AHHA

Heart and cardiovascular diseases

Heart Failure

What is Heart Failure?

Heart failure is generally defined as the condition in which heart is unable to supply sufficient blood to meet the needs of the body. In some cases heart cannot fill with enough blood where in other cases, the heart just simply can no longer pump blood with enough force to the body.

The term “heart failure” sound very frightening, here the word failure does not mean that heart has failed or stopped working.

The disease develops gradually over years as the pumping action of heart grows weaker. In most cases of heart failure both sides of the heart is involved but it can affect only the right or only the left side of the heart.

If the heart cannot pump enough blood to the lungs to pick up the oxygen then tight-side heart failure occurs and if the heart cannot pump enough oxygenated blood to the body then left-side heart failure occurs.

The best way to prevent heart failure is to control the risk factors and other conditions which can lead to heart failure. Other conditions may include coronary heart disease, hypertension, diabetes, high level of cholesterol, unhealthy weight and etc. 

Types of Heart Failure

Heart failure is classified based on which heart function or which side of the heart is affected regardless what is the cause of the disease. Hence heart failure is classified in the following categories:

Type of heart failure

Description

Left-sided heart failure
  • Most common form of heart failure.
  • Fluid may back up in your lungs, causing shortness of breath.

Right-sided heart failure
  • Often occurs with left-sided heart failure.
  • Fluid may back up into your abdomen, legs and feet, causing swelling.

Systolic heart failure
  • The left ventricle can’t contract vigorously, indicating a pumping problem.

Diastolic heart failure
  • The left ventricle can't relax or fill fully, indicating a filling problem.

Causes of Heart Failure

When other conditions have damaged or weakened the heart muscles then heart failure often develops. Eventually the heart will not be able to fill with and/or pump blood normally as it should.  When heart becomes weak then certain portions and substances might be released into the bloodstream which are toxic and can worsen the condition. 

Common Causes
The most common cause of heart failure is some underlying disease such as coronary heart disease (CHD), high blood pressure, and diabetes. If the prevention of these diseases is undertaken then heart failure can be prevented or improved. 

Coronary Heart Disease

Coronary heart disease is a condition when a fatty waxy substance called plaque builds up in the coronary arteries which are the main blood vessels to supply oxygen to the heart.

The plaque buildup causes the arteries to get narrow resulting less blood flow to the heart. Sometime an area of plaque can rupture and in the process of healing the arteries, blood will clot over the surface of plaque. If the plaque is big enough it can also block the blood flow completely. When the blood supply is entirely cut off, it can cause a heart attack.  If the blockage isn’t treated quickly the muscle which deprive from blood flow starts to die and eventually replaced by scar tissue. This change can be not obvious or can be fatal.
Coronary heart disease can lead to angina, heart attack, heart damage or even death.

High Blood Pressure
The force of blood pushing against the walls of the arteries as the heart pumps blood is the blood pressure. High blood pressure is the pressure in the arteries that is above the normal range. High blood pressure is a condition which develops over many years and if the elevated pressure stays over time, it can weaken the heart and lead to plaque buildup.
Uncontrolled high blood pressure increases the risk of serious health problemsthat can lead to coronary heart disease, heart attack and stroke.

Diabetes
Diabetes is a disease in which the level of sugar in blood is too high.  In human body when food breaks down to glucose, the cells use insulin (a kind of hormone) to turn glucose into energy. In diabetes the body cannot make enough insulin or cannot use the insulin properly. Eventually the sugar level in blood increases and this high blood sugar levels can damage or weaken the heart muscle and blood vessels around the heart causing heart failure.

Other Causes
There are some other disease and conditions which also can cause heart failure such as:

Cardiomyopathy
Cardiomyopathy is the condition of the heart muscle that interferes with the heart’s ability to pump blood with sufficient force. It can be present at birth or can be caused by any injury or infection.

Heart Valve Disease

Heart valve disease occurs when your heart’s valves do not work the way they should. It can be present at birth or caused by infection, heart attack, or damage from heart disease.A narrowed or leaky heart valve can cause the heart to lose its ability to pump blood as well as it should, eventually leading to heart failure.

Arrhythmia

Arrhythmia is a condition where the heart beats are either too fast, too slow or irregularly.In atrial fibrillation (AF) the atria contracts very fast and irregularly. The major two complications due to atrial fibrillation are heart failure and stroke and the risk increases with age.

Congenital Heart Defects

Congenital heart defects are problems with the heart’s structure that are present at birth. A large Ventricular septal defect (VSD) cause the left side of the heart to work too hard causing extra blood flow to right side of the heart and lungs as the result blood pressure increases in the right side of the heart and the lungs. Increase workload to heart can cause heart failure. 

Other Factors

Beside diseases and condition there are still some other factors which can injure the heart muscle and lead to heart failure. Some of them are as following:

  • Chemotherapy and radiation which are used as the treatment for cancer can lead to an increased risk of heart disease,especially weakening of the heart muscle (cardiomyopathy) and also cause heart attack.
  • Thyroid disorders (having either too much or too little thyroid hormone in the body).
  • Alcohol abuse and use of illegal drugs such as cocaine
  • HIV/AIDS
  • Obstructive sleep apnea: It is a disorder in which people have one or more pauses in breathing or shallow breaths while you sleep

Symptoms of Heart Failure

Symptoms of heart failure vary. In some cases there may be no any symptoms and in some cases there may be very mild symptoms or there may be very severe one. Also the symptoms can be a constant one or can come and go. The symptoms of heart failure are actually related to the changes that occurred to the heart and body.

