Heart failure

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Heart failure commonly refers to a condition in which the heart cannot sufficiently pump enough blood to sustain the body’s functions. It generally occurs due to the weakening of the heart’s cardiac muscles or an inability of blood to fill itself in the heart. It is important to understand that heart failure is a serious condition that requires medical treatment.
The condition may develop in a short duration of time or may progress slowly over a longer duration. Heart failure may affect either one or both sides of the heart and can be attributed to different underlying causes.
An existing heart or systemic disease such as coronary heart disease, irregular heart rhythm, inflammation and hypertension may precipitate heart failure.

Elderly patients are more prone to heart failure. Women generally develop heart failure at a later age as compared to men. The reasons for the development of the condition also vary depending on gender.
Symptoms of heart failure may not appear immediately but can develop over a period of time. Initially, symptoms such as tiredness and shortness of breath may occur that are sometimes ignored by some individuals or go unnoticed.

Heart failure affects various integral organs such as the kidneys, liver etc. Heart failure may also lead to other complications, including heart attack, pulmonary hypertension, development of an irregular heartbeat etc.
Diagnosis is mainly done through routine tests, physical examinations and scans. Patients with heart failure must improve their lifestyle as it can only be managed and not completely cured.

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Types

Heart failure can broadly be categorized into three main types depending on the affected side and function. Generally, the classification is as follows:


  1. Left-sided heart failure


Oxygen-rich blood flows from the lungs to the heart, where it enters the heart’s left chamber. It travels to the left atrium and then to the left ventricle, after which it is pumped to various body parts. The heart’s left chamber is the most vital and is slightly larger as it must pump blood to the entire body. Therefore, left-sided heart failure causes an increased workload on the left atrium and ventricle. Two main types of left-sided heart failure are:

  • Systolic failure: This condition involves a decrease in the ejection fraction. The heart loses its ability to pump blood with sufficient force to various parts of the body due to an inability of the left ventricle to contract sufficiently.

  • Diastolic failure: In this condition, the ejection fraction remains normal. However, the left ventricle loses its ability to relax adequately, possibly due to muscle stiffness. Due to this, the heart is unable to fill up with blood.


Right-sided heart failure

This condition mainly involves the right ventricle and usually occurs after a left-sided heart failure due to increased fluid pressure, which is inevitably transferred to the lungs post left ventricular failure. This affects the right chamber, thus leading to backflow of blood into the veins, which causes swelling in various areas of the body.

Congestive heart failure

CHF or congestive heart failure occurs when there is a decrease in the rate of flow of blood out of the heart, thus resulting in increased buildup of blood in veins, which further causes swelling in various other parts of the body such as the legs and ankles. Often, fluid collects in the lungs thus causing breathing difficulties resulting in respiratory distress if not correctly managed.

Causes And Risk Factors

CAUSES

Heart failure is generally an outcome of various other conditions affecting the heart. Commonly known causes of heart failure include:


  • Coronary heart disease: This generally occurs when there is a blockage of arteries due to the buildup of fatty substances commonly known as plaque. The formation of plaque that blocks arteries leads to atherosclerosis. Blood flow through such arteries is hampered, which decreases the amount of oxygen available to heart tissues. A lack of available oxygen, in turn, leads to the occurrence of angina or a cardiac arrest.

  • Hypertension: An elevation in blood pressure puts a strain on blood vessels and the heart, thus causing heart failure.

  • Cardiomyopathy: A condition in which the heart tissue itself is damaged may lead to heart failure as it affects the heart muscles, thus causing them to weaken.

  • Arrhythmias: Cardiac arrhythmias generally refer to a condition where abnormal heart rhythms are observed. Arrhythmic conditions such as atrial fibrillation may precipitate heart failure.

  • Damage to heart valves may lead to improper pumping of blood from the heart and may also result in the improper filling of ventricles with blood, thus causing conditions like heart failure.

  • Congenital heart diseases: These are defects present since birth and may cause heart failure if not suitably treated or managed.

  • Lifestyle-related factors such as excessive consumption of alcohol, drugs or smoking may damage the heart.

  • Other conditions such as hyperthyroidism or pulmonary hypertension (increased pressure in the lungs) may also lead to heart failure.


RISK FACTORS

Major risk factors for heart failure include:

  • The presence of existing medical conditions such as coronary artery disease, high blood pressure and previous history of heart attacks are major risk factors for the development of heart failure.

  • Age: Elderly patients over the age of 65 years are more susceptible to heart failure.

  • Gender: It has been observed that males were more likely to suffer from heart failure than women. However, women are more likely to suffer from a type of heart failure in which relaxation of heart muscles is impaired.

