Heart Failure

Narrowed arteries in your heart, poorly controlled high blood pressure cause gradual weakening and stiffening of the heart muscle, therefore it cannot pump blood efficiently. When your heart muscle does not pump blood as well as it is required occurs heart failure. Properly tuned heart failure treatment can significantly improve heart failure symptoms and signs and help you live longer. We will discuss in detail heart failure symptoms, ways to diagnose this condition, as well as treatment options and prevention of heart failure, below.

To start with, let us clarify some ideas. Heart failure is also sometimes known as congestive heart failure. Heart failure doesn’t mean that your heart is no longer working. It means that the heart isn’t pumping as well as it should be.

Certain conditions like coronary artery disease (narrowed arteries in your heart) or uncontrolled hypertension (high blood pressure) can gradually leave your heart too weak or stiff to fill and pump properly.
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This condition develops over time as the heart’s pumping action grows weaker. It may affect only the right side of the heart or it can also affect both sides of the heart. In most cases, it involves both sides of the heart.

  • Right-side heart failure: Occurs if the heart can’t pump enough blood to the lungs to pick up oxygen. It may cause fluid to build up in the feet, ankles, legs, liver, abdomen, and the veins in the neck.
  • Left-side heart failure: Occurs if the heart can’t pump enough oxygen-rich blood to the rest of the body.

Both right-side and left-side heart failure may cause shortness of breath and fatigue (tiredness). Initially, the heart tries to make up for this by:

  • Enlarging: Your enlarged heart chambers it stretches more and can contract more strongly causing the heart to pump more blood. Your body will start to retain fluid, your lungs will become congested with fluid and your heart begins to beat abnormally.
  • Developing more muscle mass: There is an increase in muscle mass as the contracting cells of the heart get bigger. This allows the heart to pump more strongly (at least initially).
  • Pumping faster: This will help to increase the heart’s output.

When this happens, the body also tries to compensate in other ways:

  • Blood vessels narrow to keep the blood pressure up as it tries to make up for the heart’s loss of power.
  • The body will divert blood away from less important tissues and organs such as the kidneys to the heart and brain.

These substitute processes will temporarily mask the problem of heart failure. However, they don’t solve it. The condition will continue to worsen until the substitute processes no longer work.

Can conditions that lead to heart failure be reversed?

Not all conditions that lead to heart failure can be reversed. However, treatments can improve the signs and symptoms of heart failure and help you live a longer healthier life.

How can I prevent heart failure?

Lifestyle changes can improve your quality of life. Good habits such as exercising, reducing salt in your diet and managing stress are all measure you can take to reduce the risk of developing heart failure.

Another way to prevent heart failure is to control conditions that lead to heart failure. These conditions include coronary artery disease, high blood pressure, diabetes and obesity.

HEART FAILURE SYMPTOMS

There are two types of heart failure. They may be ongoing (chronic) or they may start suddenly (acute). The signs and symptoms of heart failure may include:

  • Shortness of breath (when you exert yourself or when you lie down)
  • Fatigue and weakness
  • Swelling (legs, ankles and feet)
  • Rapid or irregular heartbeat
  • Reduced ability to exercise
  • Persistent cough or wheezing (with white or pink blood-tinged phlegm)
  • Increased need to urinate (at night)
  • Swelling of your abdomen
  • Sudden weight gain from fluid retention
  • Lack of appetite
  • Nausea
  • Difficulty concentrating or decreased alertness
  • Sudden and severe shortness of breath and coughing up pink, foamy mucus
  • Chest pain (if your heart failure is caused by a heart attack)

HEART FAILURE TREATMENT OPTIONS

Heart failure is a chronic disease that needs lifelong management. However, treatment helps to improve signs and symptoms of heart failure. The heart may even sometimes become stronger. Receiving treatment may help you live longer and reduce your chance of passing away suddenly.

Sometimes, heart failures can be corrected by treating the underlying cause. For instance, fixing a heart valve or controlling a fast heart rhythm may reverse heart failure. However, the treatment of heart failure involves a balance of the right medications for most people. In some cases, certain devices ae used to help the heart beat and contract properly.

