The heart muscle is specialised organ that pumps blood constantly throughout the day. Sometimes however, the heart fails to pump blood as effectively as it should do. This condition is known as ‘heart failure’, which in essence is the failure of the heart to pump blood through the body.
In this article, we shall review what heart failure is and how it is managed.
What is heart failure?
Heart failure is a clinical condition where the heart feels to pump blood and deliver oxygen to the vital organs and tissues.
As we have already discussed previously, the heart consists of the atria and the ventricles. The ventricles are the pumping chambers of the heart and are responsible for ensuring adequate circulation of blood through our body. In times where the ventricle fails to contract effectively, insufficient amount of blood that contains oxygen is pumped. This failure of contraction is heart failure.
What are types of heart failure?
Broadly classified, there are two different kinds of heart failure.
Systolic heart failure is a condition where the heart muscle fails to contract effectively. Due to this it does not pump enough blood throughout the body.
Diastolic heart failure is a condition where the heart muscle fails to relax adequately. Due to this, not enough blood fills the ventricle during the relaxation phase of the heart. This means that there is less amount of blood for the heart to pump to the vital organs.
What causes heart failure?
There are a number of different causes of heart failure. Below is a short list of the commonly encountered causes by doctors.
- Heart attacks – In a heart attack, a part of the heart muscle does not receive sufficient amount of blood supply and can become weak. If a large part of the heart muscle is involved in a heart attack, the entire heart may not pump effectively. This can lead to heart failure.
- High blood pressure – High blood pressure over a period of time can make the heart muscle thicker than normal. This thickened heart muscle is unable to relax effectively and this can lead to diastolic heart failure.
- Heart valve disease – Diseases of the heart valves can sometimes cause heart failure.
- Irregular heart rhythms – The presence of a long-standing irregular heart rhythm can increase the chances of the heart muscle becoming weak.
- Myocarditis – Myocarditis is a condition where the heart muscle is inflamed. It often occurs due to a viral infection of the heart.
- Toxic substances – The use of toxic substances such as certain drugs (used in chemotherapy) or ingestion of high quantities of alcohol can make the heart weak, leading to heart failure.
- Heart muscle disorders – Certain conditions such as amyloidosis and haemochromatosis can make the heart muscle become stiff and thick. This means that the heart is unable to relax effectively leading to the diastolic heart failure.
- Thyroid problems – Patients who have an overactive thyroid gland (called hyperthyroidism) can develop heart failure.
- Family history – Patients who have a family history of heart disease and heart failure may be at a higher risk of developing this condition.
- Medication – certain kinds of medication can increase the risk of an individual developing heart failure. Examples include non-steroidal anti-inflammatory drugs (such as ibuprofen and naproxen), steroid use and anti-diabetic medication such as a rosiglitazone.
What are the symptoms of heart failure?
1. Fatigue
The most common symptom that patients experience early in heart failure is tiredness or fatigue. Patients may find it a lot harder to perform their activities of daily living or may notice that they are unable to perform their regular exercise. They get tired a lot sooner and this can become quite troublesome.
2. Fluid accumulation
Also called ‘edema’, the accumulation of fluid is another common clinical symptom that patients with heart failure experience. Fluid accumulation is usually seen in the legs but can also be seen in the abdomen and lower back. In patients who have severe heart failure, fluid may accumulate throughout the body including the lungs and inside the abdominal cavity.
An accumulation of fluid in the legs can make the legs very heavy. Patients with this condition may find it more and more difficult to move due to the increase in body weight.
3. Difficulty breathing
This is yet another common symptom. Patients with early heart failure may not experience a great deal of breathlessness. However, those who have severe heart failure may find that they are unable to walk the same distances that they used to in the past. For example, an individual may have been able to walk 4 km before on a flat surface before but is now only able to walk 1 km.
Patients with heart failure may also find it difficult to lie down flat in bed. After they go to bed to sleep at night, they may wake up in the middle of the night feeling breathless. Typically patients with heart failure who wake up in the middle of the night walk towards the window or turn on the fan in order to get a breath of fresh air. Patients may also find that they have to use more pillows at night and prefer to sleep in an upright position rather than in a flat position on the bed.
In patients with severe heart failure, difficulty breathing may be experienced even when the patient is at rest. This can include situations such as when reading a newspaper, watching television or just sitting and talking to a family member.
4. Chest pain
Though this is an uncommon symptom, some patients who have heart failure may experience chest pain. This is because the weak heart is unable to pump sufficient amount of blood to the heart muscle.
5. Palpitations
Patients who suffer from heart failure may develop irregular heart rhythms. This may be experienced as ‘palpitations’ or ‘a thumping sensation in the chest’.
6. Neurological symptoms
Neurological symptoms refer to symptoms that affect the brain and nerves. Patients with heart failure may experience difficulty concentrating, altered sleep patterns and confusion (rarely).
How is heart failure diagnosed?
Diagnosis of heart failure is fairly straightforward.
The clinical history and examination of the patient is often sufficient to make a diagnosis. Certain tests may be requested in order to confirm the diagnosis. These tests include –
1. Electrocardiogram – This can show if the heart is beating regularly or irregularly. It can also demonstrate any problems with the way electricity is being conducted around the heart.
2. Echocardiogram – This is the best test to diagnose heart failure. An echocardiogram will show whether the heart is contracting and relaxing well, whether there are any problems with the heart valves and whether the heart muscle is weak or strong. One value that is of particular interest is the ejection fraction, also called EF. A value of over 50 to 60% is considered normal. Anything below that value is considered to be a form of heart failure. You can read more about ejection fraction in this post.
3. Blood tests – These can indicate whether the patient has a low hemoglobin, high cholesterol, blood sugar levels and the functions of other vital organs such as kidneys and liver. Blood tests can help assess the presence of risk factors and associated conditions that can worsen long term outcomes in patients with heart failure.
Some patients may need to undergo other tests such as coronary angiography or MRI scans of the heart. The appropriate test will be decided by the cardiologist depending on the findings.
Treatment of Heart Failure
Treatment strategies for heart failure are many. They are tailored to the individual requirements, and can range from simple lifestyle modifications to complex medical therapies.
As this is a very detailed section, we have discussed them separately elsewhere. Click on the links below to learn about the treatments available.