  • Family history: A previously known heart condition such as cardiomyopathy prevalent in one’s family leads to a greater risk of developing heart failure.

  • Diabetes: Patients who suffer from high blood pressure and coronary artery disease, along with diabetes, are more prone to developing this condition.

  • Lifestyle: Obesity, smoking, and alcohol consumption may lead to the development of heart diseases such as heart failure over time.

  • Medications: Drugs such as anabolic steroids or cancer medications may affect the heart, thus causing heart failure.

Symptoms

Most symptoms of heart failure depend upon the type and severity of the disease.

Individuals suffering from left-sided heart failure generally experience the following symptoms:


  • Difficulty in breathing

  • Cough due to an increase in the amount of fluid built up in the lungs

  • Fatigue and weakness

  • Inability to concentrate

  • Drowsiness

  • Bluish discolouration of fingers and lips

  • Difficulty in lying flat while sleeping


Individuals suffering from right-sided heart failure generally experience the following symptoms:

  1. Loss of appetite and nausea

  2. Abdominal pain due to swelling

  3. Swelling of ankles, legs, abdominal area and veins of the neck region

  4. Frequent urination

  5. Weight gain

Diagnosis

A physical exam may be required. It is important to inform a doctor if an individual experience any of the above symptoms. The doctor will perform a two-dimensional echocardiogram with Doppler flow studies as a confirmatory test. Additionally, routine blood tests may also be conducted to determine kidney function, total cholesterol, and levels of electrolytes in the body such as sodium, potassium, etc. A doctor may also recommend a chest X-ray. ECGs and MRIs may help determine the ejection fraction value for an individual, which helps assess ventricular function, especially that of the left ventricle. Other imaging tests such as echography, nuclear medicine scans etc. may be conducted to determine the type of heart failure and its severity.

Prevention

Evaluation of risk factors is an important step in preventing heart failure. Other measures include managing other existing conditions such as high blood pressure or diabetes and making improvements in one’s lifestyle such as stress management, weight control, quitting alcohol consumption and smoking etc.

Treatment

Treatment options generally depend upon the type of heart failure and its severity. Most patients require a combination of two or more treatment options. Some treatments must be continued lifelong. Treatment also depends upon the stage of heart failure, which may range from a high risk of developing heart failure to an advanced state of the disease. Patients who have progressed to an advanced stage may require rigorous treatment to prevent worsening of the condition.

Commonly employed treatments regimens include:


  • Lifestyle management: Changes such as healthy eating, lowering sodium and fat intake, exercising, not smoking, management of comorbidities such as diabetes, high blood pressure etc. go a long way in reducing the severity of symptoms.

  • Medications: Patients may be required to take 2-3 medicines that can help improve the condition and prevent it from worsening. Medications prescribed mainly include diuretics, beta-blockers and other classes of drugs.

  • Medical devices: Pacemakers, cardiac resynchronization therapy devices, implantable defibrillators etc. may be used to control the cardiac rhythm.

  • Surgery: Surgical methods such as angioplasty, bypass, heart transplant, valve defect correction etc. may be employed in some cases, especially those with a more severe condition.

Prognosis/complications

Heart failure may lead to the following complications:


  • Kidney or liver damage due to buildup of fluid in these organs

  • Pulmonary hypertension and fluid accumulation in lungs

  • Malnutrition due to inability to eat owing to nausea and reduced ability of the stomach to absorb nutrients from food.

  • Development of other heart conditions such as leakage of valves disrupted heart rhythm (arrhythmia) and possible occurrence of a heart attack.

References


  1. NIH. Heart Failure [Internet] Available at https://www.nhlbi.nih.gov/health-topics/heart-failure. Accessed on April 10, 2020.

  2. Cleveland Clinic. Heart Failure [Internet] Available at https://my.clevelandclinic.org/health/diseases/17069-heart-failure-understanding-heart-failure Accessed on April 10, 2020.

  3. American Heart Association. Heart Failure [Internet] Available at https://www.heart.org/en/health-topics/heart-failure/what-is-heart-failure/types-of-heart-failure. Accessed on April 10, 2020.

  4. NHS-UK. Heart Failure [Internet] Available at https://www.nhs.uk/conditions/heart-failure/ Accessed on April 10, 2020.

  5. University health- Heart Failure [Internet] Available at https://www.universityhealth.org/heart-failure/risk-factors/ Accessed on April 10, 2020

  6. King M, Kingery J, Casey B. Diagnosis and Evaluation of Heart Failure. Am Fam Physician. 2012 Jun 15;85(12):1161-1168.

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