Heart failure is a condition in which the heart is unable to pump enough blood to the organs in our body. As a consequence, too little oxygen reaches individual organs, or too much blood remains in the organs of the body. This causes a set of common complaints and symptoms for the patient.
Since heart failure can be complex, it is helpful to familiarize yourself with the basic terms doctors use when describing the condition in a patient.
Acute heart failureis a condition where symptoms of heart failure come on suddenly and increase rapidly.
Chronic heart failureis heart failure with symptoms that have lasted for at least a month. Depending on the course of clinical symptoms, it can be described as stable, worsening or uncompensated.
Congestive heart failurerefers to a form of acute or chronic heart failure with features of fluid overload that causes symptoms directly caused by blood stasis in various organs (e.g.,dyspnoeadue to pulmonary congestion,edemaof the lower limbs,jugular vein dilatation, andhepatomegaly).
Based on the results of echocardiography, the following are distinguished:
- heart failure with reduced ejection fraction (also known as systolic)
- heart failure with a moderately reduced ejection fraction
- heart failure with preserved ejection (or diastolic) fraction.
Depending on whether the patient is dominated by the symptoms of the so-called small (pulmonary, responsible for the right ventricle) or large (systemic, responsible for the left ventricle), the following terms are used:
- left ventricular heart failure
- right ventricular heart failure
- biventricular heart failure.
In this article, Niketrainers.com.co will tell you:
The causes of heart failure
Any cardiovascular disease can lead to heart failure.
The most common cause of heart failure is ischemic heart disease (most often a historyof myocardial infarction). Secondly, excessive workload of the heart should be indicated, causingarterial hypertension(in particular, insufficiently treated and poorly controlled), heart valve defects (aortic stenosis, mitral or tricuspid valve insufficiency or aortic valve insufficiency) and cardiomyopathies (primarily hypertrophic cardiomyopathy). . Other causes includemyocarditis,diabetes, andconstrictive pericarditis. Iatrogenic causes such as medications andradiation therapyin mediastinal tumors, they can also damage the heart muscle and lead to its failure.
It should be remembered that heart failure can also be caused by diseases outside the cardiovascular system, e.g. chronic lung diseases (asthma,chronic obstructive pulmonary disease), severeanemia,liver cirrhosisorhyperthyroidism.
The course of heart failure
The impairment of myocardial function activates compensatory mechanisms that initially counteract the drop in pumped blood and keep arterial pressure at a level that maintains normal blood supply to the organs. In a short time, however, the negative effects of the activation of compensatory mechanisms begin to prevail (intensification of peripheral vasospasm, sodium and water retention in the body, direct toxic effect of catecholamines and angiotensin on the heart), which leads to further damage to the circulatory system and the formation of a self-propelling vicious circle. The described mechanism explains why heart failure is usually progressive and inevitably leads to the deterioration of myocardial function.
How common is heart failure?
It is estimated that in recent decades the number of patients with heart failure has doubled, which is why it has become a social problem (there is even talk of an epidemic of heart failure). It is connected with the aging of the population, but also with more and more effective treatment of cardiovascular diseases and longer survival of patients.
The incidence of heart failure depends on age. In the general adult population it is 1-2%, but its frequency increases rapidly after the age of 75, and in people aged 70-80 it is even up to 20%.
Based on epidemiological data, it can be assumed that in Poland about 600-800 thousand people suffer from heart failure, and according to some sources, even 1 million people.
How is heart failure manifested?
The clinical signs of heart failure described below may appear imperceptibly and slowly increase (chronic heart failure) or appear suddenly and rapidly (acute heart failure). It should be remembered that symptoms may not be present in the early stages of the disease and in patients treated with diuretics.
Symptoms (perceived by the patient):
- typical:
– shortness of breath – this is the most common and characteristic symptom of heart failure. Initially, it occurs during physical exertion, then during low activity, and finally appears at rest
– constant fatigue, weariness, reduced exercise tolerance – it is not a result of excessive physical exertion or lack of physical condition, but it results from skeletal muscle hypoxia
–orthopnoë– feeling shortness of breath 1-2 minutes after lying down, which disappears a few minutes after you sit or stand up. Sometimes this symptom is so strong that the patient can sleep in a sitting position in the chair
– paroxysmal nocturnal dyspnea – this is a severe dyspnea that wakes the patient up from sleep 2-3 hours after going to bed. It usually disappears> 30 minutes after you have been sitting
– swelling around your ankles - less common:
– nightcough– usually dry, but in worsening heart failure may be associated with the production of pink-colored sputum
–wheezing
– feeling full
– loss of appetite
–confusion(especially in the elderly)
–depression
–palpitations
–dizziness
– fainting
–bendopnea– is shortness of breath that occurs when bending down, for example when tying shoes or putting on socks. Appears approx. 30 seconds after tilting.