Medications

Heart failure is usually treated with a combination of medications. You might take one or more medications depending on your symptoms, including:

  • Angiotensin-converting enzyme (ACE) inhibitors: They help people with systolic heart failure to live longer and feel better. These drugs are a type of vasodilator. They widen blood vessels to decrease blood pressure, improve blood flow and decrease the workload on the heart. Examples of medications include enalapril (Vasotec), lisinopril (Zestril) and captopril (Capoten).
  • Angiotensin II receptor blockers: These drugs have many of the same benefits as ACE inhibitors and may be an alternative for people who can’t tolerate ACE inhibitors. These medications include losartan (Cozaar) and valsartan (Diovan).
  • Beta blockers: They do not only slow your heart rate and reduce your blood pressure but they also limit or reverse some of the damage to your heart if you are suffering from systolic heart failure. Medications include carvedilol (Coreg), metoprolol (Lopressor) and bisoprolol (Zebeta). They help to reduce the risk of abnormal heart rhythms, reduce signs and symptoms of heart failure, improve heart function and they lessen your chance of dying unexpectedly.
  • Diuretics (water pills): They make you urinate more often and keep fluid from collecting in your body. Medications such as furosemide (Lasix) also reduce fluid in your lungs so that you can breathe more easily. As diuretics make your body lose potassium and magnesium, you may be prescribed supplements of these minerals. If you’re taking this medication, the levels of potassium and magnesium in your blood will be monitored through regular blood tests.
  • Aldosterone antagonists: These are potassium-sparing diuretics that also have additional properties that may aid people with severe systolic heart failure to live longer. These medications include spironolactone (Aldactone) and eplerenone (Inspra). Spironolactone and eplerenone can increase the level of potassium in your blood to dangerous levels. Speak to your doctor if increased potassium is a concern and find out if you need to alter your intake of food that’s high in potassium.
  • Inotropes: Intravenous medications used to treat people with severe heart failure in hospitals to improve heart pumping function and maintain blood pressure.
  • Digoxin (Lanoxin): Also referred to as digitalis. It increases the strength of your heart muscle contractions and it also tends to slow the heartbeat. This drug reduces heart failure symptoms in systolic heart failure. Digitalis is more likely to be administered to someone with a heart rhythm problem, such as atrial fibrillation.

    You may be required to take two or more medications to treat heart failure. In such cases, you may be prescribed other heart medications such as nitrates (for chest pain), statin (to lower cholesterol) or blood-thinning medications (to help prevent blood clots) as well as heart failure medications. If you experience any flare-ups of heart failure, you may be required to be hospitalized. You may receive additional medications in the hospital to help your heart pump better and relieve your symptoms. Supplemental oxygen may also be administered through a mask or small tubes placed in your nose. If you experience severe heart failure, you may need to use long term supplemental oxygen.

Surgery and medical devices

Sometimes, surgery may be recommended to treat the underlying problem that caused heart failure. Treatments that are being studied and used in certain people include:

  • Coronary bypass surgery: Your doctor may recommend coronary artery bypass surgery if your severely blocked arteries are contributing to your heart failure. Blood vessels from your leg, arm or chest bypass a blocked artery in your heart to let blood flow through your heart more freely in this procedure.
  • Heart valve repair or replacement: Your doctor may recommend repairing or replacing the valve if a faulty heart valve is the cause of your heart failure. The surgeon may modify the original valve (valvuloplasty) to stop backward blood flow. The valve may also be repaired by reconnecting valve leaflets or by removing excess valve tissue so that the leaflets can close tightly. In certain cases, repairing the valve may include tightening or replacing the ring around the valve (annuloplasty). When valve repair isn’t possible, valve replacement is done.

    During the valve replacement surgery, the damaged valve is replaced by an artificial (prosthetic) valve. There are certain types of heart valve repair or replacement that can now be completed without open heart surgery. They use either minimally invasive surgery or cardiac catheterization techniques.

  • Implantable cardioverter-defibrillators (ICDs): This device is implanted under the skin in your chest with wires leading through your veins and into your heart. It monitors the heart rhythm and if the heart starts beating at a dangerous rhythm or if your heart stops, the device tries to pace your heart or shock it back into a normal rhythm. It can also function as a pacemaker and speed up your heart when necessary.

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  • Cardiac resynchronization therapy (CRT), or biventricular pacing: This device sends timed electrical impulses to both of the heart’s lower chambers (the left and right ventricles) to make them pump in a more efficient and coordinated manner.

    Often a biventricular pacemaker combined with an ICD for people with heart failure as many they may have issues with their heart’s electrical system that cause their already weak heart muscle to beat in an uncoordinated fashion (this inefficient muscle contraction may cause heart failure to worsen).

  • Heart pumps: Mechanical devices such as ventricular assist devices (VADs) are implanted into the abdomen or chest and attached to a weakened heart to help it pump blood to the rest of your body. VADs are most often used in the heart’s left ventricle, but they can also be used in the right ventricle or in both ventricles.

