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.
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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.
- Echocardiography (echo)
- Chest x-ray
- Electrocardiogram (ECG)
- Magnetic resonance imaging (MRI)
- Breathing tests – To ascertain if the lung problem is responsible for breathlessness.
- Exercise stress test – This shows how the heart responds to exercise.
- 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 monitor – Electrical 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-converting enzyme (ACE) inhibitors – Captopril, enalapril, etc. to improve hemodynamics and correct ventricular arrhythmias.
- Angiotensin II receptor blockers – Losartan, valsartan, etc. to lower blood pressure.
- 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.