Heart failure

2021-07-28 05:02 PM

The best way to prevent heart failure is to control the risk factors and conditions that cause heart failure, such as coronary artery disease, high blood pressure, etc.

Define

Heart failure, also called congestive heart failure (CHF), means the heart can't pump enough blood to meet the body's needs. Over time, problems such as narrowed arteries (coronary artery disease) or high blood pressure gradually make the heart too weak or stiff to pump effectively.

Many problems that lead to heart failure cannot be reversed, but are often treatable with good results. Medicines can improve the signs and symptoms of heart failure. Lifestyle changes, such as exercising, reducing the amount of salt in the diet, managing stress, treating depression, and especially losing excess weight can improve quality of life.

The best way to prevent heart failure is to control risk factors and conditions for heart failure, such as coronary artery disease, high blood pressure, high cholesterol, diabetes, or obesity.

Symptoms

Heart failure can be chronic or acute (meaning the condition begins suddenly).

Chronic heart failure symptoms

Shortness of breath on exertion or when lying down.

Tired and weak.

Swelling (edema) in the legs, ankles, and feet.

Fast heartbeat or irregular heartbeat.

Reduced exercise capacity.

Persistent cough or wheezing with blood-tinged white or pink sputum.

Ascites.

Sudden weight gain due to water retention.

Less appetite and nausea.

Difficulty concentrating or reduced alertness.

Symptoms of acute heart failure

Symptoms are similar to those of chronic heart failure, but are more severe and begin or become suddenly severe.

Sudden accumulation of fluid.

Fast or irregular heartbeat (palpitations).

Sudden shortness of breath and coughing up pink discharge.

Chest pain, if heart failure is caused by a heart attack.

See your doctor if you experience any signs or symptoms related to heart failure. These include:

Chest pain.

Tired and weak.

Fast or irregular heartbeat.

Shortness of breath on exertion or when lying down.

Reduced exercise capacity.

Persistent cough or wheezing with blood-tinged white or pink sputum.

Swelling in the abdomen, legs, ankles, and feet.

Difficulty concentrating or reduced alertness.

It is possible to go to the emergency room first after symptoms worsen. Other heart and lung problems can cause symptoms similar to heart failure.

If there is a diagnosis of heart disease, and if symptoms suddenly get worse or develop new signs or symptoms, it may mean that heart failure is getting worse or is not responding to treatment. Contact your doctor immediately.

Causes

Type of heart failure

 

Description

Left-side heart failure 

 

The most common form of heart failure.

Fluid can return to the lungs, causing difficulty breathing.

Right-side heart failure 

 

Usually occurs with right-side heart failure.

Fluid can return to the abdominal wall, legs, and feet, causing swelling.

Systolic heart failure

 

The left ventricle cannot contract strongly, causing a pumping problem.

Diastolic heart failure
(Also called heart failure with normal ejection fraction)

 

The left ventricle cannot fully relax, indicating a filling problem.

Heart failure often develops after other heart problems have been damaged or weakened. Over time, the heart can no longer keep up with the normal need to pump blood to the rest of the body. The ventricles can become stiff and not work properly between beats. In addition, the heart muscle can weaken, and the ventricles dilate to the point where the heart can't pump blood efficiently throughout the body. The term "congestive heart failure" comes from blood stasis in the liver, abdomen, lower extremities, and lungs.

Heart failure can involve the left, right, or both sides of the heart. Usually, heart failure begins with the left side - especially the left ventricle.
 
Any of the following conditions can damage or weaken the heart and may cause heart failure. Some may be present without knowing it:

Coronary artery disease and heart attack. Coronary artery disease is the most common form of heart disease and the most common cause of heart failure. Over time, the arteries that supply blood to the heart muscle narrow from the buildup of cholesterol, a process called atherosclerosis. Blood moves slowly through narrowed arteries, certain areas of the weak heart muscle, and chronic oxygen-rich anemia. In some cases, the blood flow to the muscle is just enough to keep the muscle alive but not working properly. A heart attack occurs if plaque forms by the rupture of cholesterol plaques in the arteries. This causes a blood clot that blocks blood flow to the heart muscle, impairing the heart's pumping ability.

Hypertension. Blood pressure is the force of the heart pumping blood through the arteries. If blood pressure is high, the heart has to work harder to circulate blood throughout the body. Over time, the heart muscle can become thicker to compensate for the extra work. Eventually, the heart muscle can become either too stiff or too weak to effectively pump blood.

