Heart Failure

Heart failure is a condition where the heart fails to pump blood in order to maintain the metabolic needs of the body. In most cases heart failure is a chronic, long-standing, and ongoing condition but it can develop suddenly.

Causes

Heart failure results when the over worked heart muscle does not work as efficiently as it used to. Any factor that increases the heart workload may initiate heart failure. It is most commonly seen in old age and common causes are:

• Coronary Artery Disease – causes narrowed arteries that decrease the blood supply to the heart muscle
• Previous heart attack – interferes with the heart muscle's normal functioning
• High blood pressure – causes the heart to work harder than usual
Other causes of heart failure include
• Valvular heart disease e.g., Aortic Stenosis
• Congenital heart defects
• Cardiomyopathy – disease of the heart musle
• Lung disease
• Arrythmias – irregular heartbeat
• Alcoholism

How will you feel?

The "failing" heart keeps working but not as efficiently as it should. People with heart failure can't exert themselves because they become short of breath and tired.

Symptoms include

• Fatigue
• Breathlessness and difficulty in breathing
• Weight gain due to fluid retention
• Inability to lie flat in bed due to fluid retention in lungs
• Swelling in legs (edema)

It is useful to consult a doctor if you feel fatigue or sudden weight gain.

Aggravating factors

Any factor that increases the heart workload may aggravate existing heart failure or initiate heart failure.

Some aggravating factors are

• Arrhythmias (irregular heart beat)
• Anemia (decreased hemoglobin in blood)
• Hormonal factors e.g., increased thyroid hormone
• Pregnancy

Compensatory mechanisms

The heart is a vital organ that helps pump blood to every organ in the body. When the heart fails considerable changes occur in the heart as well as other organs as fluid starts accumulating.

Some major changes are

• Heart
  The heart tries to compensate by increasing the blood flow from the heart and the heart size may increase
  
  
• Lungs
  Swelling and fluid accumulation in the lungs (Pulmonary edema) and hence difficulty in breathing
  
  
• Kidney
  Kidneys begin to lose their normal ability to excrete salt (sodium) and water. As a result, the kidneys may begin to fail
  
  
• Liver
  Fluid accumulation in the liver impairs its ability to excrete toxins from the body and produce essential proteins.
Over time, untreated heart failure will affect virtually every organ in the body.

Diagnoses

Your doctor diagnoses Heart failure by medical history alone but may ask you to undergo a series of diagnostic tests.

• Medical History
  which includes
  • Physical examination
  • Questions about your symptoms, risk factors, personal history and family history of any heart disease
    
    
• Chest X-ray
  A chest x-ray can show if your heart is enlarged and if you have fluid in and around your lungs
  
  
• (EKG or ECG) Electrocardiogram
  This is a painless test where electrodes are put on the chest, arms, and legs to record the heart's electrical activity. The test takes just a few minutes and the record of the heart appears as a long strip of paper, or a graph with a series of wavy lines. The EKG gives a physician important information about your heart's rate and rhythm, and can provide evidence to suggest the presence of a past or current heart attack
  
  
• Echocardiogram
  Echocardiogram is a test that uses sound waves to create a moving picture of the heart. The picture is much more detailed than x-ray images and involves no radiation exposure. These ultrasound images help identify abnormalities in the heart muscle and valves, and find any fluid that may surround the heart. You can see your ventricles squeeze and relax, and watch the valves open and close in rhythm with your heartbeat
  
  
• Nuclear heart scans
  This test shows blood flow to the heart and any damage to the heart muscle. A radioactive dye is injected into your bloodstream. A special camera can see the dye and find areas where blood flow is reduced
  
  
• Angiography (Cardiac Catheterization)
  Cardiac Catheterization is a specialized test that is performed by a cardiologist in a cardiac catheterization lab. The procedure is done by making a small incision in the groin or arm area, and threading a very small catheter up through the artery to the heart. A radioactive dye is injected and then blockages to coronary arteries can clearly be seen. The test takes about 2-3 hours, and is done with local anesthetics and sedation. This test reveals clear pictures of blockages or narrowing of the coronary arteries, and can tell how efficient your heart is working as well

Management

Heart failure management should start soon after diagnosis and includes the following

• General Management
• Medications
• Surgery

General Management

• Reduction of physical activity– to reduce demand on the heart
• Dietary modifications– low salt diet
• Losing weight if overweight
• Quitting smoking
• Alcohol restriction

Heart failure medications

Heart failure drugs include.

• Diuretics – promote salt and water excretion by the kidneys thereby reducing the heart workload and symptoms of fluid retention. They help relieve shortness of breath and leg swelling
• Beta blockers – work by slowing down the heart rate and decreasing the force of the heart muscle. This reduces the heart's need for oxygen and improves the supply of blood to the heart muscle
• ACE inhibitors – these medications open up blood vessels and decrease the work load of the heart
• Digoxin (Digitalis Glycosides) – increases the ability of the heart muscle to contract properly and prevent heart arrythmias

Surgery

Cardiac Transplantation

Cardiac transplantation is the process of removing a person's failing heart and replacing it with a suitable donor heart. The donor heart is usually from a person who has been declared clinically brain dead.

It is recommended in younger patients with severe heart failure and life expectancy less than 6 months.

Prevention

Healthy life choices will improve your overall health and your heart health and can help you slow the progression of your heart disease. Some heart healthy choices include:

• Understand all about heart failure, symptoms, related conditions, etc.
  
  
• Eat Healthy – Stick to a heart-healthy low cholesterol, low fat, and low sodium diet
  
  
• Quit smoking – No matter how long you have smoked, when you quit, you lower your risk for heart disease. Also stop using any smokeless tobacco products as the chemicals in them affect the heart as well
  
  
• Exercise – Exercising and being active are important and can reduce stress and help you sleep. Walking is always an easy way to begin. Check with your doctor before starting any new exercise program
  
  
• Lose weight – If you are considered overweight or obese talk with your doctor about the best way for you to shed the extra pounds
  
  
• Treat related conditions – such as high cholesterol, high blood pressure, diabetes, obesity, and being overweight
  
  
• Regular health screenings and following your doctor's advice