Heart failure refers to the symptoms and signs that the heart cannot pump enough blood to meet the needs of the body. Many heart diseases such as rheumatic heart disease, coronary heart disease, hypertensive heart disease, cardiomyopathy and congenital heart disease can cause heart failure. Extracardiac diseases such as hyperthyroidism and anemia can also lead to heart failure.
Heart failure can be divided into left heart failure and right heart failure. Symptoms of left heart failure include dyspnea, cough, hemoptysis, fatigue and burnout. Right heart failure is characterized by anorexia, oliguria, swelling and pain in liver area and edema; Heart failure involves the left heart and the right heart, both of which have symptoms.
Heart failure is often aggravated by infection, increased physical load, excessive salt intake, arrhythmia, pregnancy and failure to take medicine according to regulations.
Precautions:
1. Patients with mild heart failure, limit physical activity. Patients with severe heart failure mainly stay in bed; After the heart function is improved, you should get out of bed properly to avoid thrombosis and lower limb lung infection.
2. Reduce the burden on the gastrointestinal tract, eat more and less meals, and properly control the total daily intake. It is advisable to adopt a low-salt diet, and the daily salt should not exceed 5g (1 yuan); Avoid salty food and roasted seeds and nuts with salt.
Smoking, drinking and not drinking strong tea or coffee are strictly prohibited.
4. Take the medicine strictly according to the doctor's advice, and don't change the usage and dosage of the medicine casually, especially when taking diuretics and digoxin, so as not to cause adverse consequences.
See a doctor as soon as possible when you have a cold, diarrhea, fever or change your condition.
6. Women of childbearing age should do a good job in contraception.
How to nurse and master the activities of patients with heart failure?
First of all, keep the ward environment quiet, comfortable and clean, the air is fresh, and keep warm in winter to prevent respiratory infection from aggravating the condition. Oxygen therapy can improve the hypoxia state of the body, promote tissue metabolism and maintain life activities, which is one of the important measures to treat cardiac insufficiency. Oxygen supply should start from a small flow rate, and the flow rate should be adjusted as needed after the patient adapts. Patients with cardiac insufficiency should take appropriate posture treatment according to the degree of cardiac insufficiency. General patients should sleep in a high pillow position; Take a semi-lying position or a sitting position for the heavier person, which can alleviate the symptoms of dyspnea such as shortness of breath and wheezing at night. For patients with severe cardiac insufficiency or acute left cardiac insufficiency, they should sit up at the same time, and their lower limbs droop, so that the blood volume decreases, the diaphragm shrinks, the thoracic volume expands, and the vital capacity increases, which can alleviate dyspnea; For patients with mild cardiac insufficiency, it is not appropriate to do heavy physical activity, and if allowed, it can be limited to daily activities. For patients with moderate cardiac insufficiency, increase bed rest and avoid strenuous exercise, which is more suitable for light activities such as walking and stop when symptoms of cardiac insufficiency appear; Patients with severe cardiac insufficiency should definitely stay in bed. After the heart function is improved, exercise should be done as soon as possible according to the recovery of the disease to prevent muscle atrophy, digestive dysfunction and venous thrombosis caused by long-term bed rest. These activities should be gradual.
How to treat heart failure correctly?
Although cardiac insufficiency is a terminal disease of various heart diseases, patients can be relieved and controlled for a long time as long as they actively cooperate with doctors for regular drug treatment, maintain a happy mood, pay attention to rest, prevent colds, and avoid unhealthy incentives such as overeating and mental stimulation, and can also ensure the quality of life and prolong life. Any bad stimulation caused by nervousness, anxiety, fear, depression, irritability, etc. It will increase the burden on the heart and is not conducive to the recovery of patients. Therefore, a healthy psychology is very necessary for the rehabilitation of patients with cardiac insufficiency.
What should be paid attention to in daily life of patients with heart failure during rehabilitation?
Keep the law of daily life:
Make psychological adjustment and improve self-control ability. First of all, we must establish confidence and courage to overcome the disease. The same heart failure, but different emotions, the prognosis is obviously different. Depression and excessive mental stress will increase the burden on the heart and cardiac insufficiency.
Emphasize the combination of static and dynamic: according to the heart function, carry out appropriate activities and exercises. Reasonable arrangement of work and rest time, insist on lunch break every day about 1 hour. Proper exercise under the guidance of a doctor can avoid bedsore and venous thrombosis on the one hand, and improve cardiac function reserve, enhance disease resistance and reduce infection on the other hand, because infection is one of the main causes of cardiac insufficiency. Patients should master the "degree" during exercise, and the highest heart rate during exercise should not exceed 120 times per minute. For example, patients with heart function 1 can jog, play Tai Ji Chuan and do exercises. Patients with cardiac function II ~ III can go for a walk on the outdoor flat ground and do some activities within their power.
