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Heart Failure:
Understanding risks, symptoms, diagnosis, and treatment

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1.What is Heart failure?

The heart pumps oxygen and nutrient-rich blood throughout the body and receives it back. Over time, due to a number of diseases / conditions it may either not fill up with enough blood or fail to pump sufficient supply of blood, which can disrupt several functions in the body. This is called heart failure.

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2.Types of Heart failure

Heart failure may happen on the left side, right side, or on both sides. Usually, it starts on the left side and can be a short-term condition (acute) or long-term (chronic) condition. Heart failure can be of any of these types:

Left-sided heart failure: The heart has two auricles and two ventricles (Heart chambers). The left ventricle happens to be larger than the right ventricle and pumps more blood to the body. Left-sided heart failure is further categorized into systolic and diastolic heart failure.

  • Systolic heart failure: In this condition, the heart muscles lose their ability to contract which is necessary to pump blood to the body.
  • Diastolic heart failure: In this case, the heart muscles become stiffer which prevents the blood to fill in properly.

Right-sided heart failure: This usually happens after the failure of the left side. In this condition the right side of the heart cannot perform its function.

Congestive heart failure: This is a more serious condition and will need immediate medical attention. As the heart fails to pump enough blood, it causes the blood to back up in the veins resulting in swelling all over the body. The swelling can be observed in legs and ankles but it can be observed in the lungs as well; therefore, resulting in serious breathing problems.

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3.Causes of Heart failure

The following conditions can influence the functioning of the heart and result in heart failure. Some of the common causes of heart failure, are as follows:

Coronary artery disease:

The heart receives oxygen and nutrients through blood vessels called arteries. Over the fatty sediments also known as plaque hardens and builds up in the blood vessels and blocks the arteries restricting or obstructing the oxygen and nutrient-rich blood to the heart. As the blood flow reduces, the heart pumps harder than necessary to push blood through the narrow blood vessels. This increased burden and the reduced blood flow to the heart can make it weak leading to heart failure.

Heart failure caused by coronary artery disease

Heart attack:

Coronary artery disease is caused by plaque buildup in the arteries. In some extreme cases, a piece of plaque can break away and lodge in narrow arteries in the heart and brain. This can obstruct the blood flow to the heart resulting in a heart attack. The heart muscles do not get sufficient oxygen and nutrition and can die which can weaken the heart and cause heart failure.

Diabetes:

The food you eat will be converted to glucose, which is utilized as energy by the body. A hormone called insulin is responsible to make the sugar available for the muscles. In this condition, the body cannot make sufficient insulin to manage blood sugar levels or the body cannot utilize the insulin well. This results in increased levels of sugar in the blood. Excess sugar in the blood damages and weakens the arteries leading to heart failure. It is not uncommon for diabetes patients to have high blood pressure and atherosclerosis.

High blood pressure:

In patients with high blood pressure, the blood pushes harder against the artery walls. Elevated blood pressure increases your chances of heart failure. It increases the workload on the heart, as a result the heart gets bigger and weaker.

Sleep Apnea:

This is a condition where the breathing gets interrupted during sleep forcing your brain to wake you up. Sleep Apnea can further lead to heart failure.

Obesity:

Body mass index or BMI is a ratio of a person’s height to weight. A BMI of 30 or higher indicates that the person is obese. Obesity increases the pressure on the heart to pump blood to the rest of the body leading to heart failure. Obesity may also cause other conditions like high blood pressure, sleep apnea, which is linked with heart failure.

Disease of the heart muscle:

Heart muscle disease is also called as cardiomyopathy. Heart muscles are responsible for the pumping action of the heart. In this condition, the heart muscles become weaker and it affects the pumping action. Heart muscle disease can happen in people who have a family history of this condition or due to coronary artery disease, a viral infection, or some other disease.

Heart valve problems:

The blood flow that goes in and out of the heart is managed by a set of valves in the heart which act as gateways. Their function is to prevent the blood from flowing back. In heart valve disease, one of the four valves become dysfunctional. It may happen at birth or may be caused by a heart attack or an infection. Dysfunctional heart valves increase the load on the heart as it has to work harder to maintain the blood flow.If it's left untreated, heart valve disease can lead to heart failure.

Arrhythmia – Irregular Heartbeat:

Your heart beats in a specific pattern to maintain a uniform blood flow. Certain diseases can disrupt that rhythm, causing an irregular heartbeat, this condition is called arrhythmia. If left untreated the heart struggles to pump sufficient blood which can ultimately cause heart failure.

