Heart Failure

Heart Failure: a Chronic and Life-threatening Condition

Heart failure (HF) is a chronic and life-threatening condition in which the heart cannot pump blood sufficiently to meet the body’s demands. It is also known as congestive heart failure and requires medical care.

Types:

  • Left-sided heart failure – Left ventricle of the heart cannot pump enough blood around the body leading to the accumulation of blood in the pulmonary veins.
    • Heart failure with reduced ejection fraction (HFrEF) or systolic failure – Left ventricle loses its ability to contract normally.
    • Heart failure with preserved ejection fraction (HFpEF) or diastolic failure – Left ventricle loses its ability to relax normally.
  • Right-sided heart failure – Right ventricle cannot pump sufficient blood to the lungs leading to the accumulation of blood in the veins.
  • Biventricular heart failure – Both sides of the heart are affected, and a build-up of fluid is seen.
  • Congestive heart failure (CHF) – Congestion in the body tissues occurs as the blood flow from the heart slows down and the blood returning to the heart via the veins backs up.

What Causes Heart Failure:

The main etiological factors are:

  •  Medical conditions that damage or overwork the heart, such as coronary artery disease or heart attack.
  •  Infection or injury that damages the heart.
  •  Blood clot in the lung.
  •  Faulty heart valves.
  •  Congenital heart disease.
  •  Arrhythmia.
  •  High blood pressure.
  •  Cardiac amyloidosis.
  •  Cardiomyopathy.
  •  Conditions that stiffen the heart chambers, such as obesity and diabetes.
  • Conditions that damage the lungs such as chronic obstructive pulmonary disease.

Risk factors:

  •  Age – Older adults and those above 65 years of age are at a higher risk due to aging–related changes of the heart muscle and the presence of other health conditions.
  • Genetics – Risk of HF is higher if there is a family history of heart failure. Gene mutations also raise the risk.
  •  Unhealthy lifestyle habits – Unhealthy diet, smoking, drug abuse, heavy alcohol consumption, and physical inactivity increases the risk.
  •  Medical conditions – Obesity, high blood pressure, diabetes, sleep apnea, atrial fibrillation, and serious lung disease also raise the risk.
  •  Medications – Diltiazem, verapamil, tricyclic antidepressants, antipsychotics, chemotherapy, and radiation therapy further elevate the risk.
  •  Ethnicity – African Americans are more likely to suffer from heart failure as compared to other races.
  •  Gender – Women are more susceptible to developing HFpEF while men are more likely to develop HFrEF. Men are more prone to heart failure at a younger age as compared to women.

What are the Signs and symptoms of Heart Failure?

  • Shortness of breath when active and resting
  • Swelling (edema) of feet, ankles, stomach, and lower back
  • Unusual tiredness
  • Water retention
  • Palpitations
  • Fatigue
  • Decreased stamina
  • Loss of appetite
  • Nausea
  • Chronic coughing

Complications:

The serious complications arising due to heart failure are:

  • Kidney or liver damage
  • Fluid buildup in or around the lungs
  • Malnutrition
  • Leaking heart valves
  • Sudden cardiac arrest
  • Cardiac arrhythmias
  • Pulmonary hypertension

Diagnosis: How is it diagnosed?

  • Medical history – The physician assesses symptoms, family history, and other risk factors.
  • Physical examination – Heart rate, blood pressure, heart sounds, and edema in the body are examined by the physician.
  • Diagnostic tests –
    • Blood tests – Electrolyte levels, kidney and liver function tests, complete blood count, C – reactive protein levels, and brain natriuretic peptide (BNP) are monitored.
    • Chest x-ray
    • Magnetic resonance imaging (MRI)
    • Breathing tests – To ascertain if the lung problem is responsible for breathlessness.
    • Radionuclide ventriculography – Radioactive substances are injected to see how well the heart chambers are functioning.
    • Cardiac catheterization with coronary angiography – Blockages in the coronary arteries and the parts of the heart that has weakened or damaged are identified.
    •  Holter or event monitorElectrical activity of the heart is monitored for 24 to 48 hours while doing the normal daily activities.

Treatment: how is How is Heart Failure treated?

  • Improving the symptoms and preventing the aggravation of the disease are the main objectives of treatment.
  • Assessing the reversible risk factors is the other goal of treatment.
  • Implantable devices –
    • Implantable cardioverter-defibrillator (ICD) – To deliver an electric counter-shock to the heart when a life-threatening abnormal rhythm is detected.
    • Left – ventricular assist device (LVAD) – Implanted in end-stage heart failure patients when heart transplantation cannot be done.
    • Cardiac Resynchronization Therapy (CRT) – A pacemaker to make the ventricles contract in synchrony and improve heart function.
  • Surgical procedures –
    • Heart transplantation – Replacement of the damaged heart in severe, progressive heart failure patients with a healthy heart.
    • Percutaneous coronary intervention (PCI) or angioplasty – An inflated balloon pushes open the artery, and a stent is kept in place to reopen the blocked blood vessels.
    • Coronary artery bypass – Rerouting the blood supply around the blocked section of the artery to restore blood flow to the heart.
    • Valve replacement – Replacement of the defective or diseased valve with a good valve.
  • Medications –
    • Angiotensin – Receptor Neprilysin inhibitors – Sacubitril/valsartan reduces the risk of hospitalization for heart failure.
    • If channel blocker – Ivabradine to reduce heart rate.
    • Beta-blockers – Bisoprolol, metoprolol, etc., to lower heart rate.
    • Aldosterone antagonists – Spironolactone, eplerenone, etc., to remove extra sodium and fluid from the body.
    • Diuretics – Furosemide, bumetanide, etc. to treat edema.
    • Digoxin – To make the heartbeat stronger and pump more blood.
    • Other medications – Anticoagulants and statins.

Prevention:

  • Living with HF–
    • Heart-healthy diet
    • Managing a healthy weight and stress.
    • Quitting smoking.
    • Medical care for other conditions.
  • Preventing HF–
    • Increasing physical activity.
    • Controlling diabetes.
    • Lowering high blood pressure.
    • Lowering cholesterol

When to see a doctor? :

Consult with a cardiologist immediately if you have a chronic cough, high heart rate, and shortness of breath while lying down. The cost of heart transplantation surgery ranges around Rs. 20 to 25 lakhs.

References:

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