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Heart Failure: Understanding risks, symptoms, diagnosis, and treatment
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.
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.
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.
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:
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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:
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.
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.
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.
While the heart struggles to pump blood, the heartbeat becomes faster and irregular. The rhythm gets more erratic as the heart becomes weaker.
The chances of having heart failure increases with the following:
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:
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.
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:
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.
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:
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.
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.
In extreme cases, the heart may not respond to any treatment and should be replaced by surgery.
In cases where the heart failure is caused by dysfunctional heart values, your doctor may repair or replace them through a surgical procedure
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.
The surgeon performs this surgery to remove a scarred area which forms a bulge called an aneurysm.
This device is surgically placed to help the heart pump blood to the rest of the body.
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:
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