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Отеки голени при сердечной недостаточности

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17 августа 2019

Что такое отеки ног многие знают не понаслышке. Но большинство считает, что они вызваны проблемами в работе почек, а о связи с сердечной недостаточностью и не догадываются. На самом деле причинами отеков на ногах могут быть серьезные проблемы в работе сердечнососудистой системы. Поэтому знать, как определить это по основным симптомам и избежать, принимая меры профилактики, не помешает каждому из нас.

Характеристика заболевания

Сердечная недостаточность – это функциональное нарушение работы сердца в плане регулирования кровяного потока и его выброса в вены и сосуды. Отеки – это накопление в определенной части тела внеклеточной жидкости и натрия. Связь этих двух на первый взгляд совершенно несовместимых процессов сложна, но давно доказана.

Выглядит это таким образом. Когда снижается частота и количество выброса крови желудочками сердца, течение крови по венам и сосудам замедляется, а объем внеклеточной жидкости значительно снижается. В результате почки рефлекторно задерживают натрий и воду.

Происходит застой крови в сосудах, из-за чего определенная часть жидкости вынуждена просачиваться через сосуды на стенке и собираться в расположенных поблизости тканях.

В итоге на них образуется отек. И в первую очередь это становится заметным в области щиколоток и стоп, что объясняется силой тяжести смещающей процесс вниз.

На начальных стадиях сердечной недостаточности образуется скрытые отеки. Общий объем избыточной жидкости еще не превышает 5 литров. И, несмотря на то, что объем этот довольно внушительный, организм способен удерживать его без заметных проявлений, то есть процесс накопления жидкости идет полным ходом, но не обнаруживается внешне.

Отекам при сердечной недостаточности присущи дополнительные явления. В этот процесс активно включен правый желудочек сердца.

При хронической недостаточности работы сердца сопровождающейся отеками нижних конечностей развивается деформация правого предсердия.

Почему из за патологий сердца развиваются отеки

Любая болезнь сердца приводит к задержке жидкости в организме. Объясняется это повышением кровеносного давления в венах и сосудах, а также длительным удерживанием почками натрия. Из-за деформированного размещения ионов вода впитывается обратно в почечные каналы, а влага сосредотачивается в нижней части тела.

Скопление влаги в ногах развивается также при застоях крови из-за слабости работы сердечного «насоса».

Основные причины сердечной отечности это:

  • гипертония;
  • эндокардит;
  • кардиомиопатия;
  • ишем. болезнь сердца;
  • аритмия;
  • кардиосклероз;
  • инфаркт миокарда и другие сердечные пороки.

Эти болезни сокращают выброс крови, в итоге замедляется перекачка тканевой жидкости, сбивается баланс воды и соли в организме, происходят застойные процессы, образуется сердечный отек ног.

Симптомы и места локализации

Отек ног при сердечной недостаточности характеризуются увеличением объема нижних конечностей, которое вызвано повышенным скоплением в них жидкости.

Основные симптомы таковы:

  • отеки образуется после длительного нахождения тела в вертикальном положении;
  • исчезают или снижаются после отдыха или пробуждения;
  • развиваются медленно и постепенно;
  • характеризуются симметричностью;
  • могут вызывать потерю работоспособности;
  • кожа становится плотной и гладкой;
  • возникает общая усталость;
  • кожные покровы холодеют и синеют;
  • появляется одышка;
  • боль и дискомфорт отсутствуют.

Если надавить на опухлость можно заметить белый след, который будет исчезать очень медленно.

Эти симптомы свойственны именно сердечным отекам, когда опухают ступни, щиколотки и пальцы на ногах. В более запущенных ситуациях сердечные отечности затрагивает лодыжки, голени, икры и даже бедра.

Хроническая сердечная недостаточность сопровождается не только отеками.

Определить, что застой жидкости вызван именно проблемами с сердцем можно по сопутствующим симптомам:

  • повышение давления;
  • увеличение температуры кожных покровов в месте скапливания жидкости;
  • бледность кожи;
  • одышка, увеличивающаяся в положении лежа;
  • замедленное или учащенное биение сердца;
  • акроцианоз.

В тяжелых случаях отекает нога при сердечной недостаточности, сопровождаясь скоплением воды в брюшной полости (водянка).