Keep the indoor temperature relatively constant: it is best to keep it around 20 degrees Celsius in winter, and avoid direct blowing when using electric fans in summer. When using air conditioning, pay attention to the indoor and outdoor temperature difference should not be too large.
Indoor ventilation: In winter, the room should be ventilated at least twice a day for half an hour each time, but it should be noted that patients can keep warm by themselves during air convection to avoid catching a cold.
Prevention of respiratory tract infection: respiratory tract infection can induce cardiac insufficiency. When going out, change clothes according to the season and pay attention to oral hygiene.
Diet: Usually, the food should be high-quality protein rich in essential amino acids, such as milk, lean meat and freshwater fish. And the heat should not be too high. Avoid drinking irritating drinks, such as strong tea, coffee, soda, etc. At the same time, give up smoking and drinking. Pay attention to the control of sodium chloride, and the daily intake should not exceed 2g. You can cook more sweet and sour dishes, and pay attention to avoid hidden high-salt foods, such as preserved eggs, pickles and bacon. Don't overeat, eat less and eat more meals, especially at dinner, so as not to increase the burden on your heart.
Keep your stool unobstructed: avoid overexertion when you are constipated.
Self-monitoring: People with cardiac insufficiency usually pay attention to the changes of their pulse, blood pressure, complexion, urine volume and weight. It is best to weigh yourself at the same time every day (after urination) and wear clothes of similar weight. Before going to bed at night, you should observe whether your ankle is swollen and whether you feel awakened at night. Pay attention to the daily urine volume, and it is best to collect the urine volume in a container for one day: when palpitation, cough, dyspnea, difficulty lying down, edema, bad habits, vomiting and decreased urine volume occur, the weight gain exceeds1000g in one day, indicating that cardiac insufficiency is aggravated, and you should go to the hospital immediately so that doctors can adjust the treatment plan when using it.
It is harmful to stop taking drugs and reduce drugs casually: diuretics are used to control the retention of liquefied gas, which involves the balance of electrolytes. Patients can reduce or increase the dosage of drugs by themselves, which may lead to the disorder of retained electrolytes in water and sodium storage and may cause serious arrhythmia. Another important drug, beta blockers, will produce short-term negative inotropic effects before producing long-term effects. It is easy for patients to stop taking medicine when they can't see the curative effect, which is extremely unfavorable to the long-term control and prognosis of cardiac insufficiency.
Regular follow-up: The treatment of cardiac insufficiency is a long-term process. When the condition is stable, you must go to the cardiac insufficiency clinic or the cardiovascular specialist clinic every 2-3 weeks, adjust the drugs when necessary, and do regular examinations such as echocardiography and electrocardiogram.
Insist on medication storage: remember the name of the medicine, put it in a fixed place, make clear the method of medication, and take the medicine on time. When buying prescription drugs or over-the-counter drugs in pharmacies, you should take the initiative to tell the pharmacist what drugs you are taking, so that the pharmacist can judge whether the drugs can be used together.
What drugs are there to treat heart failure?
Drugs for cardiac insufficiency include cardiotonic agents, diuretics, vasodilators, angiotensin inhibitors and adrenergic blockers, with different effects.
Let's start with the cardiotonic.
The main function of cardiotonic is to ensure adequate blood output by increasing the contractility of myocardium. Digitalis is a commonly used cardiotonic drug, which can obviously slow down the heart rate and reduce the ventricular diastolic pressure, thus contributing to the recovery of myocardial metabolism and the improvement of cardiac function. Cardiotonic is effective for left ventricular dysfunction and various arrhythmia. However, the dosage of digitalis should be strictly controlled to avoid poisoning.
As for diuretics,
As the name implies, it is a drug that increases urine volume to promote the excretion of water and electrolyte in the body, thus reducing the workload of the heart and eliminating edema of tissues and organs such as lungs, feet and ankles. It is worth noting that the use of some diuretics will excrete too much potassium necessary for human body, which will lead to low potassium ion concentration in blood and electrolyte disorder. Therefore, many diuretics must be used intermittently, and the dosage needs to be adjusted according to the condition. Patients should eat more foods rich in potassium ions (such as fruits and vegetables, especially orange juice), or supplement potassium salt according to doctor's advice.
Don't take diuretics too late, so as not to get up many times at night and go to the toilet, which will affect your rest. In addition, it is best to measure the weight at the same time every day to monitor the degree of weight loss (because the body fluids retained in the body are excreted) and make records so as to provide reference for doctors to evaluate the curative effect at the next visit.
