Symptoms of heart failure

The severity of symptoms of chronic heart failure may be from minimal manifestations that occur only under physical stress, to severe dyspnea at rest. According to the world literature, the number of patients with early manifestations of chronic heart failure is several times greater than severe patients who need treatment in a hospital. For patients who have a reduction in pumping function (ejection fraction less than 40%) without obvious complaints and symptoms of chronic heart failure, a special definition is used - asymptomatic dysfunction of the left ventricle. The described condition can not be identified with the clinical situation, defined as the I stage of heart failure. Clinically, the first stage of heart failure is characterized by that. That patients practically do not make complaints, but under physical exertion they note a slight decrease in the ejection fraction and an increase in the end-diastolic volume of the left ventricle, i.е. Identify a worsening of hemodynamics, provoked by functional tests.

Chronic heart failure is a progressive syndrome. Patients with a latent stage of heart failure can form a group of severe patients in 4-5 years, so early diagnosis and early treatment initiation are the key to success.

Symptoms of left ventricular heart failure

One of the earliest and most characteristic signs of left ventricular heart failure is shortness of breath. At first, shortness of breath occurs only with physical activity, fast walking, running, climbing stairs, etc. In the future, it also arises at rest, intensifying with a change in the position of the body, during conversation and eating. Shortness of breath, due to heart disease, increases in the horizontal position of the patient. Therefore, children with heart failure accept forced semisid position (orthopnea), in which they feel relief. In this position, the heart is discharged as a result of a decrease in the flow of blood to its right sections, which helps reduce pressure in the small circle of the circulation. Subjectively shortness of breath is manifested by a feeling of lack of air. Since children themselves are very rarely present such a specific complaint, the objective signs of increasing breathing are considered tension and swelling of the wings of the nose, the pulling of pliable places of the chest due to participation in the act of respiration of the auxiliary musculature.

Subjective manifestations of left ventricular heart failure include fast fatigue, increased sweating, a feeling of palpitations, a decrease in motor activity. Possible sleep disorders due to the increase in choking during the night. These symptoms, like many others, such as a worsening of appetite, can not be considered specific, and if children do not make complaints actively, early manifestations of left ventricular heart failure may be missed. A noticeable clinical sign of left ventricular heart failure is tachycardia, which appears reflexively as a result of increased pressure in the left atrium and irritation of the baroreceptors in it. Pathognomonic symptoms of left ventricular failure include coughing dry or wet with separation of mucous sputum. Cough often occurs with physical activity and at night. Hemoptysis and pulmonary hemorrhage caused by rupture of enlarged bronchial veins in children are rare. Sometimes, as a result of squeezing the recurrent nerve with an enlarged left atrium or an enlarged left pulmonary artery, hoarseness of voice and even aphonia appear. In some cases, children with obvious signs of stagnation in a small circle of blood circulation do not appear to increase the number of respiratory movements, and dyspnoea - difficulty breathing and prolonged exhalation - due to the rigidity of the lungs. In the lungs, people listen to damp, different-sized rales, first in the lower lateral parts of the lungs and / or mainly on the left because of the compression of the left lung with an enlarged heart, and then diffusely.

The consequence of respiratory failure is a characteristic sign - cyanosis of the skin and mucous membranes. The main cause of cyanosis is an increase in the content of reduced hemoglobin in the blood of more than 50 g / l. An increase in the content of reduced hemoglobin is also demonstrated by a rich crimson-red coloration of the lips, fingertips. In patients with heart failure, cyanosis can be central and peripheral. Central cyanosis occurs for two main reasons:

• as a result of the disturbance of oxygenation of the blood in the lungs, for example, in the stenosis of the pulmonary artery;
• due to mixing of arterial and venous blood, for example, with some vices of the blue type (tetralogy of Fallot); central cyanosis is diffuse and often does not correspond to the severity of circulatory disorders.

Peripheral cyanosis (acrocyanosis) is associated with increased utilization of oxygen by tissues and is more pronounced in the remote parts of the body from the heart: on the lips, the tip of the nose, and the terminal phalanges. The degree of severity of acrocyanosis usually corresponds to the severity of circulatory disorders.

With left ventricular failure, cyanosis in most patients is mixed, because along with the disturbance of oxygenation, oxygen utilization by tissues simultaneously increases. Cyanosis occurring in children with respiratory failure, with oxygen therapy, decreases or disappears, while cyanosis of circulatory origin is not eliminated.

Symptoms of right ventricular heart failure

Right ventricular failure is also characterized by such subjective symptoms as fatigue, weakness, sleep disturbances, etc. Cough, dyspnea, cyanosis are usually expressed in varying degrees and often do not correspond to the severity of stagnant phenomena in the large circulation. They often depend on the nature of the underlying disease underlying the deficiency of the right divisions.