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Сердечный отек ног: лечение

Опухшие ноги надо лечить сразу же, не допуская ухудшения ситуации. Для этого используют медикаменты, народные средства, ванночки и специальную диету. Следует отметить, что надо снимать не только отеки. Надо бороться с причиной, вызывающей их.

Медикаментозное

Самостоятельно назначать лечение нельзя. Чтобы убрать припухлости на ногах, нужно обратиться к специалисту-кардиологу. Он проведет осмотр, диагностику назначит правильную схему лечения. Для борьбы с этой проблемой используются средства как для применения внутрь, так и наружные.

Препараты для применения внутрь

В этом случае лечение в первую очередь направляется на борьбу с основной проблемой, а именно на то, чтобы снять отек ног при сердечной недостаточности.

Больным назначают Верошпирон, Альдактон (антагонисты), Дигоксин, Коргликон (гликозиды), Каптоприл, Энап (ингибиторы), Панангин, Аспаркам (препараты калия). Кроме того, выписывают мочегонные средства, чтобы снять накопленную жидкость и уменьшить нагрузку на почки. Чаще всего это Фуросемид и др.

Перечисленные препараты могут назначаться больному как в домашних условиях, так и в условиях стационара. Если лечение происходит на дому прием осуществляется в виде капсул или таблеток, если состояние тяжелое и терапия проводится под наблюдением врача, чаще всего это уколы.

В обязательном порядке назначаются кроверазжижающие препараты, а еще если опухлости сопутствует гипертония, то лекарства нормализующие давление. Запомните, назначать их может только врач. Самолечение может привести к серьезному обострению ситуации.

Наружные средства

Снять отечность ног во время сердечной недостаточности помогают мази, кремы и гели, которые действуют местно, помогают быстро убрать тяжесть в ногах, уменьшить болезненность, повышают эластичность и прочность стенок вен и сосудов, улучшают состояние растянутой из-за накопленной жидкости кожи.

Чаще всего врачи назначают Лиотон, Троксерутин, Троксевазин, Гепариновую мазь. Наносить их нужно два-три раза в день на проблемные участки, а потом желательно принимать горизонтальное положение, приподнимая ноги под углом минимум 45 градусов.

Народные средства

Народная медицина не менее эффективна в борьбе с сердечной отечностью. Облегчить состояние больного можно, используя компрессионную терапию. Очень хорошо проявил себя контрастный душ. Не обязательно принимать его полностью. Можно в течение дня несколько раз поливать опухшие ноги сначала теплой, потом холодной водичкой. Это очень хорошо стимулирует выведение жидкости из организма и помогает избежать скопления лишней жидкости в дальнейшем. Кроме того по возможности нужно стараться больше ходить босиком. А если без обуви не обойтись, то она должна быть легкой и удобной.

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Отвары василька, почек березы, брусники, полевого хвоща, календулы, бархатцев помогают побороть отеки ног при сердечной недостаточности. Лечение можно проводить используя эти травы по отдельности или в сборе.

Рецепт одинаков. 2 столовые ложки сбора заливается литром холодной воды и на водяной бане после закипания проваривается полчаса. После полного остывания его процеживают, делят на несколько равных приемов и выпивают в течение дня.

Можно просто залить две ложки сбора кипятком, накрыть крышкой, оставить до полного остывания, а потом процедить и разделить на равные части, выпить в течение дня.

Первый рецепт более эффективен.

Кроме того, в народной медицине есть вот такие рецепты против сердечных отеков:

  1. Смешать подорожник, крапиву, шиповник, зверобой, толокнянку. Пол-литра воды закипятить, всыпать в него в столовую ложку сбора, проварить ровно 5 минут. Остудить, процедить, выпить в течение суток небольшими глотками.
  2. Настой льняного семени. Смешать литр воды, 2 столовые ложки семян, варить после закипания 10 минут. Перелить в термос и оставить на ночь. Утром жидкость профильтровать, добавить в нее сок половинки лимона. Принимать каждые два часа ровно по 125 мл.
  3. Настойка конского каштана. Листья растения выложить в бутылку, залить доверху водкой или самогоном, настоять в темном прохладном месте неделю, процедить, принимать по чайной ложке 3 раза в день.
  4. Пучок петрушки мелко нарубить, залить кипятком и укутать в теплое полотенце. Настоять 5-8 часов. Процедить, смешать с соком одного лимона. Выпить за 3 раза.