Symptoms (found by a doctor when examining a patient):
– peripheral edema (lower limbs, sacrum, scrotum)
– crackles over the lungs
– increased pressure in the jugular veins
– hepatocervical symptom
– third heart tone, heart murmur
– apical beat displacement
– suppression of the protrusion at the base of the lungs
– tachycardia
– irregular pulse
–tachypnoë(rapid breathing)
– hepatomegaly
–ascites
– cold distal extremities
–oliguria(low urine output)
– weight gain (> 2 kg / week)
– weight loss (in advanced heart failure)
– cachexia.
The NYHA classification, which is based on fatigue, dyspnoea and palpitations in association with exercise, is commonly used to assess cardiovascular fitness in patients with heart failure.
| Table 1. New York Heart Association (NYHA) classification of heart failure | |
|---|---|
| Class | Exercise capacity |
| AND | no limits – ordinary physical exertion does not cause greater fatigue, shortness of breath or palpitations |
| II | slight restriction of physical activity – no discomfort when resting, but normal activity causes fatigue, palpitations or shortness of breath |
| III | significant limitation of physical activity – no discomfort at rest, but less than normal activity causes symptoms |
| IV | any physical activity causes discomfort; symptoms of heart failure occur even at rest, and any activity worsens the symptoms |
What to do in the event of symptoms of heart failure?
In the event of symptoms that may indicate heart failure, see a GP, who will assess whether further diagnosis is needed and direct it.
Rapidly appearing symptoms of heart failure or sudden significant worsening of symptoms in a person diagnosed with heart failure are life-threatening and require immediate medical attention – an ambulance should be called immediately.
How does a doctor make a diagnosis of heart failure?
For patients presenting with symptoms of heart failure for the first time to a primary care physician or to a cardiology clinic, the doctor first assesses the likelihood of the disease based on their history for the presenceof coronary heart disease,high blood pressure,and other diseases and conditions that may cause heart failure . The doctor then examines the patient for signs of heart failure. As part of the initial diagnosis, the doctor also performsan ECGandmeasures blood pressure.
If your doctor does not find any abnormalities in the above tests, heart failure is very unlikely and an alternative diagnosis responsible for your symptoms should be considered.
If deviations are found in at least one examination, the doctor extends the diagnosis to includeechocardiography, which is the most useful and commonly available examination in the case of suspected heart failure. It allows direct assessment of the volume of the heart cavities, the systolic and diastolic function of the ventricles, the thickness of the heart walls, valve function and the presenceof pulmonary hypertension. This information is crucial in making a diagnosis and in implementing appropriate treatment.
As an alternative to echocardiography, the concentration of plasmanatriuretic peptidescan be assessed (blood test). Patients with values below the cut-off point for significant cardiac dysfunction are unlikely to develop heart failure and do not require further diagnosis in this direction. However, it should be emphasized that the increased concentration of natriuretic peptides requires echocardiographic verification, as their increase does not necessarily mean that the patient has heart failure.
Data from a thorough clinical examination and the above-mentioned tests allow for the initial diagnosis and treatment planning in the majority of patients.
Additional diagnostic tests, performed when there are doubts about the diagnosis or an atypical cause is suspected, includecoronaryangiography (coronary angiography),scintigraphy,computed tomography,magnetic resonance imaging,stress test, right heart catheterization with assessment of hemodynamic parameters, andmuscle biopsy cardiac.
What are the treatments for heart failure?
Treatment of chronic heart failure is comprehensive, and its goal is to reduce mortality and severity of disease symptoms, as well as improve the quality of life.
Causal treatment
The goal of causal treatment is to eliminate the causes of heart failure. It includes, among others, the surgical correction of anatomical and valvular defects of the heart, removal of foci causing heart rhythm disturbances and all techniques of revascularization, i.e. restoring normal blood supply to the heart in the course of coronary artery disease.
Non-pharmacological management
Lifestyle is essential in treating heart failure. Merely taking medications, without following medical recommendations, especially regarding diet, is not enough.
The most important elements of non-pharmacological management are:
- Limiting the intake of sodium (salt)usually to 2-3 g per day and limiting fluid intake to 1.5–2.0 l per day.
