Heart Failure
Heart failure (HF) is a condition in which the heart is unable to pump blood effectively to meet the body's needs for oxygen and nutrients. It's important to note that "heart failure" doesn't mean the heart has stopped working, but rather that it is functioning less efficiently. Heart failure can affect either the left side, right side, or both sides of the heart.
Types of Heart Failure:
Left-sided heart failure:
This is the most common type and occurs when the left side of the heart (which pumps blood to the body) is unable to effectively pump oxygenated blood.
Systolic heart failure (reduced ejection fraction, HFrEF) occurs when the heart's pumping ability is impaired, and the heart can't contract forcefully enough.
Diastolic heart failure (preserved ejection fraction, HFpEF) occurs when the heart muscle becomes stiff and doesn't fill properly with blood between heartbeats.
Right-sided heart failure:
This occurs when the right side of the heart (which pumps blood to the lungs) is not able to pump blood effectively. It can result from left-sided heart failure or other conditions, like lung disease.
Symptoms include swelling in the legs, ankles, and abdomen (ascites), and shortness of breath.
Congestive heart failure:
This refers to the stage where fluid builds up in the lungs, liver, abdomen, and lower extremities due to the heart's inability to pump effectively.
Causes:
Heart failure can be caused by a variety of conditions, including:
Coronary artery disease (CAD): Blockages or narrowing of the blood vessels that supply blood to the heart muscle.
High blood pressure (hypertension): Over time, high blood pressure causes the heart to work harder, leading to heart failure.
Heart valve disease: Dysfunction of the heart valves can lead to inefficient blood flow and eventually heart failure.
Cardiomyopathy: A disease of the heart muscle, which can result from genetic factors, infections, alcohol abuse, or other causes.
Arrhythmias: Abnormal heart rhythms that can weaken the heart muscle over time.
Congenital heart defects: Structural heart issues present at birth can lead to heart failure.
Myocardial infarction (heart attack): Damage to the heart muscle from a heart attack can lead to heart failure.
Symptoms:
Shortness of breath (dyspnea), especially when lying flat or with exertion
Fatigue and weakness
Swelling (edema) in the legs, ankles, feet, or abdomen
Rapid or irregular heartbeats (palpitations)
Persistent coughing or wheezing, often producing pink or white mucus
Decreased ability to exercise
Nausea or lack of appetite
Sudden weight gain due to fluid retention
Diagnosis:
Physical exam: The doctor may detect signs like fluid retention (swelling) or abnormal heart sounds.
Echocardiogram: An ultrasound of the heart to measure its function, including the ejection fraction (how much blood the heart pumps with each beat).
Blood tests: To check for markers like BNP (brain natriuretic peptide), which is elevated in heart failure.
Electrocardiogram (ECG): To detect heart rhythm problems.
Chest X-ray: To see if there's fluid buildup in the lungs.
MRI or CT scan: In some cases, more advanced imaging may be used to get a detailed view of the heart.
Treatment:
Treatment depends on the severity of the heart failure and its underlying cause. It often involves a combination of the following:
Medications:
Angiotensin-converting enzyme inhibitors (ACE inhibitors): Help relax blood vessels and reduce the heart's workload.
Beta-blockers: Slow the heart rate and reduce the heart's demand for oxygen.
Diuretics: Help reduce fluid buildup and relieve symptoms of swelling and shortness of breath.
Aldosterone antagonists: Reduce fluid retention and prevent further heart damage.
Digoxin: Helps the heart pump more efficiently in some cases.
SGLT2 inhibitors: Newer medications, primarily used for diabetes, also help manage heart failure.
Lifestyle changes:
Diet: A low-salt, low-fat diet helps control fluid retention and reduce the heart's workload.
Exercise: Tailored physical activity can improve heart function, but it should be done under medical supervision.
Fluid restriction: In some cases, limiting fluid intake helps prevent fluid buildup.
Surgical and medical devices:
Pacemakers or implantable cardioverter-defibrillators (ICDs): Used to help control abnormal heart rhythms or prevent sudden cardiac arrest.
Biventricular pacing (Cardiac Resynchronization Therapy, CRT): A specialized pacemaker helps both sides of the heart beat together.
Heart valve surgery: To repair or replace a malfunctioning heart valve.
Left ventricular assist device (LVAD): A mechanical pump used in severe heart failure cases to help the heart pump blood.
Heart transplant: In the most severe cases, a heart transplant may be necessary.
Managing underlying conditions:
Addressing conditions like high blood pressure, diabetes, and coronary artery disease is crucial in managing heart failure.
Prognosis:
The outlook for someone with heart failure depends on several factors, such as the cause, the severity of the condition, and how well the person responds to treatment. With appropriate treatment and lifestyle changes, many people with heart failure can lead a relatively normal life.