Heart failure
1. What Is Heart Failure?
Heart failure is a condition in which the heart cannot pump enough oxygen-rich blood to meet the body's needs. Heart failure does not mean that the heart has stopped beating. Instead, the heart cannot pump blood as effectively as it normally does. Heart failure is often the result of other underlying medical conditions.
2. What You Need to Know About the Heart
Common symptoms of heart failure include shortness of breath, leg swelling, abdominal pain, or nausea.
Diagnosis includes tests to diagnose heart failure, followed by tests to determine the underlying cause of heart failure.
Treatment for heart failure begins with lifestyle changes and medications. In more severe cases, surgery may be required.
People can live with heart failure. Close self-monitoring and adherence to the diet, medications, and exercise plan recommended by the physician are essential to improving quality of life and prolonging life.
3. What Causes Heart Failure?
Heart failure may be caused by any of the following:
- Previous heart attacks (myocardial infarction) that create scar tissue in the heart and may impair the heart's ability to pump blood normally (the most common cause of heart failure in the United States)
- Coronary artery disease: the arteries that supply blood to the heart become narrowed due to atherosclerosis or other causes.
- Heart valve disease, which may occur following a previous episode of rheumatic fever or due to other infectious causes.
- Hypertension
- Infection of the heart valves and/or heart muscle (e.g., infective endocarditis or myocarditis)
- Cardiomyopathy, including inherited forms
- Congenital heart disease (present at birth)
- Cardiac arrhythmias
- Chronic obstructive pulmonary disease
- Pulmonary embolism (a blood clot in the lungs), which can also cause heart failure
- Certain medications
- Anemia and excessive blood loss
Some medications and dietary supplements may worsen heart failure or interfere with existing heart failure medications. Tell your doctor about all medications and supplements you are taking, including over-the-counter medications.
4. What Are the Symptoms of Heart Failure?
The following are the most common symptoms of heart failure. Each person may experience one or more different symptoms. Symptoms may include:
- Shortness of breath at rest or during strenuous activity
- Weight gain
- Leg swelling, and less commonly, abdominal enlargement due to fluid accumulation
- Fatigue and weakness
- Nausea, abdominal pain, and loss of appetite
- Persistent cough
In general, some people develop symptoms because the heart cannot supply enough blood to the body's organs (fatigue and weakness, shortness of breath during activity), while others develop symptoms due to fluid congestion in the body (worsening shortness of breath when lying down, weight gain, persistent cough, abdominal enlargement, nausea, abdominal pain, poor appetite, and leg swelling).
Some people may experience symptoms from both groups. However, some people may not have any symptoms at all.
The severity of symptoms depends on the extent to which the heart's ability to pump blood is affected. Sometimes, symptoms of heart failure may resemble those of other medical conditions or problems. Therefore, always consult your doctor for an accurate diagnosis and appropriate management.
5. How Is Heart Failure Diagnosed?
In addition to taking a detailed medical history and performing a thorough physical examination, your doctor may recommend the following tests to help diagnose heart failure:
Chest X-ray: Helps provide images of the bones, surrounding tissues, and organs within the chest.
Echocardiography: Helps assess the structure and function of the heart.
Electrocardiogram (ECG or EKG): Electrodes are attached to different locations on the body to record the heart's electrical activity.
BNP measurement: B-type natriuretic peptide (BNP) is a hormone released from the heart's ventricles in response to increased wall stress associated with heart failure. BNP levels are very useful for the rapid assessment of heart failure. The higher the BNP level, the more severe the heart failure.
6. How Is Heart Failure Treated?
The goal of heart failure treatment is to improve quality of life by addressing underlying causes, reducing symptoms, and managing overall health. Education plays a crucial role. Patients and their family members need to be counseled on how to recognize and respond to subtle changes, such as leg swelling or weight gain, which may allow early intervention to slow the progression of heart failure.
6.1. Treatment Includes
- Treatment of underlying medical conditions
- Control of risk factors
- Smoking cessation
- Weight loss (if overweight) and increased moderate exercise
- Adopting a heart-healthy diet
- Avoiding alcohol consumption
- Getting adequate rest
- Controlling blood glucose levels (if diabetic)
- Controlling blood pressure, which also means controlling the amount of sodium (salt) in the diet
- Fluid restriction
- Adherence to medication
The following medications have been shown to prolong life in people with heart failure:
- Angiotensin-converting enzyme (ACE) inhibitors: These medications reduce pressure within the blood vessels and decrease peripheral vascular resistance.
- Angiotensin receptor blockers (ARBs): These are an alternative medication for reducing the workload on the heart if the patient cannot tolerate ACE inhibitors. An ACE inhibitor or an ARB is generally prescribed as one of the two, rather than both at the same time.
- Beta-blockers: These medications reduce heart rate and decrease the workload of the heart by blocking specific receptors on heart muscle cells.
- Aldosterone antagonists: These medications block the effects of the hormone aldosterone, which promotes sodium and water retention.
- Angiotensin receptor-neprilysin inhibitors (ARNIs): This is a relatively new class of medication and has been shown to be a better option than ACE inhibitors or ARBs.
6.2. The Following Medications Have Been Shown to Reduce Symptoms
- Diuretics: Help reduce fluid accumulation in the body.
- Vasodilators: Dilate blood vessels and reduce the workload on the heart.
- Digoxin: Helps the heart beat more strongly and at a more regular rate.
- Antiarrhythmic medications: These medications help maintain a normal heart rhythm and prevent sudden cardiac death. However, some antiarrhythmic medications may cause or worsen heart failure.
- Implantable devices that help the heart function more effectively
- Biventricular pacing/cardiac resynchronization therapy (CRT): This type of pacemaker stimulates both ventricles simultaneously to coordinate cardiac contraction and improve heart function.
- Implantable cardioverter-defibrillator (ICD): A device similar to a pacemaker that detects when the heart is beating too fast and delivers an electrical shock to convert the rapid rhythm to a normal rhythm.
- Ventricular assist device (VAD): This mechanical device performs the pumping function of one or both ventricles. A VAD may be necessary when heart failure progresses to a stage at which medications and other treatments are no longer effective.
- Heart transplantation: For selected patients, replacing the patient's heart with a donated heart is a last-resort treatment for those who do not improve despite all other treatment options.
The information above is for reference purposes only and is not intended as medical advice. Please contact your doctor for detailed medical consultation.