An Overview of Heart Failure

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Heart failure is a condition in which the heart is unable to perform the work necessary to keep up with the body's needs. The most common symptoms include shortness of breath and fatigue. While it can be managed with medication and, in some cases, surgery or other procedures, heart failure is a serious condition that is associated with the risk of death within five to 10 years. Heart failure is the end-stage result of longstanding heart conditions, such as coronary artery disease and heart rhythm abnormalities.

There are two general clinical syndromes associated with heart failure:

Congestive heart failure: This is often what people are referring to when they talk about heart failure. With this type, weak heart function results in a congestion of blood flow in the lungs and throughout the body. The former results in shortness of breath, while the latter results in swelling of the legs and possibly the hands. 

Low output heart failure: Occasionally, people with heart failure may have little or no lung congestion. In these situations, the main problem tends to be that the heart muscle has become so extremely weak that the heart is no longer able to pump enough blood to the body's organs.

People whose heart failure is primarily low output heart failure are more likely to have low blood pressure, lightheadedness, and syncope. Low output heart failure is usually a sign of very advanced heart failure and is associated with a very poor prognosis.

Symptoms

Early heart failure can produce a range of symptoms. If you develop heart failure, even at the early stage, there's a good chance that you would already have had diagnosed or undiagnosed heart disease for many years. Heart failure normally affects adults but may occur in children due to congenital (from birth) heart disease.

The most common symptoms of heart disease include:

  • Dyspnea: Shortness of breath, especially with physical exertion
  • Edema: Swelling, usually in the legs and ankles. Edema may be pitting edema which is characterized by an indentation in the swollen area after pressure is applied, usually lasting for a few minutes.
  • Weakness and fatigue, particularly with exertion
  • Frequent urination
  • Trouble sleeping due to shortness of breath
  • Low blood pressure
  • Lightheadedness

For most people with heart failure, the dyspnea and edema are the most prominent symptoms. Shortness of breath can characteristically occur with certain positions, and you might experience some or all of these:

Symptoms are more severe and persistent in advanced heart failure, also referred to as ESRD (end-stage heart failure). In addition, when heart failure progresses to end-stage heart failure, additional symptoms are expected, including:

  • Shortness of breath at rest
  • Weakness and fatigue, even without exertion
  • A sensation that your heart is racing 
  • Wheezing and coughing
  • Decreased appetite or loss of appetite
  • Syncope
  • Confusion

Causes 

There are several types of heart failure and they are all characterized by inadequate pumping of the heart muscle, which results in fluid accumulation. Generalized fluid accumulation causes the dyspnea and edema of heart failure. This fluid accumulation also causes congestion, which tends to be most prominent in the lungs and the lower extremities, causing shortness of breath and low energy level.

The most common causes of heart failure include: 

Dilated cardiomyopathy: Dilated cardiomyopathy is the end result of a large variety of heart diseases, such as coronary artery disease and valvular heart disease. It occurs when the underlying cardiac disease eventually produces a significant weakening of the heart muscle itself.

Hypertrophic cardiomyopathy: Hypertrophic cardiomyopathy is usually a genetic condition and often runs in families. It is characterized by a thickening of the heart muscle, resulting in stiff ventricles.

Diastolic dysfunction: Diastolic dysfunction is similar to hypertrophic cardiomyopathy in that it is caused by a stiffening of the heart muscle, which leads to impaired filling of the heart. But unlike hypertrophic cardiomyopathy, diastolic heart failure is often not accompanied by thickening of the heart muscle and is not thought to be a genetic disorder. It tends to occur in older individuals, often in women and people with high blood pressure. It is characterized by relatively sudden episodes of severe shortness of breath due to lung congestion.

There are a number of other medical problems that can also lead to or contribute to heart failure, including heart attacks, high blood pressure, heart valve disease, smoking, obesity, diabetes, chemotherapy, and stress. 

Diagnosis

If you have symptoms of heart failure, your doctor will use several methods to determine whether heart failure is the cause of your symptoms. Heart failure diagnosis includes: 

Physical examination: Often your doctor can hear congestion by listening to your lungs and detect signs of heart failure or heart rhythm abnormalities by listening to your heart. 

