Heart failure is also known as congestive heart failure and is a condition that develops when the heart doesn’t pump enough blood for the body’s needs. It happens when either the heart doesn’t fill up with enough blood or it’s too weak to pump properly.
It’s a lifelong condition that requires timely medical attention and a healthy lifestyle. Heart failure doesn’t mean that the heat has completely stopped pumping blood but it means that its functions have been compromised and therefore it needs support to help it work better.
In a heart failure, blood often backs up and fluids can build up in the lungs causing shortness of breath. Narrowed arteries in the heart and high blood pressure are conditions that leave the heart too weak or stiff to pump blood desirably.
Some severe symptoms experienced may necessitate heart transplant, or an inserted device to help the heart to pump properly.
SYMPTOMS OF HEART FAILURE
When the heart is not pumping as well as it should, you don’t get enough oxygen which affects the way your body works, including breathing. Some of the symptoms of heart failure are:
-Shortness of breath whether engaged in activity or lying down
-Fatigue and general weakness
-Swelling in the legs, ankles, and feet
-Reduced ability to exercise
-Wheezing
-Persistent cough with white or pink mucus that could have traces of blood
-Swelling of the belly area
-Difficulty concentrating or decreased alertness
-Chest pain if the heart failure is caused by heart attack
-Very rapid weight gain due to fluid build up
-Nausea and lack of appetite
CAUSES OF HEART FAILURE
Heart failure can happen suddenly or progressively over months or years. Causes include:
Heart Attack
Heart attack can cause long-term damage to the heart which affects how the heart pumps blood.
Cardiomyopathy
This is a disease of the heart muscle which can be inherited but can also be caused by infections and pregnancy. It also causes heart failure.
High Blood Pressure
High blood pressure puts strain to the heart and if it happens over time it can lead to heart failure.
Abnormal Heart Rhythm (Arrhythmias)
This is a situation whereby your heart beats too fast or too slow, or sometimes irregularly. This can prompt heart failure.
Amyloidosis
This refers to a build-up of abnormal proteins in organs such as the heart and tissues. When it affects the heart, it’s known as cardiac amyloidosis, which is a stiff heart syndrome.
Anemia
Lack of red blood cells carrying oxygen in the blood makes the supply of oxygen to the heart deficient which can prompt heart failure.
Congenital Heart Conditions
These are heart problems one was born with which can also cause heart failure.
Endometriosis
Endometriosis can facilitate a viral muscle that can attack the heart muscle causing heart failure.
Heart Valve Disease
When blood struggles to flow through the heart properly, it puts extra strain on the heart muscle. This is as a result of heart valve disease.
Pulmonary Hypertension
This is a condition of raised blood pressure in the blood vessels supplying lungs. This can damage the right side of the heart causing heart failure.
Cancer Treatment
Cancer treatments such as chemotherapy are believed to be triggers of heart failure.
Thyroid Gland Diseases
Underactive or overactive thyroid gland can cause production of too few or too many hormones respectively, which can cause heart failure.
Too Much Alcohol
Intake of too much alcohol which is beyond the recommended 14 units per week can also trigger heart failure.
HEART FAILURE WITH PRESERVED EJECTION FRACTION (HFpEF)
This is to do with the amount of blood squeezed out of the main chambers of the heart with every heartbeat . It’s usually measured as a percentage and if it’s over 50%, it’s considered to be ideal. The ejection fraction is measured from an echocardiogram. Heart failure can be put on different groups depending on the percentage measured, and other tests. It may be classified as:
*Heart failure with preserved ejection fraction (HFpEF>50%)
*Heart failure with mildly reduced ejection fraction(>40%-49%)
*Heart failure with reduced ejection fraction (<40%)
RISK FACTORS
Heart failure can be caused by a weakened, damaged, or stiff heart. If the heart is damaged or weakened, the heart chamber may stretch and get bigger hence not pumping the needed amount of blood.
If the main pumping chambers of the heart,the ventricles, are stiff, they can’t fill with enough blood between beats. It can be damaged by certain infections, heavy alcohol use, illegal drug use, chemotherapy or genes.