Heart valve disease. The heart valves keep blood flowing through the heart in the right direction. When a valve is damaged by a heart defect, coronary artery disease, or heart disease, the heart works harder to keep blood flowing in the right direction. Over time, this work can further weaken the heart.

Damage to the heart muscle. Many causes of damage to the heart muscle, also called cardiomyopathy, include infections, alcohol abuse, and the toxic effects of drugs such as cocaine or certain drugs used for chemotherapy. In addition, systemic diseases, such as lupus, or thyroid problems can damage the heart muscle.

Myocarditis. Myocarditis is inflammation of the heart muscle. It is most commonly caused by a virus and can lead to left-sided heart failure.

Heart defects at birth (congenital heart defects). If the heart and its chambers or valves are not formed correctly, the healthy parts of the heart have to work harder to pump blood, which in turn can lead to heart failure.

Abnormal heart rhythm (arrhythmia). Irregular heart rhythms can cause a heart attack. Beating too fast creates extra work for the heart. Over time, the heart can weaken, leading to heart failure. A slow heart rate can reduce the amount of blood the heart pumps to the body and can also lead to heart failure.

Other diseases. Chronic diseases such as diabetes, severe anemia, hyperthyroidism, hypothyroidism, emphysema, lupus, hemochromatosis, and accumulation of protein in the muscles (amyloidosis) can also contribute to heart failure. Causes of acute heart failure include viruses that attack the heart muscle, severe infections, allergic reactions, blood clots in the lungs, the use of certain medications, or illnesses that affect the entire body.

Risk factors

A single risk factor may be enough to cause heart failure, but a combination of factors increases the risk.

Hypertension. The heart works harder than it would if the blood pressure were high.

Coronary artery disease. Coronary artery stenosis can restrict the supply of oxygen-rich blood, leading to the weakened heart muscle.

Heart attack. Damage to the heart muscle from a heart attack can prevent the heart from pumping as much blood as it should.

Heartbeats irregularly. These irregular rhythms can put extra work on the heart, weakening the heart muscles.

Diabetes. Diabetes increases the risk of high blood pressure and coronary artery disease.

Certain diabetes medications. The diabetes drugs rosiglitazone (Avandia) and pioglitazone (Actos) have been found to increase the risk of heart failure. Do not stop taking these medications on your own. If you are taking them, discuss with your doctor whether any changes need to be made.

Sleep apnea. The inability to breathe at the right time results in low blood oxygen levels and an increased risk of abnormal heart rhythms. Both problems can weaken the heart.

Congenital heart defects. Some people with heart failure have been born with congenital heart defects.

Viruses. Viral infections can damage the heart muscle.

Alcohol. Drinking too much alcohol can weaken the heart muscle and lead to heart failure.

Kidney. It may contribute to heart failure as many kidney diseases can lead to high blood pressure and fluid retention.

Complications

If heart failure is present, the outlook depends on the cause and severity, overall health, and other factors such as age. Complications may include:

Kidney damage or failure. Heart failure can reduce blood flow to the kidneys, which can eventually cause kidney failure if left untreated. Kidneys damaged by heart failure may require dialysis for treatment.

Heart valve problems. The heart valves, which keep blood flowing in the right direction through the heart, can become damaged from fluid and blood retention due to heart failure.

Liver damage. Heart failure can lead to a buildup of fluid, which puts too much pressure on the liver. Fluid retention can lead to scarring, making it harder for the liver to function properly.

Heart attack and stroke. Because the blood flows through the heart more slowly in heart failure than in a normal heart, there is a bigger chance of developing blood clots, which can increase your risk of having a heart attack or stroke.

Some symptoms and heart function will improve with appropriate treatment. However, heart failure can be life-threatening. It can lead to sudden death. People with heart failure can have severe symptoms, and some may require a heart transplant or assistance with an artificial heart device.

Testing and diagnosis

To diagnose heart failure, your doctor will ask for a careful medical history and perform a physical exam. Your doctor will also check for the presence of risk factors such as high blood pressure. Using a stethoscope, the doctor can listen to the lungs for signs of obstruction. The stethoscope also listens for abnormal heart sounds that may suggest heart failure. Your doctor may examine the veins in your neck and check for fluid buildup in your abdomen and legs. After a physical exam, your doctor may also order some of the following tests:

Blood tests. Your doctor may take blood samples to check kidney and thyroid function and to look for indicators of other conditions that affect the heart. Blood tests to check for a chemical peptide called brain natriuretic peptide (BNP) can help check the pressure in the heart and help diagnose heart failure.