Vasodilators can relax vascular smooth muscle to lower blood pressure, make blood flow smoother, and reduce the resistance when the heart pumps blood, thus pumping enough blood to meet the needs of the body.
The common side effects of these drugs are allergic reactions, such as rash and facial swelling; Gastrointestinal reactions, such as nausea, vomiting, diarrhea, dizziness and hypotension. Therefore, we should pay special attention to measuring blood pressure regularly (for example, once a day 1 time) and make records. In addition, every time you stand up, you should move slowly to avoid dizziness or even fainting. Some drugs can slow down the sensitivity of patients. If you feel dizzy or inflexible after taking the medicine, don't drive or operate the machine to avoid accidents.
In addition, angiotensin converting enzyme inhibitors (ACEI) and other drugs have complex effects, mainly in the neuroendocrine system. Overactivation of neuroendocrine system plays an important role in the pathogenesis of cardiac insufficiency. In view of the obvious side effects of the above drugs, modern medical research has focused on traditional Chinese medicine in China.
These drugs are generally mild and have good long-term effects. At present, the earliest cardiotonic agent of traditional Chinese medicine-Shengui capsule is the most typical representative. It has no toxic or side effects, and the curative effect is stable and lasting. It has the effects of invigorating qi and activating yang, promoting blood circulation and removing blood stasis, and is suitable for the treatment of patients with heart failure at all stages, especially filling the gaps and blind spots in the treatment of patients with chronic heart failure. However, patients with obvious acute symptoms must use western medicine under the guidance of a doctor.
What should patients with chronic heart failure eat?
The diet should be light, digestible and nutritious, and eat less at dinner to prevent heart attacks at night.
Control the amount of salt, which is generally below 5g/ day, 3-2.5g/ day for moderate cardiac insufficiency, and no more than 1g/ day for severe cases. For people who have a bad appetite, eat less and use diuretics, it is not appropriate to avoid salt excessively and increase seasonings appropriately, such as vinegar, pepper, onion and ginger.
Reduce irritating diet and prohibit strong tea, coffee or pepper;
Eat more fresh vegetables, fruits and bean products; Prohibition of drinking and smoking;
Soups and porridge suitable for eating: such as ginseng porridge, astragalus porridge, lily lotus porridge, yam barley porridge, red bean porridge, longan Danshen soup, etc.
Vegetables are especially suitable for eating more wax gourd;
Take intestine moistening medicine when you are constipated to keep your stool unobstructed.
Dietary therapy for heart failure
(1) Limit the intake of sodium salt: In order to prevent and alleviate edema, we should choose a low-salt, salt-free and low-sodium diet according to the condition. Low salt is 2 grams/day of salt for cooking; Salt contains 39 1 mg/g sodium, or equivalent to 10 ml soy sauce. The sodium content of non-staple food with 1 day should be less than 1500mg. Salt-free: that is, salt and soy sauce are not added during cooking, and the sodium content of all-purpose non-staple food is less than 70/ mg. Low sodium refers to the use of food with sodium content below 100 mg% except cooking, without adding salt and soy sauce. The sodium content of Quanshen non-staple food is less than 500 mg. In order to prevent hyponatremia syndrome, the amount of salt should be appropriately increased when the amount of diuresis is large. (2) limiting water intake: water retention in congestive heart failure is mainly secondary to sodium retention. When 7 grams of sodium chloride is retained in the body, 65438 0 liters of water must be retained to maintain the osmotic pressure balance in the body. Therefore, there is no need to strictly limit water intake when adopting a low-sodium diet. In fact, liquid intake can promote urination and reduce subcutaneous edema. Foreign scholars believe that while strictly limiting the intake of sodium salt, the intake of 2000 ~ 3000 ml of water per day can increase the net discharge of sodium and water compared with the intake of 1500 ml per day, but the net discharge of sodium and water cannot be increased when it exceeds 3000 ml. Considering this situation, increasing excessive liquid intake will increase the circulation burden. Therefore, domestic scholars advocate that the average patient's fluid intake limit is 1000 ~ 1500 ml per day (2000 ~ 3000 ml in summer), but it should be different according to the illness and personal habits. For patients with severe heart failure, especially those with renal insufficiency, due to the decline of drainage capacity, it is necessary to properly control the intake of water while taking a low-sodium diet, otherwise it may cause diluted hyponatremia, which is one of the important incentives for refractory heart failure. Once this happens, it is advisable to limit the liquid intake to 500 ~ 1000 ml and take medication. (3) Potassium intake: As mentioned above, potassium imbalance is one of the most common