Heart failure is a ventricular dysfunction syndrome. On early stages heart failure symptoms are mild. Heart failure diagnostics is performed at clinic based on symptoms and physical exam; additional tests may be run to confirm the diagnosis. Treatment options include medications, surgical procedures, such as installation of implantable cardioverter-defibrillators (ICDs) and heart pumps. You may find more detailed information about this condition below.
Heart failure – or congestive heart failure – occurs when your heart muscle doesn’t pump blood as well as it should. Due to certain conditions, such as high blood pressure or narrowed arteries in your heart (coronary artery disease) your heart can become stiff and damaged.
There are treatments that can improve the signs and symptoms of heart failure and help prolong your life, however not all conditions that lead to heart failure can be reversed. Making positive lifestyle changes can help to improve your quality of life. These can include exercising, reducing salt in your diet, managing stress and losing weight.
Controlling the conditions that cause heart failure, such as coronary artery disease, high blood pressure, obesity or diabetes is one way to prevent heart failure.
What causes Heart Failure?
The most commonly causes of heart failure are:
- Coronary heart disease and heart attack
- Cardiomyopathy (Disease of the heart muscles)
- Hypertension (High blood pressure)
- Heart valve disease
- Congenital heart disease
- Drug abuse and alcoholism
Heart attacks occur when the blood flow to an area of the heart is completely blocked, causing immense damage to the heart muscle. If the damage is so great and affects your heart’s pumping ability then heart failure will likely develop.
Causes of cardiomyopathy include coronary artery disease and various other heart problems. Sometimes, the cause of cardiomyopathy cannot be found, in which case it is referred to as idiopathic cardiomyopathy. Cardiomyopathy can weaken the heart muscle, causing complete failure.
High blood pressure – another common cause of heart failure – forces the heart to work harder in order to pump blood. This intense pumping is unsustainable over time, thus causing heart failure to develop.
HEART FAILURE SYMPTOMS
Heart failure either be sudden (acute) or ongoing (chronic) and include the following the signs and symptoms:
- Shortness of breath when you exert yourself or when you lie down
- Weakness and fatigue
- Inability to exercise
- Irregular or rapid heartbeat
- Swelling in the legs, feet and ankles (edema)
- Persistent cough or wheezing with white or pink blood-tinged phlegm
- Fluid retention causes sudden weight gain
- Nausea and an overall lack of appetite
- Chest pain – if your heart failure is caused by a heart attack
- Increased urination at night
- Swelling of your abdomen (ascites)
- Decreased alertness and concentration
- Sudden, severe shortness of breath and coughing up pink, foamy mucus
TREATMENTS OPTIONS AVAILABLE FOR HEART FAILURE
Heart failure requires lifelong management. With treatment, the prognosis can be positive, with signs and symptoms of heart failure lessening as well as the heart becoming stronger over time.
Doctors sometimes can correct heart failure by treating the underlying cause, for example, repairing a heart valve or controlling a fast heart rhythm. For most people however, the treatment of heart failure involves a balance of the right medications and devices that aid the heart in beating and contracting properly.
In most cases, doctors will treat heart failure using a combination of medications and depending on your symptoms, you may be required to take more than one medication at a time, including:
- Angiotensin-converting enzyme (ACE) inhibitors: These drugs both extend the life of people with systolic heart failure and improve the way they feel. ACE inhibitors are a type of vasodilator – drugs that improve blood flow, widen blood vessels to lower blood pressure and decrease pressure on the heart. Examples include enalapril (Vasotec), lisinopril (Zestril) and captopril (Capoten).
- Angiotensin II receptor blockers: Losartan (Cozaar) and valsartan (Diovan), are examples of angiotensin II receptor blockers that have many of the same benefits as ACE inhibitors. They may be an alternative for people who can’t take ACE inhibitors.
- Beta blockers: These types of drugs allow the heart rate to slow down and blood pressure to reduce while limiting or reverses some of the damage to the heart if systolic heart failure occurs. These medicines reduce the risk of certain abnormal heart rhythms, lessening your chance of a sudden, unexpected death. A reduction of signs and symptoms of heart failure and improved heart function can occur from taking beta blockers. Examples include carvedilol (Coreg), metoprolol (Lopressor) and bisoprolol (Zebeta).
