1) Shortness of breath appears , especially at night when lying down. This is a consequence of stagnation of blood in the lungs. 2) Due to stagnation of blood in a large circle of blood circulation, the patient’s arms and legs freeze, swelling appears . At first they are only on their feet, in the evening they can become common. 3) The liver increases and pains appear in the right hypochondrium. 4) Upon examination, the patient reveals cyanosis – a blue tint of the color of the hands and feet. 5) When listening to the heart, instead of two heart sounds, three are heard . This is called the “gallop rhythm.” The electrocardiogram shows signs of a disease that has led to chronic heart failure: myocardial infarction, rhythm disturbance, or signs of an increase in the left heart. An x-ray reveals an increase in heart size, pulmonary edema. On the echocardiogram , myocardial infarction, heart defects, cardiomyopathy , and damage to the outer lining of the heart (pericarditis) are found. An echocardiogram allows you to assess the degree of impaired heart function. CHF develops gradually, so there are several stages of this disease.

The stages of heart failure .

There are different principles for dividing heart failure at the stage, one of the most convenient and understandable classifications developed by the New York Heart Association. 

It distinguishes four functional classes of patients with heart failure.

•                I FC – the patient does not experience restrictions in physical activity. Normal stress does not provoke weakness (lightheadedness), palpitations, shortness of breath, or anginal pain. 
•                II FC – moderate restriction of physical activity. The patient feels comfortable at rest, but performing normal physical exertion causes weakness (lightheadedness), palpitations, shortness of breath, or anginal pain. 
•                III FC – a pronounced limitation of physical activity. The patient feels comfortable only at rest, but less than usual physical exertion leads to the development of weakness (lightheadedness), palpitations, shortness of breath, or anginal pain. 
•                IV FC – inability to perform any load without the appearance of discomfort. Symptoms of heart failure or angina pectoris may occur at rest. When performing a minimum load, discomfort increases.   
   

TREATMENT OF HEART FAILURE.

The goal of treating heart failure is to increase the patient’s life expectancy and improve his quality of life. First of all, they try to treat the underlying disease that led to this condition. Surgical methods are often used. In the treatment of heart failure itself, it is important to reduce the load on the heart and increase its contractility. The patient is recommended to reduce physical activity, relax more. Reduce the amount of salt and fat in food. Lead a healthy lifestyle. Previously, all patients used cardiac glycosides ( digoxin ). Now they are used less often.

•                Cardiac glycosides ( digoxin , digitoxin , strophanthin , celanide , etc.) enhance the work of the heart muscle, increase exercise tolerance. Reception of cardiac glycosides, the duration of their intake, dosage must always be under the constant supervision of a doctor. The patient should know that when applying cardiac glycosides, cumulation occurs (the accumulation of drugs in the body). If a lot of medication accumulates, cardiac glycoside poisoning may occur. Signs of poisoning: loss of appetite, nausea, slow heart rate, sometimes heart failure. In these cases, you must immediately consult a doctor.
  
•                The second class of drugs is Diuretics (diuretics). They are prescribed for signs of fluid retention in the body (swelling of the legs, lungs, a sharp increase in body weight, a sharp increase in the size of the abdomen). These are furosemide, hypothiazide, diacarb , veroshpiro.
  
•                In recent years, angiotensin-converting enzyme inhibitors ( enalapril , captopril , berlipril , lisinopril ) are considered the main drugs for the treatment of heart failure . These drugs cause the expansion of arteries, reduce peripheral vascular resistance, facilitating the work of the heart by pushing blood in them. They restore the impaired function of the inner lining of the vessels. Angiotensin-converting enzyme inhibitors are prescribed for almost all patients.
  
•                In some patients, beta-blockers are used ( metoprolol , concor , carvedilol ). They reduce the heart rate, reduce oxygen starvation of the heart muscle, reduce pressure. Other classes of drugs are also used. It is very important that the patient consults a doctor on time and is constantly monitored.