Все средства принимать два дня, затем сделать перерыв три дня и при необходимости повторить.

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Ванночки и массаж ног

Хорошо, когда текут ноги при сердечной недостаточности помогают ванночки. Готовят их на основе шалфея, листьев березы, сосны, мяты, ромашки и морской соли.

2 столовые ложки любого выбранного средства заливают литром кипятка, дают настояться около 20 минут, затем доливают теплой водой до необходимого объема и держат ноги в ванночке примерно полчаса. Затем желательно не вытирать и не ополаскивать. Пусть лекарственная жидкость остается на проблемных участках. Делать каждый день до облегчения состояния.

Массаж – еще один способ борьбы с отеками. Но это физиотерапевтическая процедура, а следовательно у нее есть как показания, так и противопоказания. Категорически запрещено массировать отекшие ноги при флебите, тромбофлебите, трофических язвах, серьезных сосудистых заболеваниях, новообразованиях, гангренах. Не стоит прикасаться к пораженным прыщиками или язвочками покровам.

Пациент должен лечь на спину. Под колени нужно положить валик из полотенца или подушку. Ноги надо ополоснуть под контрастным душем или принять лечебную ванночку. Нанести на кожу крем и начать разминать пальцы, ступни и голени, щиколотки интенсивными, но не очень сильными движениями. Начинать с легких поглаживаний около 5 минут, затем 5-7 минут длится активная стадия, и массаж завершается поглаживанием, чтобы успокоить пострадавший участок тела.

После обязательно полежать, подняв ноги под углом 45 градусов. Отдых должен длится не менее получаса, а лучше подремать.

Диета

Основное условие в изменении рациона при отеках – снижение употребления соли до 1,5 гр. в сутки. А блюда должны содержать много калия, который положительно скажется на работе сердечной мышцы. Поэтому меню следует составлять из овсянки, гречки, риса, молочных и кисломолочных продуктов, картофеля (самый полезный печеный), нежирного мяса, сухофруктов (в первую очередь изюма и кураги), отвара шиповника, свежих овощей и фруктов.

Мочегонные продукты – это тыква, капуста, огурцы, арбузы, яблоки и морковка.

  • любые соленые и жареные блюда;
  • копчености;
  • жирную рыбу и мясо;
  • сладости;
  • маринования;
  • соусы.

Еду желательно готовить на пару, варить или запекать.

Меры профилактики

Убирая отеки, толку не добиться, надо направить все меры на борьбу с основной причиной их появления, а лучше предотвратить ее. Чтобы диагноз «хронической сердечной недостаточности» вас не коснулся, нужно:

  • следить за весом, не допускать ожирения;
  • питаться правильно и разнообразно;
  • поддерживать нормальный водный баланс;
  • активно двигаться, ходить пешком, плавать;
  • не пропускать регулярные медосмотры.

Если есть предрасположенность к заболеванию, или оно уже дало о себе знать, следует раз в день лежать минимум полчаса, приподняв ноги под углом 45 градусов, делать самомассаж, постукивая пальцами от стопы по направлению к коленям.

Обязательно принимать мультивитаминные комплексы, содержащие магний и калий, необходимые для нормальной работы сердца.

Прогноз и возможные последствия

Исход лечения зависит от того, какое именно заболевание сердца вызвало отечность, насколько своевременно была начата терапия и правильно ли была составлена схема лечения. Полное исцеление возможно далеко не всегда, но при грамотной терапии можно существенно улучшить качество жизни пациента.

Опухлости ног при сердечной недостаточности, которые исчезают сами по себе после отдыха, опасности для здоровья не представляют. Но если проблема наблюдается более 10-14 дней. Спустя этот промежуток времени отмечается сдавливание опухшими тканями сосудов и вен, начинаются осложнения, которые пагубно сказываются не только на кровеносной системе, но и на работе всех внутренних систем и органов. Объясняется это тем, что при нарушении тока крови по венам, органы и ткани испытывают дефицит в кислороде и питательных веществах.