The following conditions can damage or weaken the heart and considered as risk factors:
Coronary Artery Disease
This is the most common cause of heart failure. It is a buildup of fatty deposits reducing blood flow. A heart attack occurs suddenly when an artery feeding the heart becomes completely blocked. Damage to the heart muscle means the heart can’t pump blood as it should.
High Blood Pressure (Hypertension)
This condition forces the heart to work harder than it should. Over time, the extra work can make the heart muscle too stiff or too weak to pump blood properly.
Heart Valve Disease
Valves of the heart keep blood flowing the right way. If a valve isn’t working the right way, the heart must work harder to pump blood. This can weaken the heart over time. Treating some kinds of heart valve problems may reverse heart failure.
Congenital heart disease
This is a heart problem that you were born with. If the heart and its chambers and valves haven’t formed in a correct manner then the other parts of the heart may have to work extra harder to pump blood leading to heart failure.
Irregular Heart Rhythms(Arrhythmias)
This is a situation whereby the heart beats so fast creating extra work or too slow. An irregular heart rhythm may reverse heart failure in some people.
Heart Attack
Damage to the heart muscle from a heart attack may mean the heart can no longer pump blood as well as it should.
Sleep Apnea
Sleep apnea means the inability to breathe well during sleep which results in low blood -oxygen levels and increased risk of irregular heartbeats which weakens the heart.
Other Diseases
Diabetes, HIV infection, an overactive or underactive thyroid, or a buildup of iron or protein are some of the long term diseases that can cause heart failure .
Some other risk factors include;
-Allergic reactions
-Any illness that affects the whole body
-Blood clots in the lungs
-Severe infections
-Use of certain medications
-Viruses that attack the heart
-Aging whereby the heart’s ability to work decreases with age even in healthy people
-Alcohol use being the stipulated 14 units per week may also cause heart failure
-Smoking tobacco also increases the risk of heart diseases, hence heart failure.
Some medicines also increase the risk of heart failure. Diabetes medicines such as avandia and actos have that risk factor in them. Other medicines that may lead to heart failure include non-steroidal anti-inflammatory (NSAIDs) and some medicines used to treat high blood pressure , cancer, blood conditions, irregular heartbeats, nervous system diseases, mental health conditions ,and urinary problems and infection.
Heart failure usually begins with the left heart chamber, the left ventricle, the heart’s main pumping chamber. But heart failure can also affect the right side. The lower right chamber is called the right ventricle. Sometimes heart failure affects both sides of the heart.
COMPLICATIONS
If you have had heart failure, regular health check ups are recommended to check complications. Complications of heart failure depend on age, overall health, and severity of the disease. Some of the complications of heart failure include:
Kidney Damage or Failure
Heart failure can reduce blood flow to the kidneys which if untreated can cause kidney failure which, when caused by heart failure, requires dialysis for treatment.
Other Heart Problems
Heart failure can cause changes in heart size and function which may damage heart valves and cause irregular heartbeats.
Liver Damage
Heart failure can cause fluid buildup that puts too much pressure on the liver. This fluid back up can lead to scarring making it difficult for the liver to work correctly.
Sudden Cardiac Death
If the heart is weak there’s a risk of dying suddenly due to a dangerous irregular heartbeat.
MANAGEMENT
Apart from following the doctor’s advice, lifestyle changes is another way to coast and improve your health and manage and/or prevent heart failure. Some of the lifestyles to be adopted are:
Keeping Active
This has been proved to boost energy and improve sleep, hence quality of life.
Keeping Healthy Weight and Diet
This helps improve the overall health and prevent extra strain on your heart.
Limiting Alcohol Drinking
Limiting Alcohol drinking to less than the 14 recommended units per week lowers the chance of abnormal health, high blood pressure, and diseases such as stroke, liver problems and cancer.
Stopping Smoking
Quitting smoking and use of other tobacco products reduces the risk of developing heart and circulatory diseases.
Fluid Intake
Watching the amount of fluid you take is mandatory if you have been advised by a medical team.
Regular Weighing
This should be done regularly to ensure there’s no weight gain due to too much fluid building up in the body.
Generally, you should adopt eating healthy foods and manage stress in a desirable way and quit smoking habits in order to manage or avoid heart failure.
