Heart Failure

HEART FAILURE

Definition
Heart failure, also known as congestive heart failure (CHF), means your heart can't pump enough blood to meet your body's needs. Over time, conditions such as coronary artery disease or high blood pressure gradually leave your heart too weak or stiff to fill and pump efficiently.

You can't reverse many conditions that lead to heart failure, but heart failure can often be treated with good results. Medications can improve the signs and symptoms of heart failure and lead to improved survival. Lifestyle changes, such as exercising, reducing salt intake, managing stress, treating depression, and especially losing excess weight, also can help prevent fluid buildup and improve your quality of life.
The best way to prevent heart failure is to control risk factors and aggressively manage any underlying conditions such as coronary artery disease, high blood pressure, high cholesterol, diabetes or obesity.

Symptoms
Heart failure typically develops slowly and is a chronic, long-term condition, although you may experience a sudden onset of symptoms, known as acute heart failure. The term "congestive heart failure" comes from blood backing up into — or congesting — the liver, abdomen, lower extremities and lungs.

Some of the signs and symptoms for chronic and acute heart failure are

Type of heart failure Signs and symptoms
Chronic heart failure
(A long-term condition with signs and symptoms that persist.) Fatigue and weakness
Rapid or irregular heartbeat
Shortness of breath (dyspnea) when you exert yourself or when you lie down
Reduced ability to exercise
Persistent cough or wheezing with white or pink blood-tinged phlegm
Swelling (edema) in your legs, ankles and feet
Swelling of your abdomen (ascites)
Sudden weight gain from fluid retention
Lack of appetite and nausea
Difficulty concentrating or decreased alertness

Acute heart failure
(An emergency situation that occurs when something suddenly affects your heart's ability to function.) Signs and symptoms similar to those of chronic heart failure but more severe, and start or worsen suddenly
Sudden fluid buildup
Rapid or irregular heartbeat with palpitations that may cause the heart to stop beating
Sudden, severe shortness of breath and coughing up pink, foamy mucus
Chest pain if caused by a heart attack



In addition to characterizing whether your condition is chronic or acute, your doctor will need to know whether your heart fails to pump, or fills with blood, or a combination of both. Heart failure can involve the left side, right side or both sides of your heart. Typically, heart failure begins with the left side — specifically the left ventricle, your heart's main pumping chamber.

Part of your heart affected by heart failure Description
Left-sided heart failure Most common form of heart failure.
Fluid and blood may back up in your lungs, causing shortness of breath.

Right-sided heart failure Often occurs with left-sided heart failure.
Fluid and blood 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
(also called heart failure with normal ejection fraction) The left ventricle can't relax or fill fully, indicating a filling problem.



While systolic heart failure was once thought to be more common and less serious, recent studies have shown this to be incorrect. Isolated diastolic heart failure, now also termed "heart failure with normal ejection fraction," is just as common as systolic heart failure and has a similar prognosis. Identifying the type of heart failure, whether systolic, diastolic, or a combination, is important because the drug treatments for each type may

Causes

Heart failure often develops after other conditions have damaged or weakened your heart. Over time, the heart can no longer keep up with the normal demands placed on it. The ventricles may become stiff and not fill properly between beats. Also, the heart muscle may weaken, and the ventricles stretch (dilate) to the point that the heart can't pump blood efficiently throughout your body.

Any of the following conditions can cause heart failure, which can damage or weaken your heart over time. Some of these can 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, arteries that supply blood to your heart muscle narrow from a buildup of fatty deposits, a process called atherosclerosis. Blood moves slowly through narrowed arteries, leaving some areas of your heart muscle weak and chronically deprived of oxygen-rich blood. In many cases, the blood flow to the muscle is just enough to keep the muscle alive but not functioning well. A heart attack occurs if plaque formed by the fatty deposits in your arteries ruptures. This causes a blood clot to completely block blood flow to an area of the heart muscle, weakening the heart's pumping ability.

High blood pressure (hypertension) . Blood pressure is the force of blood pumped by your heart through your arteries. If your blood pressure is high, your heart has to work harder than it should to circulate blood throughout your body. Over time, the heart muscle may become thicker to compensate for the extra work it must perform, enlarging the heart. Eventually, your heart muscle may become either too stiff or too weak to effectively pump blood.

Faulty heart valves. The four valves of your heart keep blood flowing in the proper direction through the heart. A damaged valve forces your heart to work harder to keep blood flowing as it should. Over time, this extra work can weaken your heart. Faulty heart valves, however, can be fixed if detected in time.

Damage to the heart muscle (cardiomyopathy) . Some of the many causes of heart muscle damage, also called cardiomyopathy, include infections, alcohol abuse, and the toxic effect of drugs such as cocaine or some drugs used for chemotherapy. In addition, whole-body diseases, such as lupus, or thyroid problems also can damage heart muscle. If a specific cause can't be found, it's referred to as idiopathic dilated cardiomyopathy.

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

Heart defects present at birth (congenital heart defects). If your heart and its chambers or valves haven't formed correctly, the healthy parts of your heart have to work harder to compensate. Genetic defects contribute to the risk of certain types of heart disease, which in turn may lead to heart failure.

Abnormal heart rhythms (heart arrhythmias) . Abnormal heart rhythms may cause your heart to beat too fast. This creates extra work for your heart. Over time, your heart may weaken leading to heart failure. A slow heartbeat may prevent your heart from getting enough blood out to the body and may also lead to heart failure.

Other diseases. Chronic diseases such as diabetes, severe anemia, hyperthyroidism, hypothyroidism, emphysema, lupus, hemochromatosis and amyloidosis also may 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 any illness that affects the whole body.

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

Risk factors include:
High blood pressure. Your heart works harder than it has to if your blood pressure is high.

Coronary artery disease. Narrowed arteries may limit your heart's supply of oxygen-rich blood, resulting in weakened heart muscle.

Heart attack. Damage to your heart muscle from a heart attack may mean your heart can no longer pump as well as it should.

Irregular heartbeats. These abnormal rhythms can create extra work for your heart, weakening the heart muscle.

Diabetes. Having diabetes increases your risk of high blood pressure and coronary artery disease.

Some diabetes medications. The diabetes drugs rosiglitazone (Avandia) and pioglitazone (Actos) have been found to increase the risk of heart failure. Don't stop taking these medications on your own, though. If you're taking them, discuss with your doctor whether you need to make any changes.

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

Congenital heart defects. Some people who develop heart failure were born with structural heart defects.

Viruses. A viral infection may have damaged your heart muscle.

Alcohol use. Alcohol can weaken heart muscle and lead to heart failure.

Kidney conditions. These can contribute to heart failure because many can lead to high blood pressure and fluid retention.

When to seek medical advice
See your doctor if you experience any of the signs or symptoms associated with heart failure. These include:
Fatigue and weakness
Rapid or irregular heartbeat
Shortness of breath (dyspnea) when you exert yourself or when you lie down
Reduced ability to exercise
Persistent cough or wheezing with white or pink blood-tinged phlegm
Swelling in your abdomen, legs, ankles and feet
Difficulty concentrating or decreased alertness

You may first find out you have heart failure from an emergency room visit after worsening signs and symptoms. Other heart and lung problems can cause signs and symptoms that are similar to heart failure.

If you have a diagnosis of heart failure, and if any of the signs or symptoms suddenly become worse or you develop a new sign or symptom, it may mean that existing heart failure is getting worse or not responding to treatment. Contact your doctor promptly.


Compiled By
Dr Sandeep KM Delhi