- Diuretics: Diuretics help you to urinate more frequently and thus keeping fluid accumulation at a minimum and in some cases also decreasing fluid in your lungs, helping you to breathe easier. Furosemide (Lasix) is an example of a diuretic that does this. Potassium and magnesium are lost when taking potassium so your doctor also may prescribe supplements of these minerals. If you’re taking a diuretic, your potassium and magnesium levels will be checked through regularly scheduled blood tests.
- Aldosterone antagonists: Drugs such as spironolactone (Aldactone) and eplerenone (Inspra) have additional properties that may prolong the life of people with severe systolic heart failure whilst allowing the body to retain potassium. Unlike some other diuretics, spironolactone and eplerenone may raise the level of potassium in your blood to dangerous levels. If this is a concern for you, consult your doctor and see if you need to modify your intake of foods that are high in potassium.
- Inotropes: These are intravenous medications used in hospital, in patients with severe heart failure. Inotropes help to improve the hearts’ ability to function and maintain blood pressure.
- Digoxin (Lanoxin): Digoxin (or digitalis), increases the strength of your heart muscle contractions whilst slowing your heartbeat. This drug helps to reduce heart failure symptoms in cases of systolic heart failure and may be given to It may be more likely to be given to someone with a heart rhythm problem, such as atrial fibrillation.
In order to treat heart failure, two or more medications may be required. Other heart medications such as nitrates for chest pain, a statin to lower cholesterol or blood-thinning medications to help prevent blood clots, may be prescribed along with special heart failure medications.
You may be hospitalized if your heart failure symptoms worsen. Here you may receive additional medications to relieve your symptoms as well as improving your hearts’ ability to pump. Supplemental oxygen may also be administered through a mask or small tubes placed in your nose. If your heart failure is severe, you may need supplemental oxygen long term.
Surgery and medical devices
Surgery to treat the underlying problem that caused your heart to fail is sometimes the recommend option. Some of these treatments include:
- Coronary bypass surgery: If severely blocked arteries are the root cause of your heart failure, then your doctor may recommend you having coronary artery bypass surgery. This procedure involves bypassing a blocked artery blood vessel via your leg, arm or chest bypass a blocked artery in your heart to allow blood to flow through your heart more freely.
- Heart valve repair or replacement: If your heart failure is due to having a faulty heart valve, your doctor may suggest repairing or replacing the valve. The surgeon can modify the original valve and eliminate backward blood flow via the valvuloplasty method. Reconnecting valve leaflets or removing excess valve tissue can also help the leaflets close properly. Sometimes repairing the valve includes tightening or replacing the ring around the valve (annuloplasty).
When repairing the valve is impossible, valve replacement is the next best option. In this case, the damaged valve is replaced by an artificial (prosthetic) valve. Certain types of heart valve repair or replacement can now be performed without open-heart surgery, but rather, by using either cardiac catheterization or other minimally invasive surgical procedures.
- Implantable cardioverter-defibrillators (ICDs): An ICD is similar to a pacemaker as the device is implanted under the skin in your chest and has wires leading through your veins and into your heart that monitor your heart rhythm. If the heart starts beating at a dangerous rhythm, or if your heart stops all together, the ICD will either pace your heart or shock it back into pumping at a normal rhythm. An ICD can also function as a pacemaker and speed your heart up if it is not pumping quickly enough.
- Cardiac resynchronization therapy (CRT), or biventricular pacing: This involves a biventricular pacemaker sending timed electrical impulses being sent to both of the heart’s lower chambers (left and right ventricles) so that they pump more efficiently and with more coordination.Problems with the heart’s electrical system can cause people with an already weak heart muscle to beat in an awkward fashion. Over time, this may cause heart failure to worsen. Often a biventricular pacemaker is combined with an ICD for people with heart failure.
- Heart pumps: In order to help it pump blood to the rest of your body, these ventricular assist devices (VADs), are implanted into the abdomen or chest and attached to a weakened heart. VADs can be used in in both ventricles if needed. VADs were originally used to help keep heart transplant candidates alive while they waited for a donor heart, but are now occasionally used as an alternative to transplantation. Implanted heart pumps can significantly extend and improve the lives of some people who are waiting for a new heart or who aren’t eligible for or able to undergo heart transplantation.