Если меры не принимаются и отечность увеличивается, начинают отмирать клетки и ткани. Результатом может стать хирургическое вмешательство, асцит, отек легких и лимфедема.

Хроническая сердечная недостаточность может привести к появлению трофических язв. Эта болезнь является серьезным поражением кожной слизистой оболочки.

Выделяют три этапа развития:

  • на первом язвы затрагивают только поверхностные слои кожи;
  • на втором углубляются до подкожного слоя;
  • а на третьем проникают в мышцы и сухожилия.

Лечение трофических язв длительное и дорогостоящее, причем не всегда приносит положительные результаты. Поэтому следует своевременно лечить отек ног при сердечной недостаточности, чтобы не допустить таких серьезных последствий.

Нередко может произойти летальный исход. Осложнениями сердечной недостаточности считаются анасарка, когда вода скапливается не только в нижних конечностях, но и по всему организму, язвы, некроз жировых клеток, водянка сердца и др.

Больным во время откачивания жидкости при средней степени отечности, вызванной сердечной недостаточностью, могут откачать 10-15 литров жидкости.

Отеки – это не самостоятельная болезнь, это серьезный симптом, который нельзя оставлять без внимания. Своевременно принимайте меры, чтобы не довести до тяжелых необратимых последствий.

Отеки сами по себе это признак серьезного сбоя в работе организма. Отечность ног при сердечной недостаточности свидетельствует о патологии сердечно-сосудистой системы, которую нужно срочно лечить. Важно не только знать, как снять отеки на ногах при сердечно-сосудистой недостаточности, но и как их отличить от других видов отечности.

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Как развивается отеки

Отек ног при сердечной недостаточности зачастую вызван ростом давления в центральном венозном канале и задержкой ионов натрия почечной системой. Рост указанного давления приводит к увеличению гидростатического давления в сети мелких капилляров, провоцируя переход жидкости в них. Сниженный объем крови, циркулирующей по организму, приводит к росту выработки ренина и ангиотензина 2, что влечет за собой гиперсекрецию альдостерона и реабсорбцию ионов натрия в каналах почек.

Именно ионы натрия являются основным веществом межклеточной жидкости и плазмы крови, и при патологиях сердца они равномерно по ней распределяются, что раздражает осморецепторы и усиливает выработку вазопрессина. Это вещество запускает процесс обратного всасывания жидкости и ее накоплению в тканях организма. В то же время из-за роста альдостерона начинается обратный процесс всасывания почками ионов натрия, провоцируя избыток гидростатического давления жидкости вне клеток. Это приводит к скоплению жидкости в организме, росту капиллярного давления, ткани всасывают воду, провоцируя отеки.

Сердечная недостаточность из-за дисфункции систолического типа в правом и левом желудочке ослабляет насосные функции сердца, что провоцирует отеки на ногах. При сердечной недостаточности из-за дневного нахождения на ногах орган истощается, поэтому к вечеру конечности отекают. И чем выраженнее отеки, тем серьезнее проблемы с сердцем.

Причины

Причины отека ног у пожилых при сердечной недостаточности зачастую такие же, как и у молодых. Поэтому их разделяют по физиологии ССС. Это, может быть:

  1. Сердечная недостаточность (СН), возникшая по любой причине. В насосной функции начинается сбой, это приводит к неспособности сердца перекачивать имеющийся объем крови, что провоцирует ее скопление в крупных сосудах, направляющихся в орган. Если причина в левом отделе, то переполнится малый круг кровообращения, а в правом — постепенное переполнение верхних и нижних полых вен, переходя на весь большой круг. Сила тяжести провоцирует застой крови в нижних конечностях, растягивая вены и делая их более проницаемыми.
  2. Сниженный сердечный выброс. При СН застой происходит не только в венозном русле, но и в снижение объема артериальной крови. Это провоцирует гипоксию тканей и запуск защитных функций организма.
  3. Суженное сосудистое русло из-за невозможности организмом поддерживать нормальный уровень АД. Чем уже сосудистые просветы, тем хуже почки фильтруют жидкость, способствуя ее накоплению.
  4. Повышенная проницаемость сосудов, возникающая из-за гиперсекреции, обусловленной гипоксией. В таком состоянии жидкость легче проходит в межклеточное пространство, формируя отеки.
  5. Избыточная реабсорбция жидкости, спровоцированная вазопрессином в канальцах почек. Первичная моча начинает всасываться обратно, задерживая ее в организме.
  6. Низкое онкотическое давление, возникающее на запущенных и поздних стадиях хронических патологий сердца. Это результат поражения печени из-за застоя в венозном русле.