Alcohol, Tobacco, and Medicines:

Excessive alcohol consumption can cause various heart conditions including heart failure. Alcohol abuse can also cause various other conditions like increased blood pressure, obesity which is linked with heart failure.

Smoking is a major risk factor for several heart conditions including heart failure. The chemicals in the smoke affect the flow of oxygen in the blood which increases the load on the heart, causing it to pump more blood. Smoking can also narrow the arteries and aggravates blood clots which increases the risk of coronary artery disease and heart failure.

Some drugs can increase your blood pressure and heart rate and can lead to heart attacks which can eventually cause heart failure. Drugs that can cause heart failure or make it worse are provided below.

  • Drugs to fight depression
  • Drugs to treat fungal infections
  • Medicines to improve appetite
  • Drugs to treat Asthma
  • Medicines to manage elevated blood pressure
  • Drugs to improve heartbeat or heart rhythm
  • Painkillers like non-steroidal anti-inflammatory drugs
  • Drugs to treat migraine
  • Drugs to treat Parkinson’s disease
  • Drugs to treat cancer – Chemotherapy
  • Drugs to manage diabetes

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4.Symptoms of heart failure

Heart failure may not cause symptoms or may manifest with some mild to severe symptoms. Symptoms may be related to the changes happening in the heart and body or may reflect the extent of the heart’s weakness. Heart failure symptoms are as follows:

Congestion in lungs:

The increased load makes the heart weaker and may cause the body fluids to accumulate in the lungs. This can manifest as breathing problems, dry cough or wheezing.

Fluid or water retention:

As the heart gets weaker it struggles to pump sufficient blood to kidneys causing water retention in some parts of the body. It causes swollen legs, ankles, and abdomen along with unnecessary weight gain. Patients may also suffer from frequent urination, especially during the night time. Excessive bloating in the stomach can reduce appetite or cause nausea.

Nausea and Dizziness:

Major organs do not get sufficient blood due to a weak heart, as a result, you may feel weakness and tiredness. Limited blood supply to the brain can cause dizziness.

Irregular heartbeat:

While the heart struggles to pump blood, the heartbeat becomes faster and irregular. The rhythm gets more erratic as the heart becomes weaker.

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5.Risk factors for Heart failure

The chances of having heart failure increases with the following:

  • Elevated blood pressure levels
  • Diabetes
  • Having a heart attack earlier
  • Being overweight
  • Excessive alcohol consumption
  • Smoking
  • Usage of some medication that can increase the load
  • Being born with a heart defect
  • Age (65+ years old)

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6.Diagnosis of Heart failure

Diagnosis of heart failure

Your doctor will start with a physical evaluation along with understanding your medical history. After this initial evaluation your doctor may ask for additional tests, as follows:

  • Blood tests: Heart failure increases strain on certain vital organs which can be confirmed with the increased levels of certain compounds in your blood. Blood tests can help in identifying these differences which point towards a heart failure or some conditions that cause heart failure. Your doctor may suggest a BNP test that measures the levels of B-type natriuretic peptide and N-terminal-pro-BNP. Heart failure causes an increase in the levels of both proteins.
  • Electrocardiogram (EKG): Your doctor may conduct this test to understand electrical activity in the heart which can point towards a heart condition. The readings are taken on a strip called ECG/EKG strip and is a simple test to quickly understand the possibility of a heart condition.
  • Chest X ray: Your doctor may want to look at your heart and see if is enlarged or if there is any congestion. An enlarged heart is an indicator of heart failure. Chest X-ray will provide some indication of the condition which has to be evaluated with other tests.
  • Echocardiogram: This is more sophisticated than the regular tests and it uses sound waves to make the video image of the heart with an ultrasound. The image reflects the subtle changes in the heart along with the pumping action that can point towards heart failure. Your doctor may also conduct some additional tests like Doppler ultrasound and color Doppler in combination with the echocardiogram to make a more accurate assessment of the blood flow.
  • Exercise test: Your doctor may want to know how the heart is performing during extreme situations like exercise or stress. Your doctor will be monitoring your heart while you are doing a physical activity, like walking on a treadmill.
  • Heart catheterization: Your doctor will inject a dye into your bloodstream with a tube called a catheter to analyze the blood flow. This test can accurately show the blocked arteries.
  • Radionuclide ventriculography: This is a sophisticated approach where radioactive materials are sent on the bloodstream and pictures of the heart are taken with a device called a gamma camera.

