【Health Lecture】Health guidance for elderly with chronic heart failure

In order to ensure the popularization effect of learning health knowledge in the 3rd China Elderly Health Knowledge Competition, the organizers have collected various health science articles suitable for the elderly to learn from various hospitals. We will share them through the "Health Lecture Hall" column. Today, Dr. Qi Xin from the Department of Critical Care Medicine of Beijing Boai Hospital, China Rehabilitation Research Center, brought us health guidance and popular science articles on chronic heart failure in the elderly. Elderly friends are welcome to learn. Chronic heart failure refers to a series of symptoms and signs caused by a decrease in cardiac output due to a disorder in the structure or function of the heart, resulting in insufficient tissue perfusion, accompanied by blood stasis in the systemic circulation or pulmonary circulation. It can be divided into systolic heart failure and diastolic heart failure by pathophysiology. It is not a simple hemodynamic disorder, but more importantly, it is a clinical syndrome that promotes the continuous development of heart failure due to the participation of multiple neurohumoral factors. It can be caused by either a weakening of myocardial contractility or a continuous increase in peripheral vascular or pulmonary vascular resistance, resulting in excessive heart load.

In the elderly population, the common causes of chronic heart failure are various chronic myocardial lesions and long-term ventricular overload. Such as valvular heart disease, hypertension, myocardial ischemia and myocardial infarction caused by coronary heart disease, chronic obstructive pulmonary disease, etc. Left ventricular failure is the most common, which mainly affects the patient's pulmonary circulation. It can manifest as dyspnea, cough, sputum, hemoptysis, increased nocturia, fatigue and weakness. Because the elderly often have aging and diseases of other organs, they can interfere with some clinical manifestations of heart failure. Even if many elderly people have heart failure, they do not feel obvious shortness of breath during activities, but show extreme fatigue and cough, and often have unusual sweating. Left ventricular failure is not easy to distinguish from chronic obstructive pulmonary disease and lung infection.

Chronic heart failure may be aggravated acutely under certain inducements, such as infection, arrhythmia, water and electrolyte disorders, excessive fatigue, excessive mental stress, drastic changes in the environment and climate, and other complications. It manifests as fatigue, worsening breathlessness, lower limb edema, palpitations and sweating, coughing and sputum, hemoptysis, and even inability to lie flat. Healthy prevention and treatment of chronic heart failure in life: The primary disease of chronic heart failure in the elderly is often irreversible. What we can do is to slow down the progression of heart failure and reduce the probability of acute aggravation of chronic heart failure. The main measures and points to note are as follows: 1. Avoid fatigue. Patients with heart failure often have limited physical strength. Exercise and fatigue will directly increase the burden on the heart and even induce acute aggravation of heart failure. Avoid excessive exercise according to different levels of heart function.

2. Avoid overeating, eat small meals frequently, and avoid overfilling the gastrointestinal tract, which will cause the diaphragm to rise and compress the heart.

3. Low-calorie diet, adequate vitamins, moderate amounts of protein, and appropriate amounts of carbohydrates and fats. Food should be easy to digest and should not be too much meat or fish. It is also important to quit smoking and drinking.

4. Eat a low-salt diet and limit your water intake throughout the day. Keep the daily salt intake within 3 grams. If you have obvious edema, decreased urine output, shortness of breath, palpitations, and cannot lie flat, you should strictly follow a salt-free diet. Water and sodium retention will directly increase the preload of the heart.

5. Pay attention to maintaining smooth bowel movements. Constipation and straining to defecate are common causes of acute aggravation of heart failure. You can eat high-fiber foods or laxatives according to your personal situation, and use enema and other laxatives when necessary.

6. Control your weight. For every 5 kg/m2 increase in body mass index (BMI), the risk of heart failure increases by 42%. Controlling your weight can reduce left ventricular afterload.

7. Get enough sleep. Maintaining a good and adequate sleep quality will help reduce the burden on the heart. Arrange a quiet, comfortable sleeping environment with appropriate temperature and humidity. Increase the sleep time at night and take a nap appropriately. Rest in bed if necessary.

8. Drug treatment controls the primary disease, such as controlling blood sugar, controlling blood pressure, reducing afterload, improving cardiac blood supply with drugs or digitalis drugs, inhibiting myocardial remodeling drugs, etc., to delay the progression of chronic heart failure.

9. Regular check-ups, including cardiac ultrasound, blood biochemical liver and kidney function tests, are required because chronic heart failure due to insufficient perfusion is often accompanied by damage to other organ functions and can easily cause secondary hyperkalemia and other electrolyte disorders, which require timely detection and symptomatic treatment.

10. Psychological adjustment and a calm and stable mental state can help alleviate the symptoms of heart failure.

11. Finally, if the symptoms of chronic heart failure tend to worsen acutely, seek medical attention promptly and call an ambulance if necessary. If conditions permit, use oxygen while waiting, sit down, and take oral medications to reduce the workload on the heart.

About the Author:

Qi Xin graduated from Capital Medical University with a master's degree in cardiovascular medicine. She is currently employed as an associate chief physician in the Department of Critical Care Medicine at Beijing Boai Hospital, China Rehabilitation Research Center. She has accumulated more than 20 years of experience in the monitoring, rescue, treatment and rehabilitation of critical illnesses.