Симптомы и места локации

Возникновение отеков на ногах при сердечной недостаточности дает следующие симптомы:

  1. Отеки зачастую симметричные. Сначала страдают лодыжки, и чем сильнее сердечная недостаточность, тем выше будут подниматься отеки. Если отечность несимметричная, то это говорит о варикозном расширении вен, но даже в этом случае будут поражены сразу две конечности. При постоянном постельном режиме по разным причинам, отечность перейдет на бедра и поясницу, делая ее практически незаметной, что усложняет диагностику. Нарушение симметричности зачастую обусловлено тем, что больной предпочитает лежать на одном боку.
  2. Основные припухлости усиливаются в вечернее время, когда больной за день много ходил. После отдыха к утру симптомы становятся менее заметными. Первые признаки сердечного застоя крови и отеков — это следы от обуви на ногах, которая ранее была впору.
  3. Из-за гипоксии тканей изменяется температура кожных покровов в области отека. Из-за кислородного голодания все окислительные процессы замедляются, поэтому конечности будут более холодными, чем остальное тело. Именно холодные ноги сигнализируют о проблемах с сердцем. Когда горячие, говорят о воспалении.
  4. Из-за того, что ноги начинают опухать меняется цвет кожи на синюшный или даже фиолетовый. У смуглых людей это заметить сложнее.
  5. Застойные отеки из-за сердечной недостаточности всегда будут плотными, т. к. жидкость, попавшая в межклеточное пространство, распирает его изнутри. При надавливании вмятина проходит не сразу, а оставляет характерный след. Это также говорит и о почечной природе отека.
  6. Боль при надавливании свидетельствует о распирании тканей жидкостью. Иногда при местном отеке чувствительность снижается, что говорит о выраженной гипоксии тканей и пережатии нервных окончаний.
  7. Сердечные отеки развиваются быстрее остальных, поэтому за ночь человек может проснуться с отечными ногами.
  8. В домашних условиях от них практически невозможно избавиться, используя массаж, компресс или ванночку. Но при устранении основной причины исчезают за сутки, когда нормализуется насосная функция сердца.

Дополнительно больного может беспокоить приступы:

  • одышки;
  • слабости;
  • головокружения;
  • цианоза кожи;
  • болей в сердце и правом подреберье;
  • сбоев в сердцебиении;
  • пальцев Гиппократа.

Отличия отеков ног при патологиях сердца

Отечность ног при СН отличается от других видов отеков:

  • проявлением в вечернее время, и затуханием к утру;
  • они симметричные;
  • начинаются с пальцев и стоп, постепенно переходя выше;
  • скоростью развития;
  • плотностью, цветом и температурным режимом;
  • исчезновением после нормализации работы сердца.

Важно! При тяжелой патологии отечность переходит на все тело.

Появление трофических язв

Они возникают при поздней стадии декомпенсированной СН, чаще всего на ногах чуть выше или ниже отека. Это зоны гибели живых клеток, что является благотворной средой для любых патогенов. Течение болезни усугубляется. В основном трофические язвы при сердечной недостаточности возникают из-за:

  • длительной гипоксии тканей;
  • венозного застоя;
  • пережатия артерий отеком;
  • нарушения иннервации.

Отеки ног при сердечной недостаточности, лечение которых не было начато своевременно покрываются трофическими язвами, что ухудшает прогноз для больного. Поэтому даже противомикробная терапия окажется бессильной, и требуется хирургическое вмешательство.

Лечение

Отеки ног при сердечной недостаточности имеют комплексное лечение: одни мочегонные средства здесь не помогут.