Due to the weakness of the contractile function of the heart, the following changes occur.

• There is not enough emptying of large veins in the heart.
• The right departments (as, indeed, the left) are not able to translate the venous influx into an adequate cardiac output.

Due to these circumstances, venous blood accumulates in the venous system of a large circle of blood circulation, which leads to venous fullness of the corresponding organs, to stagnant phenomena. External signs of an increase in venous pressure for a large range of blood circulation is the swelling of the veins close to the heart, especially the jugular ones. Peripheral veins are usually enlarged, and their apparent network is enlarged. The increasing volume of venous pressure is also promoted by the growth of the volume of circulating blood.

Venous congestion in a large circle of blood circulation is accompanied by an increase in liver size. First, there is an increase in the left lobe of the liver, and then the right lobe also increases. When determining the size of the liver in children with heart failure, it is necessary to determine its upper and lower boundaries along three lines (according to Kurlov). According to the consistency, the liver with soft heart failure is soft, the surface is even, the edge is rounded. When palpation, it is often painful, especially with the rapid development of right ventricular failure. When pressing on the liver region in children with significant venous stasis, swelling or increased pulsation of the cervical veins (Plesh's symptom) is noted. With a significant increase in the liver, palpation is often determined by its pulsation. With chronic venous stasis, the liver becomes painless, denser, its pulsation decreases, the size decreases - "cardiac cirrhosis of the liver" develops. Clinically, violations of liver function are detected in heart failure II B-III stage.

Possible changes in laboratory indicators: an increase in bilirubin, dysproteinemia. Increased activity of serum transaminases. Dysfunction of the liver can be a cause of aggravation of the severity of the condition.

A moderate increase in spleen up to 1.5 cm is found in young children.

When right ventricular failure is often a violation of the gastrointestinal tract associated with stagnation of blood in the mesenteric vessels and congestive gastritis, which can often manifest not only abdominal pain, but also violations of intestinal motility (diarrhea, constipation), often vomiting.

Peripheral edema in heart failure is characteristic of older children, because babies have a sufficiently high hydrophilicity of tissues, and edemas have a hidden nature. Peripheral edema appears more often by the end of the day. The earliest edema begins to appear on the lower extremities, especially on the soles of the feet, at the ankles, then they are found in other places, edema is located according to hydrostatic pressure, i.e. Under the influence of gravity, in gentle places: in a patient lying in bed. - in the sacral region, the patient, who continues to walk or must sit, is on his feet. Later edema appears elsewhere. The upper border of edematous tissue goes horizontally. The dropsy of the cavities appears usually later than edema, rarely it dominates, especially this refers to the accumulation of transudate in the abdominal cavity, which can be significant also in those cases when there are no large edema (for example, with stagnant and indurated liver). The transudate can fill the pleural cleft and the pericardium, sometimes the genital organs swell considerably.

The amount of urine decreases in the daytime, nicturia and oliguria increase, the kidney block is an extreme situation, when anuria is possible - a very formidable symptom that requires emergency therapy.

Features of heart failure in newborns

The most common causes of heart failure in newborns are congenital heart defects, less often - acute and congenital myocardial diseases and extracardiac pathology.

In newborns, heart failure is characterized by rates of development, clinical symptoms and course, which is explained by insufficient adaptive capabilities of the newborn, anatomical and physiological features of organs and systems, and, in general, some immaturity of the functions of organs and systems. In particular, there is a pronounced centralization of blood circulation. On the part of the respiratory system, a deficiency of the surfactant system is possible. Progression and development of heart failure in newborns are also due to the weakness of the development of the peripheral channel and the increased fragility of the capillaries. In newborns, the development of heart failure is accompanied by increased sweating, associated with an increase in activity of the sympathetic-adrenal system. Rarely, cervical veins swelling due to a relatively short neck. Rarely do they swell. Heart failure of stage III occurs rarely, and newborns die mainly in cases of heart failure of stage II.

The diagnosis of heart failure of the first degree is very difficult, since tachycardia and dyspnea occur in children of this age under physiological conditions, with physical and emotional stress, in particular when feeding. With heart failure of grade II, the same symptoms are noted as in older children. However, signs of dizziness (dyspnea, tachycardia, wet wheezing in the lungs) prevail, in connection with this, it is possible to underestimate the syndrome and make an erroneous diagnosis of pulmonary pathology, more often - pneumonia. Since therapy aimed at treating pneumonia, in this situation is ineffective, then after an additional examination (ECG, a complete X-ray examination) reveal the cardiac cause of the disorders.

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