Heart Failure

Heart failure is considered one of the most prevalent cardiac disease presenting poor prognosis. In the United States alone an estimated 5.1 million people are living with heart failure and around 550,000 new cases are diagnosed every year. It is a structural disorder or functional impairment that causes reduced cardiac output and therefore a reduced ability to meet the body’s metabolic needs. There are several underlying conditions that can cause heart failure such as hypertension, diabetes mellitus, coronary artery disease, congenital heart disease, endocrine disorders, arrhythmia and excessive alcohol intake or a viral infecting affecting the heart muscle. The American College of Cardiology Foundation / American Heart Association guidelines define heart failure by stage A to D.

  • Stage A includes a large proportion of people who have one or more risk factors such as diabetes or hypertension for heart failure. The treatment for this stage includes changing diet, low salt intake, increasing exercise and reducing alcohol.
  • Stage B is also considered early in the progression of the condition. Individuals at this stage may have experienced some changes to the heart that may result in heart failure. The treatment could include a possible surgery or other intervention depending on the heart problem.
  • Stage C is indicated among those diagnosed with heart failure and could experience symptoms such as shortness of breath, swelling of the legs and inability to exercise.
  • Stage D is the advanced stage of heart failure needing a heart transplant, mechanical heart pump or may require the support of end of life care. However, consultation with a specialist could help determine the best treatment options available.

Individuals with suspected heart failure require a clinical evaluation that includes medical record, physical examination that detects the symptoms and also by incorporating data of various testing such as a chest radiograph, electrocardiogram and cardiac imaging. The ejection fraction of the heart may also be required that refers to the quantity of blood pumped out of the left ventricle. As some individuals with heart failure could also have a normal ejection fraction, therefore this is used along with other tests to help diagnose heart failure. As it is a long term condition that could deteriorate with time, with the right treatment and lifestyle changes, many of the affected individuals could have a better quality of life.

Different Types of Heart Failure

Left-sided heart failure: This is the most common type of heart failure characterized by the inability of the left ventricle of the heart to pump sufficient blood around the body. Therefore, the blood accumulates in the pulmonary veins causing symptoms such as trouble breathing, coughing and shortness of breath particularly with physical activity. There are two subtypes; Heart failure with reduced ejection fraction (HFrEF), also known as a systolic failure, is characterized by the inability of the left ventricle to contract normally, thereforem lacking force to push blood into circulation. The other subtype of Heart failure is preserved ejection fraction (HFpEF), also known as a diastolic failure when the left ventricle is not able to relax normally meaning the heart cannot properly fill with blood between each beat.

Right-sided heart failure: The right ventricle heart failure develops because of advanced left-sided heart failure. When the left ventricle fails, increased fluid pressure travels back through the lungs, therefore, damaging the heart’s right side also. As the right-side is not able to pump effectively, the blood backs up in the veins causing symptoms such as swelling of the legs and less commonly on the genital area and the abdomen. In some cases, it can also develop because of high blood pressure in the lungs or with certain lung diseases such as COPD.

Congestive heart failure: This is the inability of the right side, the left side or both part of the heart to be able to pump out all the blood. Therefore, the blood backing up in the veins causes the fluid to accumulate in various parts of the body. When the fluid collects in the lungs, it can affect breathing causing shortness of breath particularly when the individual is lying down. This is known as pulmonary edema and can cause respiratory distress if left untreated. Heart failure also reduced the kidney’s ability to excrete sodium and water. This retained water increases the swelling in various tissues of the body. Therefore it is important to restrict sodium intake and to take note of one’s weight every day to detect fluid build-up.

How to keep a healthy heart

As the heart is not able to pump the blood effectively, the cells of the body cannot receive the nutrient rich blood for their normal function. Therefore, everyday activities such as walking or carrying small things can become very difficult. However, individuals with heart failure can have an enjoyable life when the condition is managed with medications and with healthy lifestyle changes. Otherwise, complications can develop including kidney damage or failure, heart rhythm problems and liver damage. Some of the changes that can be made for a healthy heart include; controlling the blood pressure by reducing the salt intake, quit smoking, keeping active, maintaining a healthy weight and watching the amount of fluid taken every day.

Advanced Heart Failure Therapies

The advancement in mechanical circulatory support technology has positively changed the ability to care for certain individuals with advanced heart failure. Although the heart transplant has been an option for several decades, the suitable organ donors have limited the number of heart transplants. Also, the use of left ventricular assist devices (LVAD) has been very helpful for affected individuals which are used as a temporary mode of treatment until a suitable organ becomes available. Alternatively, it is also used as a destination therapy meaning it remains in situ until death thereby improving the quality of life for those who otherwise are not suitable candidates for heart transplantation because of advanced age. However, as research and technology are continuing to advance, it is hoped that smaller and less invasive devices may become available.

References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4224604/

https://www.ncbi.nlm.nih.gov/books/NBK481485/

https://www.umms.org/bwmc/health-services/heart-disease/conditions-treatments/congestive-heart-failure