Медикаментозное

Для восстановления оттока лимфы и движения крови используют:

  • ингибитор АПФ, как Фозиноприл;
  • антагонисты ангиотензина-2 — Лозартан;
  • мочегонные препараты;
  • сердечный гликозид Дигоксин;
  • ангиопротектор мазь Троксевазин.

Народные средства

Уменьшить отечность можно отварами калины, боярышника, мяты, календулы и соком полевого хвоща. Довольно эффективным методом устранения кровяного застоя является использование пиявок. Однако любое народное средство предварительно должно быть согласовано с лечащим врачом, чтобы не усугубить ситуацию, например, аллергией.

Ванночки и массаж ног

Они полезны только в начале патологического процесса.

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Для ванночек можно использовать морскую соль, отвары трав или березовых листьев.

Хорошо помогает сбор из ромашки, мяты и шалфея. Принимать ванночку не менее получаса, а после сделать легкий массаж, разгоняющий лимфу.

Диета

Если не сменить рацион, то даже эффективные медицинские препараты окажутся бесполезными. Поэтому диета при отеках является основой терапии, особенно если первопричиной патологии сердца является диабет или другое гормональное нарушение. Врачи рекомендуют придерживаться следующих правил:

  1. Суточный рацион должен находится в пределах 2000 ккал, а при избыточной массе тела еще меньше, а также с обязательными днями разгрузки.
  2. Сократить количество жиров в блюдах, при этом оставив белки в норме.
  3. Обязательно кушать много овощей и фруктов.
  4. Потребленная жидкость за день не должна перервать 1 литра с учетом первых блюд и напитков. При тяжелых патологиях, осложненных плохим мочевыделением эта цифра должна быть уменьшена.
  5. Желательно полностью отказаться от соли или минимизировать ее количество.
  6. Полностью отказаться от копченостей, жирных, жареных продуктов, а также солений и маринованных консервов.
  7. Только дробный рацион, чтобы не вздувался кишечник и не поднималась диафрагма.

Меры профилактики

Основная профилактика начинается с контроля за состояние здоровья особенно у людей склонных к сердечным патологиям. Если не доводить до обострения, то и отеков не будет. Поэтому важно регулярно проходить медицинские осмотры и при выявлении патологий незамедлительно их лечить. Важно не злоупотреблять жидкость в течение для, если есть подозрение на отеки. От соли лучше отказаться и строго придерживаться рекомендаций относительно рациона. Не пренебрегать лечением и врачебным рекомендациями. Только в таком случае отеков удастся избежать и последствий, которые они несут.

Появление отеков на ногах всегда сигнализирует о развитии заболеваний и является одним из симптомов патологий сердечно-сосудистой системы. При сердечной недостаточности отечность нижних конечностей развивается вследствие нарушения функционирования сердца, которое приводит к недостаточному кровоснабжению органов и тканей и застою крови в нижних отдела тела. Головной мозг реагирует на снижение количества жидкости и «подает сигнал» почкам «удерживать» воду – таким образом формируются отеки в мягких тканях.

Почему возникают такие отеки, как от них избавиться и как лечить сердечную недостаточность, — об этом данная статья.

Механизм развития отеков ног при сердечной недостаточности

Задержка жидкости в организме при сердечной недостаточности вызывается повышением центрального венозного давления и избыточной задержкой ионов натрия почками.

При повышении центрального венозного давления происходит увеличение гидростатического давления в капиллярах, и жидкость из них переходит в ткани. При сниженном объеме циркулирующей крови повышается секреция ренина и ангиотензина II. Это приводит к гиперсекреции альдостерона и реасорбции ионов натрия и воды в почечных канальцах.

Этот электролит является основным осмотическим компонентом межклеточной жидкости и плазмы крови. Основное количество ионов натрия содержится во внеклеточной жидкости. При сердечной недостаточности ионы натрия равномерно распределяются в крови и межклеточной жидкости. Это приводит к раздражению осморецепторов и усилению секреции вазопрессина, который приводит к обратному всасыванию воды в почечных канальцах и накоплению жидкости в организме.

Также при снижении объема сердечного выброса происходит гиперсекреция альдостерона, который приводит к обратному всасыванию ионов натрия в почечных канальцах и увеличению гидростатического давления внеклеточной жидкости. На фоне повышенного скопления воды в организме, повышения венозного давления и увеличения давления в капиллярах, вызванного гиперсекрецией вазопрессина, происходит обратное всасывание воды в мягкие ткани и развивается их отечность.

