may be effective in myocardial diastolic dysfunction (e.g. hypertrophic cardiomyopathy). Cardiac glycosides may be important in heart failure against the background of atrial fibrillation with rapid ventricular action (slowing of sinus rhythm). The role of hydralazine in the treatment of PNS is currently negligible. However, the mistake in art is not to diagnose a sick beta-blockers (due to excessive tension of the sympathetic system – but taking into account their inotropic effect, negative doses cannot be high) and properly selected diuretics (due to the reduced glomerular filtration rate). In general, PNS is used to treat:
• angiotensin converting enzyme inhibitors – are the basic drugs in the treatment of patients with left ventricular systolic dysfunction regardless of its cause and coexistence of PNS symptoms. In the event of intolerance (usually persistent cough) it is replaced with sartans.
• diuretics – are basic medicines in patients with heart failure and overhydration (manifested as pulmonary stasis or edema); the choice of drugs depends on the glomerular filtration rate
• beta blockers
• aldosterone receptor blockers
• sartans
• nitrates (most often isosorbide dinitrate)
• hydralazine (used occasionally in selected cases)
• cardiac glycosides (second-line drugs, most often digoxin)
• positive inotropic drugs (second-line drugs, e.g. dobutamine)
• anticoagulants (confirmation of the beneficial effects of anticoagulants in patients with enlarged left atrium requires further testing)
• anti-arrhythmic drugs
• oxygen
In the absence of improvement after pharmacological therapy, with persistent ventricular tachycardia, with an episode of ventricular fibrillation, in selected ECG disorders (e.g. Morgagni-Adams-Stokes syndrome) a cardioverter-defibrillator is used.
Recommended pharmacotherapy in individual NYHA classes according to ESC guidelines:
• I – ACEI + spironolactone + beta-blocker
• II – ACEI + beta-blocker + spironolactone + thiazide diuretic
• III – ACEI + ARB + ​​beta-blocker + spironolactone + thiazide / loop diuretic + digitalis
• IV – ACEI + ARB + ​​beta-blocker + spironolactone + loop diuretic + glycosides + non-batch inotropic positive drugs.
The important role of periodic monitoring of electrolyte levels, especially potassium (hypokalemia, hyperkalemia), sodium (hyponatraemia), deficiencies in the levels (pool) of ionized magnesium and calcium should be emphasized. Inappropriate electrolyte levels may contribute to the ineffectiveness of PNS pharmacological treatment.

Invasive treatment
• coronary revascularization
• permanent electrostimulation of the heart
• implantable cardioverter-defibrillator
• a device supporting the work of the ventricles
• fake heart
• ultrafiltration
• hemodialysis
heart transplantation
• left ventricular plastic surgery
• mitral valve plastic surgery

PROGNOSIS
Increased concentration of BNP and NT-pro-BNP is an unfavorable predictor of the course of the disease.
The need to monitor electrolyte and renal parameters in patients with PNS should be emphasized. The pharmacological therapeutic effects used (ACEI, ARB group drugs) in addition to electrolyte disturbances cause a decrease in the glomerular filtration rate, which on the one hand has a beneficial nephroprotective effect, however, leads to pre-adrenal nitrogenemia and an increase in creatinine and urea levels. Therefore, it is important for the patient to monitor important laboratory test indicators during treatment.

In order to reduce the risk of heart disease and regeneration and support during or after illness, it is worth using the Biofiton Healthy Vessels supplement. Biofiton Healthy Vessels Phytotablets include medicinal plants, the effect of which is aimed at:

  1. NORMAL PRESSURE. Biologically active substances of Hawthorn Flowers, Birch Leaves and Horsetail Aerial Parts improve heart work and regulate blood pressure.
  2. NORMAL BLOOD FLOW. Hawthorn Flowers, Melilot Aerial Parts, Horse Chestnut Seeds, Horsetail Aerial Parts and Buckwheat Flowers have mild action and favorable effect on blood circulation.
  3. NORMAL CHOLESTEROL LEVEL. Active substances of Alder Buckthorn Bark and Peppermint Leaves prevent fatty deposits on vascular walls and maintain normal blood cholesterol level.
  4. STRENGTHENING AND CLEARANCE. Common Periwinkle and Melilot Aerial Parts, Dog Rose Fruits and Cowberry Leaves clean vessels from various deposits, normalizing their elasticity and flexibility.
  5. NORMAL METABOLISM. Hawthorn Flowers, Horse Chestnut Seeds, Dog Rose Fruits and Buckwheat Flowers activate metabolic processes, providing delivery of nutrients to all body cells, thus normalizing the blood flow.