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7.Stages and prognosis

There are four stages of heart failure that range from the high risk of developing heart failure to advanced heart failure. The first stage is also called a pre-heart failure because of your family history, or some other factors, are indicating the possibility of heart failure in the future. In stage B, your doctor may have diagnosed systolic left ventricular dysfunction. In stage C, the diagnosis of heart failure is confirmed. Stage D is the final stage of heart failure, which is the final stage with advanced symptoms.

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8.Treatment of Heart failure

There is no treatment for heart failure. Your doctor may suggest some treatment options to ease symptoms and make your heart pump better. Lifestyle changes are central to the treatment and can include the following:

  • Exercise regularly
  • Maintain a healthy weight to minimize any load on the heart
  • Quit smoking
  • Follow a heart-healthy diet
  • Maintain fluid balance
  • Limit salt intake
  • Take your medicines regularly

Your doctor may suggest medication like ACE inhibitors, diuretics, beta-blockers and digoxin along with lifestyle changes to manage the condition. In some cases, lifestyle changes and medication may not be sufficient and patients may need surgery.

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9.Surgery for Heart Failure

In extreme cases, surgery may be performed to improve the heart’s functions. Your doctor may recommend any one of the following surgeries based on the severity of the condition, and the treatment strategy:

Bypass surgery

The artery blockage caused due to plaque can affect the blood flow to the heart. Your doctor may recommend bypass surgery where the blood flow is rerouted through another blood vessel around the blocked artery.

Cardiac resynchronization therapy

Irregular heartbeat can worsen heart disease. Your doctor will recommend a device called a pacemaker that can help in maintaining the heartbeat and rhythmic pumping of the heart.

Heart transplantation

In extreme cases, the heart may not respond to any treatment and should be replaced by surgery.

Surgery of the heart valves

In cases where the heart failure is caused by dysfunctional heart values, your doctor may repair or replace them through a surgical procedure

Implantable cardioverter-defibrillator

This is also called as ICD and is placed under the skin of your chest. The device is connected to your veins and heart which monitors the heart rhythm regularly. It paces your heart during times of arrhythmia and brings the heart back to normal rhythm. This device can also act as a pacemaker.

Surgery to exclude the Infarct

The surgeon performs this surgery to remove a scarred area which forms a bulge called an aneurysm.

Ventricular assist device

This device is surgically placed to help the heart pump blood to the rest of the body.

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10.How to adapt your lifestyle

Lifestyle management is central to the management of heart conditions. They are combined with other treatments including surgery for better results. You have to adapt your lifestyle to minimize the load on your heart and avoid worsening of the condition. Here are some recommendations to adapt your lifestyle:

  • Smoking can influence the oxygen levels in your blood. Quitting smoking can be very helpful.
  • Keep your health in check.
  • Be active and exercise regularly.
  • Keep BP, blood sugar levels and cholesterol levels in check
  • Avoid alcohol
  • Eat a healthy diet

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11.Heart Failure FAQs: All your concerns addressed.

Q.  Does heart failure mean that it does not function anymore?

  1. Heart failure does not suggest a complete failure of the heart. The condition means that the heart has become weak and struggles to pump enough blood to the rest of the body. It can be managed with various treatment methods.

Q.  What are the differences between congestive heart failure and heart failure?

  1. Congestive heart failure is a specific type of heart failure where fluid retention happens in the lungs causing breathing problems. The condition affects the blood flow to the kidneys, making them less effective to pump the fluids out of the body.

Q.  Does heart failure need immediate medical attention?

  1. Yes, it is a serious and chronic condition that needs your immediate attention. The condition may get worse if timely treatment is not provided. Your doctor can discuss several options to manage the condition.

Q.  Is there any treatment for heart failure?

  1. Careful management of heart failure can ease the symptoms and patients can live a healthy and normal life for a longer period. Your doctor may recommend lifestyle changes along with medicines or surgery based on the seriousness of the condition. You have to seek medical treatment immediately to avoid worsening the condition.

Q.  What is a BNP test?

  1. BNP test is a blood test conducted to measure the levels of two proteins called B-type natriuretic peptide and N-terminal-pro-BNP. The levels of both these proteins get elevated in patients with heart failure. This test will guide your doctor to make a diagnosis of heart failure. It may also show how the condition has deteriorated since your last visit and will allow him to formulate an effective treatment strategy. You will be required to provide a small amount of blood which is placed in a machine that measures the protein levels. Your doctor will discuss the results with you along with the treatment recommendations.

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