Today, in the age of technology, the development of cardiovascular diseases causes quite serious concerns not only among employees of medical organizations, but also in the upper levels of government. That is why more and more new strategies are being developed to reduce the diseases in question, scientific research is being actively funded that will allow us to achieve these goals in the future.
One of the directions in the treatment of patients with cardiovascular diseases is the prevention and treatment of cardiac pathology. If in this area some of the diseases can be successfully treated, others still remain "intractable" due to the lack of techniques and other necessary components of proper treatment. This article discusses the concepts of cardiac output, its norms and methods of treatment, the ejection fraction of the heart (the norm in children and adults).
Current position
Due to the increase in life expectancy among the elderly, this group is increasingthe prevalence of cardiac pathology, especially with impaired ejection fraction. In recent years, proven methods of drug treatment and the use of resynchronization devices, a cardioverter-defibrillator have been developed that prolong life and improve its quality in patients with this pathology.
However, methods of treating heart pathology with a normal fraction have not been determined, the treatment of this pathology remains empirical. There are also no proven treatments for acute forms of cardiac decompensation (pulmonary edema). Until now, the main drugs in the treatment of this condition are diuretics, oxygen and nitro drugs. The ejection fraction of the heart, the norm, its pathology, require a serious approach to the problem.
You can visualize the heart muscle and determine the work of the heart chambers (atria, ventricles) using Doppler cardiography. To understand how the heart works, examine its ability to contract (systolic function) and relax (diastolic function) of the myocardium.
Fraction values
The ejection fraction of the heart, the norm of which is discussed below, is the main instrumental indicator that characterizes the strength of the heart muscle.
Doppler Ejection Fraction Values:
- Normal readings are greater than or equal to 55%.
- Slight deviation - 45-54%.
- Moderate deviation - 30-44%.
- Strong deviation - less than 30%.
If this figure is less than 40% - the "power of the heart" is reduced. Normal values are above 50%, "heart strength" is good. Allocate a "gray zone" from 40-50%.
Heart failure is a combination of clinical manifestations, biochemical markers, research data (electrocardiography, dopplerography of the heart, radiography of the lungs), which occur with a decrease in the force of contraction of the heart.
Distinguish between symptomatic and asymptomatic, systolic and diastolic heart failure.
Relevance of the problem
In the past 20 years, the incidence of heart failure among Europeans has been decreasing. But the number of cases in the middle and older groups of the population is increasing due to the increase in life expectancy.
According to European studies (ECHOCG), a decrease in ejection fraction was found in half of patients with symptomatic heart failure and half of asymptomatic patients.
Patients with heart failure are less able to work, their quality of life and its duration are reduced.
The treatment of these patients is the most expensive for them and for the state. Therefore, the search for ways to prevent the occurrence, early diagnosis and effective treatment of heart disease remains relevant.
Studies conducted in recent decades have proven the effectiveness of a number of groups of drugs to improve prognosis, reduce mortality in patients with low cardiac fraction:
- adenosine converting enzyme inhibitors("Enalapril");
- angiotensin II antagonists ("Valsartan");
- beta-blockers ("Carvedilol");
- aldosterone blockers ("Spironolactone");
- diuretics ("Torasemide");
- "Digoxin".
Causes of heart failure
Heart failure is a syndrome that is formed as a result of a violation of the structure or work of the myocardium. Pathology of conduction or heart rhythm, inflammatory, immune, endocrine, metabolic, genetic, neoplastic processes, pregnancy can cause heart weakness with or without ejection fraction.
Causes of heart failure:
- ischemic heart disease (more often after a heart attack);
- hypertension;
- combination of coronary artery disease and hypertension;
- idiopathic cardiopathy;
- atrial fibrillation;
- valve defects (rheumatic, sclerotic).
Heart failure:
- systolic (ejection fraction of the heart - the norm is less than 40%);
- diastolic (ejection fraction 45-50%).
Diagnosis of systolic heart failure
Diagnosis of systolic heart failure suggests:
1. ejection fraction of the heart - the norm is less than 40%;
2. congestion in circulatory circles;
3. changes in the structure of the heart (scars, foci of fibrosis, etc.).
Signs of blood stasis:
- increased fatigue;
- dyspnea (shortness of breath), including orthopnea, nocturnal paroxysmal dyspnea - cardiac asthma;
- swelling;
- hepatomegaly;
- expansion of the jugular veins;
- crepitus in the lungs or pleural effusion;
- murmurs during auscultation of the heart, cardiomegaly.
Combination of several of the above symptoms, the presence of information about heart disease helps to establish heart failure, but the Doppler ultrasound of the heart with the definition of structural changes and assessment of myocardial ejection fraction is decisive. In this case, the ejection fraction of the heart will be decisive, the norm after a heart attack of which will be definitely different.
Diagnostic criteria
Criteria for diagnosing heart failure with a normal fraction:
- heart ejection fraction - normal 45-50%;
- stagnation in the small circle (shortness of breath, crepitus in the lungs, cardiac asthma);
- violation of relaxation or increase in myocardial stiffness.
To exclude heart failure in recent years, biological markers have been determined: atrial natriuretic peptide (acute heart failure - more than 300 pg / ml, with chronic heart failure - more than 125 pg / ml). The level of the peptide will help in determining the prognosis of the disease, choosing the optimal treatment.
Patients with preserved heart fraction are usually older and more often women. They have many comorbidities, including arterial hypertension. In these patients, plasma levels of natriuretic peptidetype B is lower than in patients with a low fraction, but higher than in he althy people.
Tasks for doctors to treat patients
Goals for treating patients with heart failure when the ejection fraction of the heart is above normal:
- relief of symptoms of the disease;
- decrease in re-hospitalizations;
- prevention of premature death.
The first step in the correction of heart failure is non-drug treatment:
- restriction of physical activity;
- restriction of s alt intake;
- fluid restriction;
- weight loss.
Treatment of patients with reduced EF
Step 1: diuretic (torasemide) + angiotensin-converting enzyme inhibitor (enalapril) or angiotensin II receptor blocker (valsartan) with a gradual dose increase to a steady state + beta-blocker (carvedilol).
If symptoms persist - step 2: add an aldosterone antagonist ("Veroshpiron") or angiotensin receptor P.
If symptoms persist, it is possible to add "Digoxin", "Hydralazine", nitropreparations ("Cardiket") and / or perform invasive interventions (installation of resynchronizing devices, implantation of a cardioverter-defibrillator, heart transplantation) to the treatment, after having previously performed ultrasound hearts. The ejection fraction, the norm of which is described above, in this case is determined by ultrasound.
Modern tacticstreatment of heart failure with angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, beta-blockers, aldosterone blockers, diuretics, nitrates, hydralazine, digoxin, omacor, if necessary, the installation of resynchronization devices and cardioverter defibrillators in the last two decades has led to a significant increase in the survival of patients with terminal forms of this disease. This poses new challenges for clinicians and researchers.
The search for methods to replace myocardial scar tissue remains relevant.
Conclusion
Thus, from the presented article, one can see the practical value of the methods undertaken by doctors. The ejection fraction of the heart (norm and pathology) has not yet been fully studied. And although medicine is currently not yet perfect to combat the pathologies under consideration, one must hope and invest a sufficient amount of investment in the development and development of scientific research in this area. After all, the development of the medical industry mainly depends on scientists. Therefore, public authorities should provide support to all scientific medical institutions trying to get the issue off the ground.