- Regular, moderate, daily physical activity. Regular exercise improves the efficiency of the respiratory muscles, reduces the feeling of shortness of breath and increases maximum exercise capacity. Isometric exercises are not recommended.
- Limiting alcohol consumptionto 10–12 g / day for women and ≤ 20–25 g / day for men (if alcoholic cardiomyopathy is suspected as the cause of heart failure, complete abstinence is required).
- Stop smoking
- Avoiding(if possible)certain drugs, which include frequently abused painkillers from the group of non-steroidal anti-inflammatory drugs (e.g. ibuprofen, ketoprofen). Glucocorticosteroids, class I antiarrhythmics, lithium salts, and tricyclic antidepressants and a number of other drugs should also be avoided.
- Influenza(annual)and pneumococcal vaccinations
- Avoid traveling to locations> 1500 meters above sea level or hot and humid environments. Air is the preferred mode of transport for long journeys in order to avoid the consequences of long-term traffic restrictions.
- Regular weight control– checking it every day allows you to quickly notice the symptoms of water retention in the body, i.e. rapid weight gain by several kilograms, even overnight.
Moreover,the education of the patient and his family is very important. Education should be provided by a group of people caring for the sick (doctor, nurse, cardiac rehabilitation specialist and psychologist). The importance of these simple actions is huge. Patient discipline and compliance with the above recommendations enable efficient functioning and reduce the occurrence of ailments.
Pharmacological treatment
In the pharmacological treatment of the disease, it is assumed that the damaging neurohormonal activation associated with heart failure is modified as strongly as possible. To achieve this, a combination of multiple drugs with complementary effects is necessary. There is strong evidence that such treatments reduce mortality, hospitalization, and the severity of clinical symptoms.
The mainstay of treatment of heart failure are three classes of drugs,angiotensin converting enzyme (ACEI) inhibitors,β-blockersandaldosterone antagonists(aldosterone receptor blockers), which are recommended for all patients with heart failure. In patients with symptoms of fluid overload (peripheral edema, pulmonary congestion, increased pressure in the jugular veins), diuretics (diuretics) are used in combination with the above-mentioned drugs. Other medications for heart failure with additional indications include angiotensin receptor antagonists (ARBs), neprilysin inhibitors (ARNIs), ivabradine and digitalis glycosides.
Invasive treatments
Resynchronization therapy (CRT)– involves implanting electrodes into the heart, which, thanks to electrical discharges, stimulate the work of the heart chambers and improve their function, reduce the severity of symptoms, improve the quality of life, and reduce morbidity and mortality.
Cardioverter-defibrillator (ICD)– is a device that restores normal heart function in the event of dangerous arrhythmias, especially if there is a risk of cardiac arrest and the patient’s death.
Heart Transplant
In extreme cases of heart failure, the only method of causal treatment is surgical treatment consisting in heart donation transplantation. Heart transplantation is used in patients who are generally in good health, whose life expectancy after transplantation is relatively long, and the risk of perioperative complications is low, and who are also in NYHA Class IV (Table 1) and are often hospitalized due to worsening heart failure. In Poland, slightly over a hundred heart transplants are performed annually, and the number is limited by the lack of donors, as the demand is much greater. Transplantation is associated with an estimated 20% risk of death related to the possibility of infection, transplant rejection or the development of heart failure. However, if successful, it ensures a much longer survival and a better quality of life for the patient,
Left ventricular assist devices (LVAD) may be temporarily used while waiting for a heart transplant.
Treatment of acute heart failure focuses on supporting vital functions and preventing permanent changes in the patient’s key organs. In addition to drugs used in chronic heart failure, painkillers and sedatives, oxygen, respiratory support and, if necessary, resuscitation and electrostimulation of the heart are used.
Is it possible to cure heart failure completely?
Chronic heart failure is usually progressive. This means that it inevitably leads to the deterioration of the function of the heart muscle, which can generally be explained by overloading the remaining functional cardiomyocytes – the cells that make up the heart. However, there are effective treatments to slow the progression of heart damage (see above).
Annual mortality is estimated at 10–15%, and in asymptomatic left ventricular systolic dysfunction, approximately 5%.
What should I do after treatment for heart failure is finished?
Chronic heart failure requires life-long treatment. In some patients it will only consist of periodic check-ups and treatment of the cause of the heart damage (e.g. diabetes, hypertension), while in the most severe cases it is waiting for a heart transplant.
What to do to avoid getting heart failure?
The basic procedure to prevent the occurrence of circulatory failure is appropriate and systematic treatment of diseases that may lead to it, and preferably prophylaxis of their occurrence.
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