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Heart Failure

Overview

Overview

Heart Failure

Heart Failure is a serious condition in which your heart fails to pump blood sufficient enough to meet your body’s oxygen needs. It is also called as congestive cardiac failure, right side heart failure, left side heart failure or cor pulmonale. Heart Failure occurs when the heart cannot relax properly to fill in enough blood (right sided heart failure) or cannot contract properly to pump out enough oxygen rich blood (left sided heart failure) or due to a combination of both problems (congestive heart failure).

Right sided heart failure is a result of high blood pressure in pulmonary arteries (arteries taking blood from heart to lung) is called cor pulmonale.

As heart becomes weaker, toxins build up in the body, which worsen the symptoms.

Currently, there is no cure for heart failure. However, it can be managed by medications and life style changes to allow you to lead a normal and active life.

Heart failure is treated by cardiologists. However your regular doctor can help in diagnosis, and in managing your medication and treatment.

What Happens in Heart Failure

Heart has four chambers, two upper (right and left atrium) and two lower (right and left ventricle).

In normal condition the right atrium receives oxygen poor blood from the body, pushes it to right ventricle. From the right ventricle the blood is pushed to lungs through pulmonary arteries for purification. Oxygen rich blood from the lungs fills the left atrium. This blood is pushed to the left ventricle which contracts to push the oxygen rich blood to the rest of the body.

In left side heart failure, the heart fails to contract or relax properly. When the heart does not contract properly, less oxygen rich blood is pushed out to the body. The excess blood accumulates in the left ventricle and atrium. This creates a backward pressure and pushes the blood back into the lung. Thus fluid accumulates in the lung.

In right side heart failure, the right atrium and ventricle fail to relax properly. Hence they are unable to take the oxygen poor blood from rest of the body. This causes a backward pressure such that fluid accumulates in the body, especially in feet, ankle, legs and abdomen.

Usually both right and left sided heart failures are present at the same time. However one may be more prominent than the other.

Causes

Causes

Heart failure occurs due to conditions that either damage or tire the heart or cardiac muscles.

The three common causes of heart failure are

  • coronary heart disease (CHD) (blockage in heart blood vessels, angina or heart attack)
  • hypertension or high blood pressure (140/90 mmHg or above or 130/80 or above if you have chronic kidney disease or diabetes)
  • diabetes or high blood sugar

Other Causes:

  • Cardiomyopathy or heart muscle disease.
  • Heart valve disease or valvular heart disease.
  • Arrhythmias or irregular heartbeats.
  • Congenital heart defects (birth defect).

Conditions which damage heart muscle:

  • Cancer treatment (chemotherapy and radiotherapy)
  • Thyroid disorders
  • Alcohol or illegal drug abuse
  • Cigarette smoking
  • HIV/AIDS
  • Taking too much vitamin E
  • Obstructive sleep apnea (sleep disorder)
  • Viral infections

Symptoms

Symptoms

The signs and symptoms common in all types of heart failure are:

  • Shortness of breath, initially with physical work and then at rest
  • Fatigue (tiredness), initially with physical work and then at rest
  • Confusion (in advanced stages)
Right Side Heart Failure
  • Swelling in the ankles, feet, legs, abdomen, and neck veins
  • Weight gain due to fluid accumulation
  • Increased urine formation
  • Enlarged liver
Left Side Heart Failure
  • Increase in respiratory rate
  • Increase in breathing effort with panting and gasping
  • Cough, worse on lying down (usually a sign of fluid build up in lungs or pulmonary edema)
  • Pleural effusion (fluid accumulates in the lining of lungs)
  • Othropnea or inability to breathe lying down
  • Rales and crackles in lung field
  • Cyanosis or blue tinge of lips, and tips of fingers and toes

Diagnosis

Diagnosis

Early diagnosis and treatment improves the life span and quality of life.

The diagnosis is made on the basis of medical and family history, physical examination and certain tests.

Medical and Family History

Your doctor would like to know if you or any family member has a history of heart disease, diabetes or high blood pressure. You will be asked to explain your symptoms in detail, when they started, how they progressed etc. Do your best to answer the questions to the best of your ability.