X-ray. The images help the doctor see the condition of the lungs and heart. In heart failure, the heart may appear enlarged which may cause fluid accumulation to be seen in the lungs. Your doctor may also use X-rays to diagnose conditions other than heart failure, which can explain signs and symptoms.

Electrocardiogram (ECG). This test records the electrical activity of the heart through electrodes attached to the skin. The pulse is recorded as a wave and displayed on a screen or printed on paper. This test helps your doctor diagnose heart rhythm problems and damage to the heart from a heart attack.

Echocardiography. An important test to diagnose and monitor heart failure is an echocardiogram. Echocardiography also helps distinguish systolic heart failure from diastolic heart failure, in which the heart is stiff and unable to work properly. An echocardiogram uses sound waves to create a video image of the heart. This image can help doctors determine how well the heart is pumping, by measuring the percentage of blood that is pumped out of the left ventricular chambers with each heartbeat. This is called the ejection fraction. An echocardiogram can also look for valve problems or evidence of a previous heart attack, as well as some other unusual causes of heart failure.

Ejection fraction. Ejection fraction is measured in echocardiography. The ejection fraction is an important measurement of the pumping heart and is used to help classify heart failure and guide treatment. In a healthy heart, the ejection fraction is about 55 percent.

Stress test. Check the heart and blood vessels in response to exercise. It is possible to walk on a treadmill or ride a bicycle while attached to the ECG machine. Or you may receive an intravenous drug, which stimulates the heart similar to exertion. Stress testing helps doctors see if coronary artery disease is present. Stress testing also determines how well the heart pumps to the body and can help determine long-term treatment guidelines. If the doctor wants to see an image of the heart during exercise, he or she can do a nuclear test, which is similar to a stress test but also uses an injected dye and special imaging techniques.

Cardiac computed tomography (CT) or magnetic resonance imaging (MRI). These tests can be used to diagnose heart problems, including the cause of heart failure. CT scan of the heart, lying on a table inside a machine. The X-ray tube inside the machine rotates around the body and collects images of the heart and chest.

During a cardiac MRI, you lie on a table inside a machine that generates a magnetic field. Magnetic fields attach atomic particles to some of the cells. When radio waves are emitted against these connective particles, it produces signal changes depending on the type of tissue. The signals create images of the heart.

Coronary catheterization (angiography). In this test, a catheter is inserted into a blood vessel in the groin or arm and through the aorta into a coronary artery. Injecting dye through the catheter causes the arteries that supply blood to the heart to be seen on an X-ray. This test helps your doctor identify coronary artery disease that may be the cause of your heart failure.

Classification of heart failure

The results of these tests help your doctor determine the cause of your signs and symptoms and develop a program for treatment. To determine the best course of treatment, doctors can classify heart failure using two scales:

According to the New York Heart Association. Classified heart failure in categories one through four. In grade I, the most moderate form is able to carry out daily activities and not feel short of breath or fatigued. Grade IV is the most severe and is short of breath even at rest.

According to the American College of Cardiology. The classification system uses letters A through D. The system includes a category for people at risk of developing heart disease. For example, a person with multiple risk factors for heart failure is stage A, but someone with end-stage heart failure requiring hospital care is stage D. Doctors use a grading system to define it. risk factors and initiate early, more aggressive treatment to help prevent or delay heart failure.

Ask your doctor about the extent if interested in determining the severity of heart failure. Your doctor can help understand the extent and plan of treatment based on the condition.

Treatments and drugs

Heart failure is a chronic disease that requires lifelong management. However, with treatment, the signs and symptoms of heart failure can improve and the heart sometimes becomes stronger. Doctors can sometimes manage heart failure by treating the underlying cause. For example, repairing heart valves or controlling tachycardia can reverse heart failure. But for most people, heart failure treatment involves a balance of medications and, in some cases, devices that can help the heartbeat properly.

Medicine

Doctors usually treat heart failure with a combination of drugs. Depending on the symptoms, one or more of these drugs may be used. These include:

Angiotensin-converting enzyme (ACE) inhibitors. These drugs help people with heart failure live longer and feel better. An ACE inhibitor is a vasodilator, which dilates blood vessels and lowers blood pressure, improving blood circulation and reducing the workload on the heart. Examples include enalapril (Vasotec), lisinopril (Prinivil, Zestril), and capxopril (Capoten).

Angiotensin II receptor blocker (ARB). These drugs, which include losartan (COZAAR) and valsartan (Diovan), have many of the same benefits as ACE inhibitors. It may be an alternative for people who cannot tolerate ACE inhibitors.

