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TREATMENT OF CHRONIC HEART FAILURE
Mukhtarov Saidorifkhon Abdukodirkhuja ugli
Assistant of the Department of Therapy, Faculty
Andijan State Medical Institute
Abstract.
Chronic heart failure (CHF) is one of the most severe and prognostically
unfavorable complications of cardiovascular diseases. Over the past 30 years, the average
life expectancy of patients with this diagnosis has increased from 3.5 to 8 years. This
module contains information on modern CHF treatment options that a cardiologist should
have at all stages of medical care: from outpatient care to a heart failure specialist.
Kеywоrds:
chronic heart failure, treatment, high-tech treatment methods.
INTRОDUСTIОN
Chronic heart failure (CHF) is a disease with a complex of characteristic symptoms
(shortness of breath, fatigue and decreased physical activity, edema, etc.), which are
associated with inadequate perfusion of organs and tissues at rest or under stress and often
with fluid retention in the div. The underlying cause is a deterioration in the heart's ability
to fill or empty, caused by myocardial damage, as well as an imbalance of vasoconstrictor
and vasodilating neurohumoral systems [1].
MАTЕRIАLS АND MЕTHОDS
Ischemic heart disease is the main cause of heart failure in 2/3 of all cases [2]. This poses the
problem of choosing approaches to myocardial revascularization in CHF for the clinician.
Isolated left ventricular plastic surgery in patients with CHF of ischemic etiology with low
left ventricular EF, despite a decrease in cardiac volume, did not affect the prognosis and
cannot be considered recommended (class III, level of evidence B). The decision on the
advisability of aneurysmectomy is made jointly by the surgeon and cardiologist; such
intervention is justified in the case of large saccular aneurysms of the LV. The relevance of
the problem of surgical treatment of post-infarction aneurysms is due to the low survival rate
of patients: only 30-50% survive for 5 years, according to various authors (development of
heart failure, thromboembolic complications, life-threatening rhythm disturbances in more
than half of patients). Remodeling of the LV in post-infarction aneurysm is the appearance
of akinesia zones, a decrease in stroke volume, an increase in the size and volume of the left
ventricle, a compensatory increase in heart rate, and the occurrence of "ischemic mitral
insufficiency".
RЕSULTS АND DISСUSSIОN
One of the main problems in patients with left ventricular systolic dysfunction is aortic valve
stenosis with a low gradient (EF <40%, aortic valve orifice area <1 cm2, mean gradient <40
mmHg). In some patients this is a true severe stenosis, and in some it is a “pseudo-aortic
stenosis”, when the reduced blood flow through the aortic valve is caused not by leaflet
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obstruction, but by a low stroke volume. If the mean gradient is >40 mmHg, then there are
no theoretical limitations for valve replacement in symptomatic patients. In patients with
contraindications to open surgery (for example, due to severe lung pathology), it is possible
to use transcatheter techniques for aortic valve replacement TAVI (Transcatheter aortic
valve implantation) [3].
Aortic valve repair or replacement is recommended for all symptomatic and asymptomatic
patients with severe aortic regurgitation and EF <50%, unless there are contraindications to
surgery. Surgery may also be appropriate in patients with severe aortic regurgitation and LV
end-diastolic diameter >70 mm or end-systolic diameter >50 mm (or >25 mm/m2 of patient
div area) [4].
Evaluation of mitral regurgitation should be comprehensive, especially in patients with LV
systolic dysfunction (in mitral regurgitation there are certain difficulties in assessing systolic
function).
Differential diagnosis between primary and secondary mitral regurgitation is complex. The
decision to perform surgery should be based on the severity of clinical symptoms, patient
age, atrial fibrillation, degree of left ventricular systolic function impairment, pulmonary
hypertension, and the possibility of valve replacement. The latter is the most important
predictor in the postoperative period. Relative (non-valvular) mitral regurgitation occurs due
to dilation and change in the shape of the left ventricle and the mitral valve annulus, which
leads to incomplete closure of its leaflets. Full-scale drug therapy and, in some cases,
resynchronization therapy can lead to reverse left ventricular remodeling and a decrease in
functional mitral regurgitation. depending on the area of mitral regurgitation.
Ischemic mitral regurgitation is a special type of secondary mitral regurgitation that is most
suitable for surgical intervention [2]. Combined surgical intervention – CABG + mitral
valve replacement – can be considered appropriate in symptomatic patients with left
ventricular dysfunction, coronary artery disease with a sufficient amount of viable
myocardium. Predictors of late complications after mitral valve reconstruction are a large
distance between the papillary muscles, rigidity of the posterior mitral valve leaflet and a
marked increase in the left ventricle (end-diastolic diameter >65 mm). In such patients,
mitral valve replacement is preferable to plastic surgery. In atrial fibrillation, atrial
arrhythmogenic ablation procedures and left atrial appendage closure may be appropriate
during mitral valve surgery.
Heart transplantation is a generally accepted treatment for end-stage CHF [3]. Although
controlled studies have never been conducted, it is believed that HT, provided that patient
selection criteria are met, significantly increases patient survival, increases exercise
tolerance, improves quality of life, and enables a faster return to work compared with
traditional treatment.
СОNСLUSIОN
In addition to the shortage of donor hearts, the main problems with HT are the consequences
of the limited effectiveness of the method and complications from immunosuppressive
therapy in the late period (for example, antigen-antidiv-mediated graft rejection, infectious
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complications, hypertension, renal failure, malignancy and vasculopathy of the coronary
arteries).
RЕFЕRЕNСЕS
1. Cleland J.G., Freemantle N., Erdmann E. et al. Long-term mortality with cardiac
resynchronization therapy in the Cardiac Resynchronization-Heart Failure (CARE-HF) trial
// Eur. J. Heart Fail. 2012. Vol. 14. P. 628–634.
2. Hunt S.A., Baker D.W., Chin M.H. et al. ACC/AHA guidelines for the evaluation and
management of chronic heart failure in the adult: a report of the American College of
Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to
Revise the 1995 Guidelines for the Evaluation and Management of Heart Failure // J. Am.
Coll. Cardiol. 2001. Vol. 88. P. 2101–2113.
3. Chin M.H., Goldman L. Factors contributing to the hospitalization of patients with
congestive heart failure // Am. J. Public Health. 1997. Vol. 87. P. 643–648.
4. Velazquez E.J., Lee K.L., Deja M.A. et al. Coronary-artery bypass surgery in patients
with left ventricular dysfunction // N. Engl. J. Med. 2011. Vol. 364. P. 1607–1616.