DIAGNOSIS
After asking you questions on your family history, your care provider will listen to your lungs and heart using a device known as a stethoscope. A whooshing sound known as a murmur may be heard when listening to your heart.
The diagnosis involves the following:
Blood Tests
These tests help diagnose diseases that can affect the heart. They can also look for a specific protein made by the heart. In heart failure, the level of these proteins goes up.
Chest X-ray
The images on a chest X-ray shows the conditions of the lungs and heart.
Electrocardiogram (ECG and EKG)
This is a quick and painless test that records the electrical signals in the heart which shows the speed of heart pumping.
Echocardiogram
Here sound waves create images of the beating heart. It shows the size and structure of the heart and heart valves and blood flow through the heart.
Ejection Fraction
This is the measurement of the percentage of blood leaving the heart each time it squeezes. It’s taken during an echocardiogram and it helps classify heart failure and guide treatment. Ejection fraction of 50% and above is considered ideal but it doesn’t mean the person is immune to heart failure.
Exercise Tests or Stress Tests
This involves walking on a treadmill or riding a stationary bicycle while the heat is monitored. This shows how the heart responds to physical activity.
CT Scan of the Heart
It’s also called a cardia CT scan. It uses X-ray to create cross-sectional images of the heart.
Heart MRI Scan(Cardiac MRI)
This uses magnetic fields and radio waves to create detailed images of the heart.
Coronary Angiogram
This helps spot blockages in the heart artery. A catheter is inserted into a blood vessel in the groin or wrist then guided to the heart. Due flows through the catheter to the arteries which help the arteries to show up more clearly on X-ray images and video.
Myocardial Biopsy
In this diagnosis, very small pieces of the heart muscle are removed for examination. It’s done to diagnose certain types of heart muscle diseases that cause heart failure.
It’s important to know the stage of the disease so as to determine the most appropriate treatment.
MEDICATION AND TREATMENT
Medication for patients of heart failure depends on the cause and symptoms of the disease. Some of the dished-out medications include:
Angiotensin-converting enzyme ACE inhibitors
This relaxes blood vessels to lower blood pressure, improve blood flow, and decrease the strain on the heart.
Angiotensin 2 receptor blockers (ARBs)
This is used mostly as an option for those who can’t tolerate ACE inhibitors.
Angiotensin receptor|neprilysin inhibitors
This uses blood pressure drugs to treat heart failure. It’s used to treat some people with reduced ejection fraction and can prevent the need for hospital stay.
Beta Blockers
It slows heart rate and lowers blood pressure. It reduces symptoms of heart failure and helps the heart to work better. It can also help someone with heart failure to live longer.
Diuretics
This treatment is also called water pills because it makes one urinate frequently which helps prevent fluid buildup in the body. Some of the diuretics also help decrease fluid in the lungs making it easier to breathe.
It should be noted that some diuretics help the body to lose potassium and magnesium and so supplements are recommended.
Potassium Sparing Diuretics
These are also called aldosterone antagonists. They help people with severe heart failure with reduced ejection fraction (HFrRF) live longer.
It should be noted that they can raise the level of potassium in the blood to dangerous levels.
Sodium Glucose Cotransporter-2(SGLT2) Inhibitor
This lowers blood sugar. It is prescribed with a diet and exercise to treat type 2 diabetes. It’s also one of the first treatments of heart failure and studies show that the medicine lowers hospital stay and death for heart failure patients, even those without diabetes.
Digoxin (Lanoxin)
It’s also called digitalis and it helps the heartbeat. It also reduces heart failure symptoms in people with HFrEF, and can help people with a heart rhythm problem, for example, atrial fibrillation.
Hydralazine and Isosorbide dinitrate (BiDil)
This combination helps relax blood vessels. It may be added if you have severe heart failure symptoms and ACE inhibitors and Beta blockers have been unable to help.
Vericiguat (Verquoro)
This treatment is for chronic heart failure cases and is taken by mouth once a day. It’s called ‘ oral soluble guanylate cyclase (sGC) stimulator’. It helps people with high risk heart failure with fewer hospital stays and heart related deaths than dummy pill takers.