Chest X-ray: A chest X-ray may show that you have an enlarged heart or signs of lung congestion. 

Echocardiogram: The dilation and weakening of the left ventricle are usually estimated by measuring the left ventricular ejection fraction. The ejection fraction measures the percentage of blood held by the left ventricle that is ejected with each heartbeat. Typically, the ejection fraction is 50 percent or greater. With dilated cardiomyopathy, that value is decreased.

Blood tests: Blood tests are not typically considered standard in the diagnosis of heart failure. B-type natriuretic peptide (BNP), a blood test that can help doctors decide whether heart failure is occurring, may be considered in some cases.

Treatment

Fortunately, a lot of progress is being made in the treatment of heart failure. With aggressive therapy, both symptoms and the risk of dying can be extremely reduced. Medications, as well as some procedures, can improve symptoms and increase survival for people who have heart failure. 

The most common medications used in the treatment of heart failure include:

  • ACE (angiotensin-converting enzyme) inhibitors: ACE inhibitors block the formation of angiotensin II. This medication lowers blood pressure and reduces sodium retention in people who have heart failure.
  • Beta blockers: Beta blockers block the effect of adrenaline on the heart to reduce excess stress on the failing heart. These medications are most commonly used for dilated cardiomyopathy.
  • Diuretics: Often called "water pills," these medications stimulate the body to lose water by acting on the kidneys. This effect decreases fluid retention and edema. 

Procedures may also be used for heart failure, but not everyone who has heart failure is expected to benefit. Furthermore, some people with heart failure may not be in good enough health to be able to tolerate these procedures. 

Depending on your heart function, you might discuss these procedures with your doctor. 

  • Pacemaker: A pacemaker is a device that stimulates the heart to pump. Normally, pacemakers are implanted to stimulate only one side of the heart. In the treatment of heart failure, however, a pacemaker stimulates the right and left side of the heart. This is often referred to as CRT (cardiac resynchronization therapy). 
  • Heart transplant: A heart transplant is the surgical replacement of your heart with a heart that can function well. This is not a simple procedure for a number of reasons. If you have heart failure, your health may make it difficult for you to tolerate the physical intensity of the procedure. And, given that you would need a donor heart from a healthy donor, there are not an abundance of available organs for transplantation. 

Coping

Heart failure causes a limitation in your activities, as well as exhaustion. Coping with heart failure requires an adjustment in mindset, as well as practical considerations. 

Lifestyle adjustments include making sure that you do not take part in activities that could worsen your condition, as well as taking on activities that can optimize your health.

Some important strategies include:

Habits: Smoking and alcohol use are both associated with heart disease and can exacerbate the condition if you already have it, so it is beneficial to stop these activities if you have heart failure.

Diet/salt management: Maintaining a healthy diet is important in managing heart failure. It is important to get adequate calories and nutrients to maintain your energy. You might also need to meet with a dietician to get advice about specific issues such as weight maintenance, salt restriction, and fluid restriction. A low salt diet can help alleviate some of the fluid retentions that occur with heart disease. 

Weight management: The weak heart that characterizes heart disease cannot easily tolerate the demands put on by the strain of extra weight. Maintaining an optimal weight can help alleviate some of the excess work that is difficult for a failing heart to keep up with. 

Exercise: Physical activity can train your heart to become stronger and more efficient. However, if you have heart failure, you should discuss exercise with your doctor and follow medical advice in this area. 

A Word From Verywell

If you or your loved one has heart failure, you should know that you are not alone. This is a very common medical problem, but it is a medical problem that must be taken seriously. 

In addition to the symptoms that cause discomfort, such as shortness of breath and dizziness, it is also difficult to adjust to the decrease in activity level caused by lack of energy and fatigue. With good management, you can experience an improvement of your symptoms.

When your loved one has heart failure, you may need to select modified activities that suit your energy level as well as the energy level and activity tolerance of your loved one.

Symptoms and Complications of Heart Failure
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