Digoxin (Lanoxin). This drug, also called digitalis, increases the strength of heart muscle contractions. It also tends to slow the heart rate. Digoxin reduces the symptoms of heart failure and improves the ability to live with the condition.

Beta-blockers. This drug slows the heart rate and lowers blood pressure. Examples include carvedilol (Coreg), metoprolol (Lopressor), and bisoprolol (Zebeta). These drugs also reduce the risk of certain irregular heartbeats. Beta-blockers can reduce the signs and symptoms of heart failure and improve heart function.

Diuretic. Diuretics make urinating more often and block fluid build-up in the body. Diuretics commonly prescribed for heart failure include bumetanide (Bumex) and furosemide (Lasix). The drugs also reduce fluid in the lungs, making it easier to breathe. Because diuretics cause the body to lose potassium and magnesium, your doctor may also prescribe mineral supplements. If you're taking diuretics, your doctor will likely monitor your blood potassium, and magnesium levels through regular blood tests.

Aldosterone resistance. These drugs include spironolactone (Aldactone) and eplerenone (Inspra). Primarily potassium-sparing diuretics, but with additional properties that help the heart work better, can reverse scarring of the heart, and may help people with severe heart failure live longer. Unlike some other diuretics, spironolactone can raise blood potassium levels to dangerous levels, so talk to your doctor if increased potassium is a concern.

You will probably need to take two or more medications to treat heart failure. Your doctor may prescribe other heart medications - such as nitrates for chest pain, statins to lower cholesterol, or blood thinners to help prevent blood clots, along with heart failure medications.

You may need to be hospitalized for a few days if symptoms of heart failure develop. While in the hospital, you may be given additional medication to help your heart pump better and relieve symptoms. Supplemental oxygen may also be given through a mask or tube placed in the nose. If severe heart failure is present, long-term use of supplemental oxygen may be necessary.

Surgery and medical equipment

In some cases, doctors recommend surgery to treat the underlying problem leading to heart failure. Some of the treatments being studied and used in certain people include:

Coronary surgery. If a blocked artery is contributing to heart failure, your doctor may recommend coronary artery bypass surgery. In this procedure, a piece of blood vessel from the arm, leg, or chest replaces the blocked vessel in the heart to allow blood to flow more freely.

Repair or replace the valve. If a faulty heart valve is causing heart failure, your doctor may recommend valve repair or replacement. Surgeons can repair the original valve (valvuloplasty) to eliminate backflow. The surgeon can also repair it by reconnecting the valve or by removing excess valve tissue so that the leaflets can close tightly. Sometimes valve repair includes ligation or replacement of the valve rings (annuloplasty). Valve replacement is performed when valve repair is not possible. In valve replacement surgery, damaged valves are replaced with an artificial (prosthetic) valve.

An implantable cardioverter-defibrillator (ICD). An ICD is a device that is implanted under the skin through a vein in the chest to the heart with small wires. Heart rate monitoring. If the heart starts beating at a dangerous rhythm, or if the heart stops, the ICD tries to shock it back to a normal rhythm.

Cardiac resynchronization therapy (CRT) pacemaker. The pacemaker sends the right electrical impulses at the right time to both the left and right ventricles, to pump more efficiently. Up to half of the people with heart failure have problems with the heart's electrical system. Ineffective myocardial contraction can worsen heart failure. Often a biventricular pacemaker is combined with an ICD for people with heart failure.

Left ventricular assist devices (LVADs). Mechanical devices are implanted in the abdomen or chest and attached to the weakened heart to help it pump. Doctors use a heart pump to keep the heart alive while waiting for a donor's heart.

LVADs are now sometimes used as an alternative to transplantation. Heart transplant pumps can prolong and improve the lives of some people with severe heart failure who do not qualify for or may undergo a heart transplant or are waiting for a new heart to be transplanted.

Heart transplant. Some people have severe heart failure for which surgery or medication doesn't work. It may be necessary to replace it with a healthy heart from a donor. A heart transplant can improve the survival and quality of life for some people with severe heart failure. However, candidates for transplantation often have to wait months or years before a matching donor heart is found. Some transplant candidates improve in the meantime through drug or device treatment and can be removed from the transplant waiting list.

End of life care and heart failure

Even with the number of heart failure treatments available, it is possible that heart failure has worsened to the point that a heart transplant is not an option, and admission to the hospital may be required for care. Care provides special treatment for people who are sick.