Common symptoms of heart failure may include:

  • Shortness of breath: Shortness of breath occurs with or without exercise and when lying flat in bed
  • Fluid buildup in the lungs: Fluid buildup in lungs can cause shortness of breath, and cough that’s worse at night and when you’re lying down
  • Dizziness: It occurs due to less blood to brain.
  • Tiredness (fatigue) and weakness:It occurs due to less blood to major organs and muscles.
  • Rapid or irregular heartbeats: It occurs because heart beats fast to pump enough blood to the body.
  • Swelling in ankles, legs and abdomen and weight gain:When blood supply to kidney becomes less the kidney retain fluid and water, resulting edema and due to extra water weight is gained.

Other symptoms of heart failure may include:

  • Nausea
  • Palpitations
  • Chest pain
  • Wakingsuddenly at night unable to breathe
  • Changesin sleep pattern

Who is at the risk of Heart Failure?

The number of people who have heart failure is growing in Azerbaijan. A single factor may be enough to cause heart failure. So if there is a combination of risk factors then the risk of heart failure increases.

Risk Factors

Coronary heart disease: Due to plaque buildup the coronary arteries becomes narrow and limit the oxygenated blood to the heart resulting in weakened heart muscle.

High blood pressure: When the uncontrolled high pressure remains for a long time it can cause plaque buildup and also it make heart to work harder which eventually make heart muscles to become loose.

Diabetes:  Diabetes increases other risk factor such as high blood pressure and CHD.

Congenital heart defects: Congenital heart defects can make the heart work harderwhich weakens the heart muscle, and can lead to heart failure.

Arrhythmia: Arrhythmia has abnormal heartbeat and creates extra work to the heart, which weakens the heart muscle, and can lead to heart failure.

Viral infection: A viral infection can cause damage to the heart muscle causing it hard to pump.

Kidney conditions: in many disease or condition related to kidney there is rise in blood pressure and also kidneys will retain fluid which is the major risk contributor for heart failure.

Heart attack: Heart attack is the condition when the heart muscle gets damaged causing heart difficulty in pumping blood.

Sleep apnea: Sleep apnea is a sleep disorder when there are abnormal pauses in breathing or instances of abnormally low breathing, during sleep which increases the risk of abnormal heart rhythms causing problems that can weaken the heart.

Alcohol abuse: excess amount of alcohol consumption can weaken the heart muscles. 

Diagnosis of Heart Failure

The doctor will diagnose coronary heart disease based on the medical and family histories, the risk factors, a physical examination and the results from medical tests. It is important to find out other underlying diseases as heart failure has similar sign and symptoms with other conditions.

Medical and Family Histories

The doctor may ask series of question regarding the symptoms of heart failure to that and also ask patience is has any underlying disease or conditions that can lead toheartfailureAlso may ask if the patience smoke or use alcohol or drugs and etc.
Further the doctor may ask regarding the background of patience’s family if any of the sibling or parents had a history of heart disease, diabetes, high blood pressure etc.

Physical Examinatiom

The doctor will listento your lungs for signs of congestion and to the heartto find out abnormal heart sounds that may suggest heart failure.  Also check the abdomen, legs, and neck for fluid buildup.

Tests and Procedures

Some of the tests and procedures will be prescribed.

Laboratory Tests

  • Blood Tests
  • B-type Natriuretic Peptide (BNP) blood test

Imaging Tests

  • Chest X-ray
  • Electrocardiogram (ECG or EKG)
  • Echocardiogram (ECHO)
  • Ejection fraction (EF)
  • Doppler Ultrasound
  • Stress Test
  • Cardiac Computerized Tomography (CT)
  • Magnetic Resonance Imaging (MRI)
  • Nuclear Heart Scan
  • Holter Monitor

Invasive Testing

  • Coronary Angiography
  • Cardiac Catheterization

Treatments of Heart Failure

Treatment for heart failure depends upon the type and the severity of the condition. Treatment usually involves lifestyle changes, medicine and certain medical procedures and ongoing care for lifetime. Sooner the treatments, better the result and long life.  However what type of stage of the heart failure is there are same goals to improve the quality of life, such as:

  • Find out the underling condition and treat them
  • Reduce the symptoms of heart failure
  • Prevent the heart failure from getting worse

Lifestyle Changes

There are some lifestyle factors changing them can control thedisease. These factors include:

  • Follow a heart healthy diet
  • Drink the correct amount and type of fluid
  • Avoid alcohol use
  • Quitting smoking or tobacco using 
  • Maintain a healthy weight
  • Be physically active
  • Get enough rest

Medicines

Depending on the type, severity of the condition doctors will prescribe a combination of medicines to control heart failure. The following medicines are commonly used to treat heart failure:

  • Angiotensin-converting enzyme (ACE) inhibitors
  • Angiotensin II receptor blockers
  • Digoxin (Lanoxin)
  • Beta blockers
  • Diuretics (Water or fluid pills)
  • Aldosterone antagonists

These medicines can help in:

  • To widens blood vessels;
  • To lower blood pressure;
  • To reduce the workload of heart;
  • To increases the strength of your heart muscle contractions;
  • To decrease the blood pressure;
  • To slow down the heart rate;
  • To makes the heart beat stronger, pump more blood and improve blood flow;
  • To reduce fluid buildup in the lungs and swelling in the feet and ankles;
  • To reverse scarring of the heart;
  • To help people with severe heart failure live longer;
  • To reduce the risk of a future heart attack.

Medical Devices

  • Implantable cardioverter-defibrillators (ICDs)
  • Cardiac resynchronization therapy (CRT) or biventricular pacing
  • Heart pumps (left ventricular assist devices, or LVADs)

SurgicalProcedures

  • Coronary bypass surgery
  • Heart valve repair or replacement
  • Heart transplant

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