electrolyte disorders in congestive heart failure. Potassium deficiency is the most common in clinic, mainly due to insufficient intake (such as malnutrition, loss of appetite, malabsorption, etc. ); Additional losses (such as vomiting, diarrhea, malabsorption syndrome); Kidney loss (such as nephropathy, adrenocortical hyperfunction, metabolic alkalosis, diuretic therapy) and other conditions (such as parenteral nutrition, dialysis, etc.). ). Potassium deficiency can cause intestinal paralysis, severe arrhythmia, respiratory paralysis, etc. And easy to induce digitalis poisoning, causing serious consequences. Therefore, patients who use diuretics for a long time should be encouraged to eat more foods and fruits with high potassium content, such as bananas, oranges, jujubes and papaya. If necessary, potassium should be supplemented, or combined with potassium-preserving diuretics to excrete potassium, or combined with diuretic Chinese herbal medicines with high potassium content, such as Lysimachia christinae, Medicago sativa, Akebia Akebia, Prunella vulgaris, Achyranthes bidentata, Stigma Maydis, Houttuynia cordata and Poria. On the other hand, when the excretion of potassium is lower than the intake, hyperkalemia can occur, which can be seen in severe heart failure, or accompanied by renal insufficiency and careless use of potassium-preserving diuretics. Mild patients responded well to controlling potassium and sodium in diet and stopping using potassium-preserving diuretics. Moderate or severe hyperkalemia should be treated with drugs immediately. (4) Thermal energy and protein should not be too high. Generally speaking, there is no need to restrict the intake of protein too strictly, and it is enough to take 1g daily and 50-70g daily. However, when heart failure is serious, the supply of protein should be reduced to 0.8g per day ... The special dynamic effect of protein may increase the extra energy demand of the heart and increase the metabolic rate of the body, so it should be limited to varying degrees. As we all know, obesity is not good for circulation or breathing, especially when heart failure occurs, because it will cause diaphragm elevation, lung volume reduction and heart position change, thus becoming a more serious factor. In addition, obesity will increase the burden on the heart itself, so it is advisable to adopt a low-calorie diet to maintain the patient's net weight at a normal or slightly lower level. Moreover, a low-calorie diet will reduce the oxygen consumption of the body, thus reducing the workload of the heart. (5) carbohydrate intake: the supply amount is (300g ~ 350g)/ day, because it is easy to digest, it can stay in the stomach for a short time, and it can be emptied quickly, which can reduce the pressure of bloating on the heart. It is advisable to choose foods containing starch and polysaccharide and avoid too much sucrose and dessert to prevent flatulence, obesity and triglyceride increase. (6) Limit fat: Obese people should pay attention to control the intake of fat, which should be (40g ~ 60g)/ day. Because the heat energy generated by fat is high, which is not conducive to digestion, staying in the stomach for a long time makes the stomach full and uncomfortable; Too much fat can inhibit gastric acid secretion and affect digestion; And can surround the heart and squeeze the myocardium; Or too much abdominal fat makes the diaphragm rise, oppressing the heart and feeling bloated and uncomfortable. (7) Vitamin supplementation: Patients with congestive heart failure generally have poor appetite, and the low-sodium diet lacks flavor, so the diet should be rich in various vitamins, such as fresh vegetables, green leafy vegetable juice, hawthorn, fresh dates, strawberries, bananas, oranges and so on. Vitamin b and c should be supplemented orally when necessary. Vitamin B 1 deficiency can lead to beriberi, heart disease, congestive heart failure and high output. Folic acid deficiency can lead to heart enlargement and congestive heart failure. (8) Electrolyte balance: One of the most common electrolyte disorders in congestive heart failure is the imbalance of potassium. Hypokalemia can occur due to insufficient intake, increased loss or diuretic treatment, causing intestinal paralysis, arrhythmia, digitalis poisoning and so on. At this time, you should eat foods with high potassium content, such as mushrooms, laver, water chestnuts, red dates, coriander, Toona sinensis, spinach, amaranth, bananas, cereals and so on. If hyperkalemia occurs due to renal insufficiency, you should choose foods with low potassium content. Calcium is closely related to myocardial contractility. High calcium can cause premature beats and ventricular ectopic contractions, while low calcium can weaken myocardial contractility, so maintaining calcium balance is of positive significance in treatment. Magnesium can help myocardial cells release toxic substances from the heart and help maintain normal rhythm. In congestive heart failure, magnesium concentration can be reduced due to insufficient intake and diuretics. If not corrected in time, it can further aggravate heart failure and induce digitalis poisoning. Increasing magnesium intake is beneficial to treatment.