Heart failure

 

Heart failure

 

Heart failure occurs when your heart cannot pump enough blood to support your body functions. Seek help immediately if you’re experiencing symptoms such as heart palpitations, shortness of breath, or swelling.

Heart failure is characterized by the heart’s inability to pump an adequate supply of blood to the body. Without sufficient blood flow, all major body functions are disrupted. Heart failure is a condition or a collection of symptoms that weaken or stiffen your heart.

In some people with heart failure, the heart has difficulty pumping enough blood to support other organs in the body. Other people may have a hardening and stiffening of the heart muscle itself, which blocks or reduces blood flow to the heart.

What causes heart failure?

Heart failure is most often related to another condition. The most common cause of heart failure is coronary artery disease (CAD), a disorder that causes narrowing of the arteries that supply blood and oxygen to the heart. Other conditions that may increase your risk of developing heart failure include:

• cardiomyopathy, a disorder of the heart muscle that causes the heart to become weak
• congenital heart disease
• heart attack
• heart valve disease
• certain types of arrhythmias, or irregular heart rhythms
• high blood pressure
• emphysema, a disease of the lung
• untreated sleep apnea
• diabetes
• an overactive or underactive thyroid
• HIV
• severe forms of anemia
• certain cancer treatments, such as chemotherapy
• substance misuse disorder

 

Signs and symptoms

Signs and symptoms of heart failure include the following:

·         Exertional dyspnea and/or dyspnea at rest

·         Orthopnea

·         Acute pulmonary edema

·         Chest pain/pressure and palpitations

·         Tachycardia

·         Fatigue and weakness

·         Nocturia and oliguria

·         Anorexia, weight loss, nausea

·         Exophthalmos and/or visible pulsation of eyes

·         Distention of neck veins

·         Weak, rapid, and thready pulse

·         Rales, wheezing

·          gallop and/or pulsus alternans

·         Increased intensity of heart sound

·         Hepatojugular reflux

·         Ascites, hepatomegaly, and/or anasarca

·         Central or peripheral cyanosis, pallor

What are the different types of heart failure?

Heart failure can occur in either the left or right side of your heart. It’s also possible for both sides of your heart to fail at the same time.

Heart failure is also classified as either diastolic or systolic.

Left-sided heart failure

Left-sided heart failure is the most common type of heart failure.

The left ventricle is located in the bottom left side of your heart. This area pumps oxygen-rich blood to the rest of your body.

Left-sided heart failure occurs when the left ventricle doesn’t pump efficiently. This prevents your body from getting enough oxygen-rich blood. The blood backs up into your lungs instead, which causes shortness of breath and a buildup of fluid.

Right-sided heart failure

The right heart ventricle is responsible for pumping blood to your lungs to collect oxygen. Right-sided heart failure occurs when the right side of your heart can’t perform its job effectively.

It’s usually triggered by left-sided heart failure. The accumulation of blood in the lungs caused by left-sided heart failure makes the right ventricle work harder. This can stress the right side of the heart and cause it to fail.

Right-sided heart failure can also occur because of other conditions, such as lung disease or valve disease. Right-sided heart failure is marked by swelling of the lower extremities or abdomen. This swelling is caused by fluid backup in the legs, feet, and abdomen.

Diastolic heart failure

Diastolic heart failure occurs when the heart muscle becomes stiffer than normal. The stiffness, which is usually due to heart disease, means that your heart doesn’t fill with blood easily. This is known as diastolic dysfunction. It leads to a lack of blood flow to the rest of the organs in your body.

Diastolic heart failure is more common in people who are female than in those who are male.

Systolic heart failure

Systolic heart failure occurs when the heart muscle loses its ability to contract. The contractions of the heart are necessary to pump oxygen-rich blood out to the body. This problem is known as systolic dysfunction, and it usually develops when your heart is weak and may be enlarged.

Systolic heart failure is more common in males than in females.

Both diastolic and systolic heart failure can occur on the left or right sides of the heart. You may have either condition on both sides of the heart.

 

Diagnosis heart failure 

Heart failure criteria, classification, and staging

The Framingham criteria for the diagnosis of heart failure consists of the concurrent presence of either two major criteria or one major and two minor criteria. 

Major criteria comprise the following:

·         Paroxysmal nocturnal dyspnea

·         Weight loss of 4.5 kg in 5 days in response to treatment

·         Neck vein distention

·         Rales

·         Acute pulmonary edema

·         Hepatojugular reflux

·         S ₃ gallop

·         Central venous pressure greater than 16 cm water

·         Circulation time of 25 seconds or longer

·         Radiographic cardiomegaly

·         Pulmonary edema, visceral congestion, or cardiomegaly at autopsy

Minor criteria (accepted only if they cannot be attributed to another medical condition) are as follows:

·         Nocturnal cough

·         Dyspnea on ordinary exertion

·         A decrease in vital capacity by one third the maximal value recorded

·         Pleural effusion

·         Tachycardia (rate of 120 bpm)

·         Hepatomegaly

·         Bilateral ankle edema

 

 

Testing heart failure 

The following tests may be useful in the initial evaluation for suspected heart failure^:

·         Complete blood cell (CBC) count

·         Iron studies

·         Urinalysis

·         Electrolyte levels

·         Renal and liver function studies

·         Fasting blood glucose levels

·         Lipid profile

·         Thyroid stimulating hormone (TSH) levels

·         B-type natriuretic peptide levels

·         N-terminal pro-B-type natriuretic peptide levels

·         Electrocardiography

·         Chest radiography

·         Two-dimensional (2-D) echocardiography

·         Nuclear imaging 

·         Maximal exercise testing

·         Pulse oximetry or arterial blood gas

·         Noninvasive stress testing.

Treatment heart failure

Damage that affects the heart’s pumping action is not always reversible. Nevertheless, treatments can significantly improve quality of life by keeping heart failure under control and helping to relieve many of the symptoms. Treatment can also prevent the progression of heart failure.

Doctors also focus on treating the cause of heart failure. This will reduce the burden on the heart. The doctor, who may be a cardiologist, will present the treatment options and make recommendations that suit each person’s circumstances.

Common treatments for heart failure include:

Medications

Many medications can treat the symptoms of CHF. They include:

• Beta blockers
• angiotensin concerting enzyme inhibitors (ACE-inhibitors)
• angiotensin receptor blockers (ARBs)
• aldosterone antagonists
• diuretics

Controlling blood pressure and cholesterol are also important considerations for treating heart failure, and a doctor may prescribe separate medications for this.

Surgery

Not everyone with heart failure responds to drug treatments. In some cases, a doctor may recommend surgery to address the underlying causes of heart failure and to help manage symptoms.

Coronary artery bypass graft: Doctors commonly recommend this procedure when coronary artery disease is the cause of CHF.

Percutaneous coronary intervention: Sometimes called PCI, this is a nonsurgical procedure to place a stent in the heart to open up the blood vessels.

Pacemaker: This is a small device that a surgeon places under the skin in the chest to help correct an irregular heartbeat.

Cardiac ablation: This procedure can help correct a heart rhythm problem. A doctor inserts a catheter into the arteries or veins.

Heart valve surgery: This procedure repairs a defective valve that makes the heart pump inefficiently.

Implantable left ventricular assist device: For people with advanced heart failure who have not responded to other treatments, this can help the heart pump blood. Doctors may recommend them for people who are waiting for a transplant.

Heart transplant: If no other treatments or surgeries help, a transplant is an option. Medical teams only consider a transplant for a person who is healthy beyond the problem affecting their heart.