HEART FAILURE DIAGNOSTICS
- Consult with the doctor and physical exam: During this examination, your doctor will look at your symptoms and look carefully at your medical history. Your doctor will also check for the presence of any other potential risk factors such as high blood pressure, coronary artery disease and diabetes. Using a stethoscope, your doctor will listen to your lungs for any signs of congestion while also listening for any abnormal heart sounds that may suggest your heart is failing. The doctor may examine the veins in your neck and check for fluid build up in your legs and abdomen. After the physical exam, your doctor may also order some of the following tests:
- Blood tests: Samples of your blood may be taken to check your kidney, liver and thyroid function as well as looking for indicators of other possible causes of heart failure. In addition to other forms of testing, checking for a chemical called N-terminal pro-B-type natriuretic peptide (NT-proBNP) may help in diagnosing heart failure if the diagnosis isn’t certain.
- Chest X-ray: During heart failure, your heart may appear enlarged and a build up of fluid may be visible in your lungs. X-ray images help your doctor to see the overall condition of your lungs and heart whilst also being able to diagnose conditions other than heart failure that may explain the signs and symptoms you are experiencing.
- Electrocardiogram (ECG): This test records the electrical activity of your heart through electrodes attached to your skin. These electrical Impulses are then recorded as waves and are displayed on a monitor or on printed on paper. This test helps your doctor to diagnose heart rhythm problems as well as any other causes of underlying heart failure, such as a heart attack.
- Echocardiogram: An echocardiogram helps distinguish systolic heart failure from diastolic heart failure, which is when the heart is stiff and can’t fill properly. This test can help doctors see the size and shape of your heart as well as how well it is pumping via the use of sound waves viewed on a video image. Heart valve problems or evidence of previous heart attacks, other heart abnormalities can also be discovered using an echocardiogram. Your ejection fraction is measured during an echocardiogram and can also be measured by cardiac catheterization and cardiac MRI and nuclear medicine tests. This is vital information as it shows how well your heart is pumping and is used to help classify heart failure and to guide the necessary treatment.
- Stress test: Stress tests measure how your heart and blood vessels respond to exertion. You may walk on a treadmill or pedal a stationary bike while attached to an ECG machine. If you cannot perform the aforementioned activities then your heart may be stimulated via drugs administered intravenously. Sometimes the stress test can be done while wearing a mask that measures the ability of your heart and lungs to take in oxygen and breathe out carbon dioxide. Stress tests help doctors see whether you have coronary artery disease or not, while also determining how well your body is responding to your heart’s decreased pumping effectiveness. These results can help guide long-term treatment decisions. If your doctor also wants to see images of your heart while you’re exercising, he/she may order a nuclear stress test or a stress echocardiogram, which is very similar to an exercise stress test but with imaging techniques incorporated in order to see your heart’s pumping in action.
- Cardiac computerized tomography (CT) scan or magnetic resonance imaging (MRI): Whilst lying on a table inside a doughnut-shaped machine, an X-ray tube inside the machine rotates around your body and collects images of your heart and chest. In a cardiac MRI, you lie on a table inside a long tube-like machine that produces a magnetic field that aligns atomic particles in some of your cells. When radio waves are broadcast toward these aligned particles, they produce signals that vary depending on the type of tissue they are, thus forming images of your heart.
- Coronary angiogram: In this test, a thin, flexible tube, known as a catheter, is inserted into a blood vessel in your groin or arm and is then guided through the aorta into your coronary arteries. A dye injected through the catheter makes the arteries supplying your heart more easily seen on an X-ray. This test helps doctors pinpoint any narrowed arteries leading to your heart that can potentially be the cause of heart failure. In order to determine the strength of the heart’s main pumping chamber (left ventricle) and the health of the heart valves, a test called a ventriculogram may be included.
- Myocardial biopsy: This test involves inserting a flexible biopsy cord into a vein in your neck or groin, and extracting small pieces of the heart muscle. This test may be performed in order to diagnose certain types of heart muscle diseases linked to heart failure.