Physical Examination

During the physical examination, your doctor will:

  • Listen to your heart and lungs sounds
  • Look for swelling in your ankles, feet, legs, abdomen, and neck veins.
Diagnostic Tests

There is no single test specific for heart failure. After taking your medical and family history and physical exam, your doctor may ask for one or more of the following tests:

  • Electrocardiogram (EKG/ECG): This simple test helps record your heart beat. It tells the doctor about irregular heart beats, fast beats, previous heart attacks, and problem in the conduction of impulses in the heart.
  • Chest X Ray: This can show a large heart or fluid in lungs. It can also tell the doctor if you have a lung disease.
  • B-type natriuretic peptide (BNP) Blood Test: BNP is a hormone whose level rises during heart failure. The test can also be done to monitor progress of treatment.
  • Echocardiography (ECHO): This is like an ultrasound of heart where your doctor can see your moving heart. This test tells your doctor about the size of heart and its chambers, the thickness of the walls of the artery, contraction of heart, mixing of blood, previous heart attack, force of blood flow etc.
  • Doppler Ultrasound: This test gives the speed and direction of blood flow.
  • Holter Monitor: A machine with leads or electrodes will be attached to your chest to record your heart beat. The recorder can be kept in a pocket or slung over your neck. You have to wear it for 24-48 hours while you go about your normal routine.
  • Stress Test: If you are capable of running on a tread mill, your doctor may take you up for this to examine how your heart behaves under stress. The test is often followed up with ECHO and nuclear heart scans.
  • Nuclear Heart Scan: This shows the amount of oxygen rich blood reaching your heart muscles and identifies areas which do not receive the blood.
  • Coronary Angiography: Your doctor may ask for this test if he suspects a block in the heart arteries. A dye is injected through a tube placed in the blood vessel of your groin or arm and taken up to your heart. The doctor can see the flow of the dye on a screen in front of him.
  • Other tests: These may include blood sugar, thyroid, liver and kidney function tests

Treatment

Treatment

The treatment of heart failure is aimed at keeping the symptoms in check and preventing worsening of the condition. The treatment includes medication, lifestyle changes, and other treatments.

Medication

Medication

Your doctor will prescribe medications depending on your symptoms and results of your tests. Please take the medications as prescribed. Do not miss doses and do not self-medicate. If you feel the medication is not suiting you, please inform your doctor immediately.

The various medications prescribed for heart failure are:

  • Water pills or diuretics: remove water from feet, ankles, legs, abdomen and lungs.
  • Digoxin: improves heart’s contraction.
  • Angiotensin-converting-enzyme (ACE) inhibitors: lower blood pressure, reduces strain on your heart, reduce risk of heart attack.
  • Angiotensin receptor blockers (ARB): dilate the blood vessels and lower blood pressure to lower your heart’s workload.
  • Aldosterone antagonists: remove excess salt and water in the body through urine.
  • Beta blockers: reduce heart rate and blood pressure to lower your heart’s workload.
  • Isosorbide dinitrate: dilates blood vessels to lower your heart’s workload.
Lifestyle Changes

Simple lifestyle changes along with medications will help you dramatically improve your symptoms and lead a better quality of life.

A Heart Healthy Diet: You can ask the dietician in your heath care team to make customized diet plans for you. Otherwise you can follow these simple tips.

  • Cut down or avoid refined flour and grains and solid or trans fat (butter, cream etc).
  • Eat green vegetables, fresh fruits, whole grains, nuts, peas and beans
  • Include some low fat or fat free dairy products
  • Opt for lean cuts of meat/poultry, fish, sea food, eggs without yolk.
  • Eat starchy vegetables and fruits in moderation.
  • Keep salt intake to minimum. Avoid sprinkling salt on salads
  • Eat at least one of the following every day to maintain your potassium levels: potato, sweet potato, banana, orange, nuts, beans etc every day.
Fluid Intake

Since you have excess fluid in your body and you may be on water pills, it is important to drink only as much fluid as allowed. Drinking too much or too less may worsen your symptoms. Avoid alcohol completely.

Other Lifestyle Changes
  • Keep your blood sugar, thyroid hormones and blood pressure under control if you have these problems.
  • If you are overweight or obese, lose weight. Please do not diet or exercise without discussing with your doctor. Your health care team will help you lose weight safely.
  • Be as active as you are allowed. Ask your doctor about the level of physical activity allowed. Stop any activity that makes your tired or breathless and inform your doctor regarding this.
  • You may be asked to weigh yourself daily while you are being treated. Also, whenever you see any swelling in feet, ankle, legs, or abdomen, please start weighing yourself every day, same time, wearing same type of clothes. Keep a record of your weight.
  • Quit smoking or illegal drugs if you take them
  • Get enough rest as advised.
  • Apart from medications and life style changes you may need oxygen therapy from time to time, either at home or in hospital
Other Treatments
  • If condition worsens you may need an implantable cardioverter defibrillator (ICD) to help your heart contract or a mechanical heart pump (left ventricular assist device).
  • Heart Transplant if all treatments fail.
External Links/References
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