При сердечной недостаточности, вследствие систолической дисфункции правого и левого желудочка и диастолической дисфункции левого желудочка, ослабляется насосная функция сердца, и это приводит к застою крови в нижних отделах тела. После того, как больной проводит день в вертикальном положении тела, ресурс сердца истощается, и к вечеру ноги отекают. Выраженность таких отеков будет зависеть от степени поражения сердца.

Особенности отеков ног при сердечной недостаточности

Для отеков ног при сердечной недостаточности характерны следующие признаки:

  • появляются вечером после длительного пребывания на ногах, а утром могут исчезать или уменьшаться;
  • на начальных стадиях локализируются в дистальных отделах нижних конечностей (пальцах и стопах), при декомпенсации сердечной недостаточности «поднимаются» вверх;
  • симметричны;
  • развиваются постепенно и медленно (в течение нескольких дней или месяцев);
  • отечные ткани плотные, гладкие (при длительном отеке блестящие), синюшные, холодные на ощупь, при надавливании образуют ямку;
  • при компенсации сердечной недостаточности они исчезают.

Отеки ног при сердечной недостаточности сопровождаются:

  • болями в сердце;
  • повышенным артериальным давлением (реже – пониженным);
  • гепатомегалией (увеличением размеров печени);
  • одышкой, усиливающейся при физической нагрузке или в положении лежа;
  • снижением толерантности к физической нагрузке;
  • сердцебиением;
  • бледностью с акроцианозом.

В тяжелых случаях отеки ног при застойной сердечной недостаточности могут усугубляться анасаркой, которая сопровождается распространением выраженной отечности по всему телу (ногам, половым органам и всему туловищу) и развитием асцита и гидроторакса.

Лечение отеков при сердечной недостаточности

Для устранения отеков при сердечной недостаточности больной должен обратиться за помощью к терапевту или кардиологу. После проведения ряда дополнительных исследований (ЭКГ, Эхо-КГ, лабораторных анализов крови и мочи и др.), больному даются рекомендации по дальнейшему лечению сердечной недостаточности. На начальных стадиях сердечной недостаточности они могут включать в себя:

  • ограничение потребления соли до 1-1,5 г в день;
  • ограничение потребления жидкости до 0,8-1 литра в сутки (включая жидкость в первых блюдах);
  • регулярное измерение суточного диуреза (объем выделяемой за сутки мочи должен быть равен объему потребляемой в течение дня жидкости);
  • введение в рацион продуктов с высоким уровнем содержания калия (печеного картофеля, овсяной крупы, риса, кураги, изюма, шиповника);
  • ношение эластичных чулок или бинтов;
  • легкий массаж конечностей;
  • ванночки для ног;
  • холодные компрессы;
  • отдых с приподнятыми ногами;
  • прием мочегонных настоев из березовых почек, василька, спорыша, бархатцев, семян петрушки и др.

При более тяжелом течении сердечной недостаточности помимо этих рекомендаций больному назначается медикаментозная терапия:

  • мочегонные средства: Фуросемид, Пиретанид, Гипотиазид, Этакриновая кислота, Бритомар, Трифас, Торасемид);
  • сердечные гликозиды: Коргликон, Дигоксин и др.;
  • сартаны (антагонисты рецепторов ангиотензина II): Лориста, Вальсакор, Кандесар, Микардис и др.;
  • препараты калия: Аспаркам, Панагин;
  • антагонисты рецепторов к альдостерону: Альдолактон, Спиронолактон, Верошпирон;
  • бета-адреноблокаторы: Корвитол, Небилет, Кориол и др.;
  • ингибиторы ангиотензинпревращающего фермента: Каптоприл-Гексал, Энам, Ирумед, Гоптен, Лизоретик и др.

Медикаментозная терапия сердечной недостаточности и отеков ног, как одного из ее признаков, назначается пожизненно. Подбор препаратов для компенсирования состояния сердечно-сосудистой системы должен выполняться только врачом, и больной должен постоянно наблюдаться у кардиолога для контроля над этим процессом.

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