Positive Inotropes
This may be given by IV to people with certain types of severe heart failure who are in the hospital. It helps the heart to pump blood better and to maintain blood pressure. Its long term use can increase death risk to some people
Prescriptions to treat specific symptoms can be given. For example, nitrates for chest pain, statins for lower cholesterol, or blood thinners to help prevent blood clot.
Changes in medicine doses may occur if you’re starting a new medicine or your condition gets worse. You may get, upon admission, medicine to help the heart pump better, oxygen through a mask, or small tubes placed in your nose. You can also get medicine to relieve symptoms. There is also use of supplemental oxygen in severe cases.
Surgery or other procedures
Surgery, or placement of a device to treat a problem that led to heart failure are several in number. They include:
Coronary Bypass Surgery
If severe blocked arteries are causing heart failure, this method is employed. It involves taking a healthy blood vessel from the leg, arm, or chest and connecting it to below and above the blocked arteries. These new pathways improve blood flow to the heart muscle.
Heart Valve Repair or Replacement
The type needed to repair or replace the heart valve depends on the cause of the problem. The repair or replacement may be done as open heart or minimally invasive surgery.
Implantable Cardioverter-defibrillator (ICD)
An ICD is used to prevent complications of heart failure. It is not a treatment on its own. It’s similar to a pacemaker. It’s implanted under the skin in the chest with wires leading through the veins into the heart and corrects the beat if the rhythm is dangerous. In the event the heart stops, the ICD shocks it back into regular rhythm.
It can also speed up a slow heartbeat.
Cardiac Resynchronization Therapy (CRT)
Biventricular pacing is treatment for people whose lower Chambers are not pumping in sync with each other. A device sends electrical signals to the lower heart chamber to squeeze in a more coordinated way. This improves the pumping of blood out of the heart. CRT and ICD can be used together.
Ventricular Assist Device (VAD)
This helps to pump blood from the lower Chamber of the heart to the rest of the body. It’s also called a ‘mechanical circulatory support device’. It’s usually placed in the lower left chamber though it can be placed in both chambers. It can be recommended if you are waiting for a heart transplant. It can also be used as a permanent treatment for people who have heart failure but are not in a medical fitness to undergo a heart transplant.
Heart Transplant
This is a risky medical undertaking and has to be determined by a team of health providers. In this case, the heart failure patient is usually in a situation whereby medications and surgeries can’t work and therefore a heart replacement by a healthy donor heart is needed.
SYMPTOMS AND END OF LIFE CARE
Special medical care known as palliative care can be recommended for a patient by a healthcare provider. It’s recommended for those with a serious and life-threatening illness. It can be used to treat symptoms of the disease or handle the side effects of treatment.
In some people with heart failure, medicines no longer work and a heart transplant or devices are no longer options. In such cases, special end-of-life care may be recommended. It’s also known as hospice care. Hospice care allows family members, with the aid of nurses, social workers, and trained volunteers to care for, and comfort a loved one. Hospice care provides emotional support, psychological support, and spiritual support.
Although it’s difficult to discuss end-of-life issues with everyone, it’s important that you discuss with your family and medical team what can be termed as advance care directive. This is a general term for spoken and written instructions you give concerning your medical care, should you be unable to speak for yourself eventually.
One such consideration that can be discussed in the event you have an ICD is whether the device should be turned off so that it can’t deliver shocks to make your heart continue beating.
The fact that there’s no cure for heart failure is upsetting and raises concerns about one’s life. But you need to talk to a specialist to explain to you what to expect during treatment and give you advice. Conversations about life expectancy are difficult but you need to discuss things like care, finance, and wills, which may give you and your loved ones peace of mind.
The uncertainty of having heart failure can be difficult to live with. You need to learn about your status and get actively involved in decision making that may keep anxiety at bay.
Stress affects people differently and failure to manage stress ably may lead to unhealthy habits such as smoking, drinking alcohol, or snacking on unhealthy foods which may be disastrous to an already existing problem of heart failure.
In case you are experiencing stress, it’s important that you identify what is triggering that stress then find a healthy way of coping with that stress and learn to relax in order to manage the heart failure.