    Heart pumps were first used to help keep heart transplant candidates alive while they waited for a donor heart. Today, VADs may sometimes be used as an alternative to transplantation. The lives of some people with severe heart failure who aren’t eligible for or able to undergo heart transplantation or are waiting for a new heart may be improved by heart pumps that can significantly extend and improve

  • Heart transplant: People with severe heart failure that even surgery or medications don’t help may need to have their diseased heart replaced with a healthy donor heart. The survival and quality of life of some people with severe heart failure can be dramatically improved with heart transplant.

    With that said, candidates for transplantation often have to wait for a long time before a suitable donor heart is found. In some cases, the transplant candidates’ condition may improve during this waiting period through drug treatment or device therapy. In such cases, they can be removed from the transplant waiting list.

DIAGNOSING HEART FAILURE

  • History taking and physical exam: Your doctor will ask you questions about your usual life style, symptoms you are having and family history of heart diseases. Then he will perform a physical examination, which includes checking you pulse, blood pressure, auscultation and percussion of your heart. As well as the above mentioned, doctor will discuss your risk factors with you.
  • Blood tests: A sample of your blood may be taken to check your kidney, liver and thyroid function and also to look for indicators of other diseases that may affect your heart. A blood test may also be used to identify a chemical called N-terminal pro-B-type natriuretic peptide (NT-proBNP). It helps in diagnosing heart failure if the diagnosis isn’t certain when used in addition to other tests.
  • Chest X-ray: Your doctor can see the condition of your lungs and heart with X-ray images. Your heart may appear enlarged and fluid build-up may be visible in your lungs if you have heart failure. X-ray may also be used to diagnose conditions other than heart failure (that may explain your signs and symptoms).
  • Electrocardiogram (ECG): Electrical activity of your heart through electrodes attached to your skin is recorded. The impulses are recorded as waves and shown on a monitor or printed on paper. Heart rhythm problems and damage to your heart from a heart attack may also be detected and they may help with the diagnosis.
  • Echocardiogram: An echocardiogram helps distinguish systolic heart failure from diastolic heart failure where the heart is stiff and can’t fill properly. It uses sound waves to produce a video image of your heart and can help doctors see the size and shape of your heart and how well your heart is working. It can also assist your doctor in looking for valve problems or evidence of previous heart attacks, other heart abnormalities, and some unusual causes of heart failure.

    During an echocardiogram, your ejection fraction is measured. It can also be measured by nuclear medicine tests, cardiac catheterization and cardiac MRI. It is a crucial measurement of how well your heart is pumping as it is used to help classify heart failure and guide treatment.

  • Stress test: This measures how well your heart and blood vessels respond to exertion. You may be required to perform certain exercises such as walking on a treadmill or pedalling a stationary bike while attached to an ECG machine. Alternatively, you may receive a drug intravenously that stimulates your heart similar to exercise. In some cases, the test can be done while wearing a mask that can measure the ability of your heart and lungs to take in oxygen and breathe out carbon dioxide.

    It can also diagnose coronary artery disease. How well your body is responding to your heart’s decreased pumping effectiveness can be determined. It can also help guide long-term treatment decisions.Your doctor may order a nuclear stress test or a stress echocardiogram if they want to see images of your heart while you’re exercising. It’s similar to an exercise stress test, but it also uses imaging techniques to visualize your heart during the test.

  • Cardiac computerized tomography (CT) scan or magnetic resonance imaging (MRI): May be used to diagnose heart problems including causes of heart failure. During the procedure, you will be required to lie on a table inside a doughnut-shaped machine. Images of your heart and chest will be collected as an X-ray tube inside the machine rotates around your body.During a cardiac MRI, you will be required to lie on a table inside a long tube-like machine that produces a magnetic field.

    The magnetic field will align atomic particles in some of your cells and radio waves will be sent toward these aligned particles which will produce signals that vary according to the type of tissue they are. These signals create images of your heart.

  • Coronary angiogram: A thin, flexible tube (catheter) is inserted into a blood vessel at your groin or in your arm and guided through the aorta into your coronary arteries. A dye is then injected through the catheter to make the arteries visible on X-ray.

    This may help to identify coronary artery disease (may be a cause of heart failure). The test may include a ventriculogram, a procedure that determines the strength of the heart’s main pumping chamber (left ventricle) and the health of the heart valves.

  • Myocardial biopsy: A small, flexible biopsy cord is inserted into a vein in your neck or groin where small pieces of the heart muscle are taken. This test is performed to diagnose certain types of heart muscle diseases that lead to heart failure.
  • Doppler Ultrasound: This uses sound waves to measure the speed and direction of blood flow. It is normally done with an echo to give a more complete picture of blood flow to the heart and lungs. Doppler ultrasound is used to help diagnose right-side heart failure.