Cardiac Insufficiency
Classification
Source: Diana Hysi
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The functional classification of cardiac insufficiency
There are many cardiac insufficiency classifications being used. These classifications are used in order to help with a better understanding of the different stages and the treatment of the various stages.
Here, two of the most common classifications will be described:
The first classification separates patients into 4 groups:
- Group 1: This includes patients with various types of cardiopathies, but without any loss of physical capability.
- Group 2: patients do not display dyspnea or any other symptoms when practicing light exercise, but functional symptoms are only apparent after intense physical exertion.
- Group 3: functional symptoms of cardiac insufficiency are emergent during any kind of exertion, however light it may be.
- Group 4: they exhibit signs of cardiac insufficiency even at rest, but they become more severe during exertion, however light it may be.
The second classification separates the condition into three stages:
Stage 1
Is characterized only by changes in the heart cavities, and usually representative of the latent stage of cardiac insufficiency.
Those suffering from the condition at stage one display:
- Dyspnea
- Palpitation
- Tachycardia (only during exertion)
Stage 2
Stage 2 is separated into Stage 2A and Stage 2B.
Stage 2A: Patients must sleep using a tall pillow, due to their dyspnea even under resting conditions. They experience palpitations, hence they cannot sleep on their left side.
They also experience:
- A sensation of heaviness in their right hypochondrium, as a consequence of a liver enlargement
- Malleolar edema (around the ankles) emerging from the very onset appear in the evening and disappear in the morning, and later on the edemas become stable and spread to the shins and to the lumbosacral region.
Patients also suffer from:
- cyanosis
- tachycardia
- stasis rales in the lungs
- signs of renal stasis (albuminuria, hyaline cylinders, and high density urine)
Stage 2B:
The symptoms mentioned above become more accentuated, the patients exhibit:
- orthopnea (they have difficulties breathing if they sit in any other position than upright)
- cough and hemoptoic (with blood) sputum, which also contains the so-called cardiac cells, etc.
Upon an objective examination the patients exhibit:
- cyanosis
- generalized edema, or anasarca (edema in the entire body)
- the heart is enlarged in all directions, it is called cor bovinum
- heart rhythm problems
- hepatomegaly
- renal stasis, oliguria, nicturia (reduction of urination during the day and night)
- respiration of the Cheyne-Stokes type, as a consequence of cerebral perturbation, etc
An important symptom that differentiates Stage 2A from Stage 2B is the accumulation of transudate in the serous cavities ; ascites, hydrothorax, and less commonly hydro pericarditis.
Stage 3
Stage 3 is characterized by:
- dystrophic changes (in various organs)
- the liver becomes sclerotic and cardiac cirrhosis develops
- portal hypertension
- spleen enlargement
- varicose esophagus and hemorrhoids
- irreversible ascites
- the skin becomes dry, the subcutaneous tissue disappears, the muscles become atrophied, the patients become cachectic (lose a lot of muscle mass, lose weight, and suffer from hypothermia. The heart is enlarged in all directions and a systolic noise/rumour is heard at the tricuspid valve as a consequence of its functional insufficiency. In this condition the heart cannot compensate.
Articles for Cardiac Insufficiency
Causes
The causes of cardiac insufficiency are multiple and include: determining factors, factors which lead to the emergence of the disease like extreme physical exertions, various infections such as acute pneumopathies, influenza, etc.
Classification
There are many cardiac insufficiency classifications being used. These classifications are used in order to help with a better understanding of the different stages and the treatment of the various stages.
Complications
Patients suffering from cardiac insufficiency are more predisposed to developing acute pneumopathy, which is favored for development due to pulmonary stasis; embolisms and pulmonary infarctions; bacterial endocarditis, etc.
Diagnosis
The diagnosis is based on the information collected from the patient history; organic cardiopathic signs such as dyspnea, pulmonary stasis, tachycardia, galloping rhythm, coughing with hemoptoic sputum etc, are all symptoms related to the left ventricle.
Diagnosis (left venticular insufficiency)
Upon conducting an examination of the heart, one can observe the left ventricle has been displaced to the bottom left, the heart sounds are muted, fast and a galloping rhythm and systolic noise can be heard at the apex of the heart as a consequence of the functional mitral insufficiency.
Diagnosis (right chronic insufficiency)
Upon conducting a heart examination, it is noted that there is tachycardia, the heart sounds have become muted, there are galloping sounds and systolic rumours in the vicinity of the xiphoid process, which all indicate a functional insufficiency of the tricuspid valve.
Introduction
Cardiac insufficiency is a clinical syndrome which is characterized by the inability of the heart to pump well enough to supply all the tissues of the body with blood. Since the heart and peripheral vessels are functionally a joint system, one can also use the term cardiovascular insufficiency as well as cardiac insufficiency.
Symptoms (left venticular insufficiency)
Acute insufficiency of the left ventricle is characterized by dyspnea which occurs mostly at night, resembling cardiac asthma or acute pulmonary edema. The earliest symptom to emerge in chronic insufficiency of the left ventricle is dyspnea.
Treatment
Preventive non-drug based treatments include bed rest and diet. Drug based treatments vary across different stages, symptoms and various patients belonging to various age groups and specifications. Treatment is usually complex and involves utilizing drug combinations.
Two pathogenic theories behind cardiac insufficiency
The reduction in contractile power of the myocardium causes the cavities of the heart to not be fully emptied, hence the residual systolic blood and the ventricular diastolic pressure rise. Alongside the aforementioned, the atrial pressure rises, and the flow of venous blood is obstructed.
Types of cardiac insufficiency (right ventricle)
Acute insufficiency of the right ventricle usually emerges as a consequence of a pulmonary embolisms. Chronic insufficiency of the right ventricle patients complain of a feeling of heaviness or pain in the right hypochondrium.