Caring allows family and friends - with the help of nurses, social workers, and trained volunteers - to comfort a loved one. It also provides social and emotional support for the sick and those closest to them. Although most people in intensive care stay at home, the program is available anywhere – including nursing homes and support centers. For those who stay in the hospital, comfort life care professionals can provide compassion and dignity.

Lifestyle and Remedies

Making regular lifestyle changes can help reduce the signs and symptoms of heart failure and prevent the disease from getting worse. These changes are possibly some of the most important and beneficial can do:

Stop smoking. Damages blood vessels, reducing the amount of oxygen in the blood and making the heart beat faster. If you smoke, ask your doctor to recommend a program to help you quit. Can't be considered for a heart transplant if you continue to smoke.

Weigh yourself daily. Do this every morning after urinating, but before breakfast. Notify your doctor if you gain a weight of 1.4 kg or more in a day. It could mean that fluid is on hold and a change in the treatment plan is needed. Record your weight each morning and bring it to your doctor.

Limit salt. Sodium is a component of salt. Too much sodium contributes to water retention, makes the heart work harder, and causes shortness of breath and swelling in the legs, ankles, and feet. For people with heart failure, the recommended daily sodium intake of the diet is no more than 2,000 mg per day. Remember that most of this salt has been added to processed foods, and be careful when using salt substitutes.

Maintain a healthy weight. If you are overweight, a dietitian will help you work towards your ideal weight.

Limit fat and cholesterol. In addition to avoiding high sodium, limit foods with saturated fat, trans fat, and cholesterol in your diet. A diet high in fat and cholesterol is a risk factor for coronary heart disease, often causing or contributing to heart failure.

Limit alcohol and fluid intake. Your doctor may advise against drinking alcohol if you have heart failure, as it can interact with medications, weaken your heart muscle, and increase your risk of an irregular heartbeat. If you have severe heart failure, your doctor may also recommend limiting the amount of fluids you drink.

Do exercise. Exercise helps keep the rest of the body healthy and conditioned to reduce the demands on the heart muscle. Before you start exercising, talk to your doctor about an appropriate exercise program. Your doctor may recommend a walking program.

Reduce stress. When you are anxious or sad, your heart beats faster and you breathe more. This can make heart failure worse because the heart is already having trouble meeting the body's needs. Find ways to reduce stress in your life. To give your heart a rest, try napping or keeping your legs elevated when possible.

Sleep easily. If you have trouble breathing, especially at night, sleep with your head at a 45-degree angle using a pillow. If you snore or have other sleep problems, definitely get tested for sleep apnea.

To improve sleep at night, avoid large meals right before bed. Also, discuss with your doctor changes to the timing of medications, especially diuretics. Taking a diuretic earlier in the day can keep you from having to urinate frequently at night.

Prevention

The key to preventing heart failure is reducing risk factors. Many of the risk factors for cardiovascular disease - high blood pressure and coronary artery disease, for example - can be controlled or eliminated by making lifestyle changes with the help of any necessary medications.

Lifestyle changes you can make to help prevent heart failure include:

No smoking.

Control certain conditions, such as high blood pressure, high cholesterol, and diabetes.

Maintain physical activity.

Eat healthy food.

Maintain weight.

Reduce and manage stress.

Coping and supporting

Although many cases of heart failure are irreversible, treatment can sometimes improve symptoms and lead to a longer life. Doctors can work together to help make life more comfortable. Pay attention to your body, tell your doctor when you feel better or feel worse. This way, the doctor will know what treatment is best.

Don't be afraid to ask your doctor about living with heart failure. These steps can help you work best with your doctor:

Keep track of medications taken. Make a list and share it with any new doctors.

Avoid certain medications. Do not take steroids, anti-inflammatory drugs (ibuprofen, naproxen …), cold medicines that can cause heart failure and lead to fluid accumulation.

Track your weight and bring your records to your doctor. Weight gain can be a sign of water retention. Your doctor may add a diuretic if your weight increases by more than one pound (0.5 kg) in a day.

Monitor blood pressure. Consider buying a blood pressure monitor.

Write down the questions. Before seeing your doctor, prepare a list of any questions or concerns. For example, is it safe to have sex? Most people with heart failure can resume sexual activity when symptoms are under control.

Request clarification. Make sure you understand what your doctor says.

Managing heart failure requires an open dialogue between the patient and the physician. Be honest with the recommendations regarding the lifestyle of the diet and medication. Your doctor can recommend follow-up strategies.