What To Know About Heart Failure And Its Treatment

Written by Clement Mbah, MD, PhD, MBChB | Published on October 01, 2021



Heart failure describes the clinical syndrome that develops when the heart cannot maintain an adequate cardiac output (pump out enough blood) to meet the body’s requirements. When this happens, blood and fluid build-up in other parts of the body that are drained by the heart. Fluid can be retained in the lungs, causing the commonest symptom of heart failure which is shortness of breath. [1]

Heart failure can affect the right or left side of the body individually or on both sides of the body at the same time. It can also be an acute (short term) or chronic (long term) condition.

Heart failure is a serious medical condition that requires urgent attention and treatment. Early treatment increases the chances of a good outcome with few complications.

Epidemiology of Heart Failure

According to the World Health Organization (WHO), heart diseases are the leading cause of death globally, taking an estimated 17.9 million lives each year.

Heart failure is commoner among elderly people compared to young adults or children. It is said to affect about 1-3 per cent of the general population but it can be as high as 10% in elderly people between ages 80-89years.

In the UK, most patients admitted to the hospital with heart failure are 70years or older and they usually remain hospitalized for a week or more.[2]

Symptoms Of Heart Failure

People who have heart failure will experience some of these symptoms. They include;

  • Shortness of breath ( usually progressive, starts with normal exercises like walking, jogging and subsequently progresses to shortness of breath even at rest)
  • Having trouble breathing when lying down (they usually sleep with a lot of pillows as this helps to prevent the symptom)
  • Paroxysmal nocturnal dyspnea ( the person whose heart has failed may wake up at night feel extremely breathless, they usually quickly sit up and try to catch their breath)
  • Cough ( usually persistent, productive of pink frothy sputum)
  • Fatigue and weakness
  • Abdominal swelling ( usually rapid and progressive)
  • Tender hepatomegaly ( people living with heart failure may have pain in the right side of their abdomen when it is touched because of the build-up of fluids in the liver, it expands and distends the liver capsule causing pain)
  • Anorexia and early satiety (people living with heart failure usually lack gusto to eat or get full early, this is because of the build-up of fluids in the liver and abdomen, shrinking the space for the stomach)
  • Leg and ankle swelling (Due to buildup of fluids in the body)
  • Irregular or rapid heartbeats
  • Chest pain.

These symptoms can vary depending on the type of heart failure.

Causes Of Heart Failure

 Heart failure could result from a wide array of conditions, these conditions usually damage the heart[3]. They include;

  • Coronary artery disease (This is the most common cause of heart failure. This results from the buildup of fatty deposits in the arteries of the heart, this reduces blood flow to the heart, depriving the heart of oxygen and the essential nutrients it needs to work causing injury or death to the heart muscles and this can lead to heart failure)
  • Cardiomyopathies (These are disorders of the heart muscle that causes the heart to become weak)
  • Valvular Heart diseases
  • Congenital heart diseases (Some people are born with a deformity of the heart, this can lead to heart failure later in the future)
  • High blood pressure ( Hypertension increases the workload of the heart, if this is not properly managed, the heart can become weak from overexertion over years and fail)
  • Abnormal heart rhythms
  • Hyper/Hypothyroidism
  • Diabetes mellitus
  • HIV

Risk Factors For Heart Failure

Heart failure can happen to anyone. However, certain actors may increase the risk of developing this condition. There is a higher incidence of heart failure in males than females. Other conditions that increase the risk for heart failure are;

  • Smoking
  • Foods high in fat or cholesterol
  • Sedentary lifestyle
  • Obesity
  • Congenital heart diseases etc.

Types Of Heart Failure

There are many types of heart failure. They include;

  • Left heart failure ( left chamber of the heart fails)
  • Right heart failure (right chamber of the heart fails)
  • Diastolic heart failure ( heart fails as a result of poor ventricular filling & high filling pressure caused by abnormal ventricular relaxation)
  • Systolic heart failure (results from the impaired contraction of heart muscles)
  • Acute heart failure
  • Chronic heart failure (progresses slowly)

Diagnosis

Before treatment is started your doctor will ask questions about your symptoms & examine you, request for investigations to arrive at a definitive diagnosis. They include;

  • Echocardiogram (this is the most effective way to diagnose heart failure. It uses sound waves to create detailed pictures of the heart, this helps the physician to evaluate the damage to the heart)
  • Chest X-ray
  • B-type natriuretic peptide (BNP) blood test (BNP is a substance secreted from the heart in response to changes in blood pressure that happens when heart failure develops or worsens)
  • Electrocardiogram (Records the electrical impulses travelling through the heart
  • Cardiac catheterization (This is an invasive procedure is used to assess the state of the coronary artery)

Management And Treatment

Heart failure is a chronic disease that needs lifelong management. With appropriate management, the condition improves. Sometimes the underlying cause of heart failure can be corrected, but most times this is not the case and the condition has to be managed. Treatment can be medical or surgical and some lifestyle changes. Medications include;

  • Angiotensin-converting enzyme (ACE) Inhibitors (Helps to relax blood vessels and lower blood pressure, reducing the heart’ work)
  • Diuretics (prevents the buildup of fluids by making you urinate more often)
  • Beta-blockers (They slow the heart rate and blood pressure helping to Improve heart’ function)
  • Aldosterone antagonists
  • Digoxin (increases the strength of heart contractions)

Surgery is also an option of treatment, cardiac devices may be implanted to treat the underlying cause of heart failure. Lifestyle changes that could be recommended by your physician to relieve and prevent worsening the condition include;

  • Stop smoking (Smoking damages the blood vessels, this causes raised blood pressure and worsens or increases the risk of heart failure)
  • Limit salt intake (Salt raises blood pressure causing increase work of the heart)
  • Limit Alcohol (Alcohol weakens heart muscles)
  • Maintain healthy weight
  • Good diet (avoid foods high in fat)
  • Exercise( Moderate exercises are advised like walking for 30minutes per day)
  • Good clinic and medication compliance
  • Consistent monitoring of blood pressure.

Complications Of Heart Failure

Untreated heart failure can eventually lead to congestive heart failure (CHF), a condition where both sides of the heart fail and accumulate in other parts of the body, this is a potentially life-threatening condition. Other complications include;

  • Pulmonary oedema ( heart failure can cause fluid to accumulate in the lungs, making it very difficult to breathe)
  • Stroke ( This happens because the heart that has failed can no longer pump enough blood to the brain, this starves the brain for essential oxygen and food, damaging the brain)
  • Thromboembolism (Because the heart is not pumping blood as well as it should. There might be the formation of clots in the veins)
  • Irregular Heartbeats
  • Death

Conclusion

Heart failure is a serious medical condition that requires prompt attention and medical intervention. With the right care, people who have suffered heart failure can hope to continue with their normal life.

 

References:

  1. Davidson principles and practice of medicine 21st edition- Heart failure[1]
  2. WHO - Heart failure[2]
  3. Oxford Handbook of Clinical medicine - Causes and predisposing conditions to heart failure.[3]
  4. Katzung and Trevor Pharmacology textbook - Drugs used in Heart failure.