Heart failure

Choose the content to read

• How many types of heart failure?
• What are the causes of heart failure?
• What are the symptoms of heart failure?
• What are the risk factors for developing heart failure?
• How is heart failure diagnosed?
• How is heart failure treated?
• How can heart failure be prevented?
• Lifestyle management when having heart failure

Heart failure

Heart failure arises when the heart muscle cannot pump blood efficiently, causing the congestion of blood returning to the heart and the buildup of fluid in the lungs, causing shortness of breath. Typically, heart failure involves the left ventricle -- the predominant pumping chamber of the heart. However, it can also affect the right heart. Heart failure is life-threatening, but early diagnosis and prompt treatment can prolong the quality of life of patients.

How many types of heart failure?

1. Left-Sided Heart Failure: This condition involves the left ventricular, often leading to fluid buildup in the lungs and causing shortness of breath.
2. Right-Sided Heart Failure: This condition impacts the right ventricular muscle, causing fluid accumulation in the abdomen, legs, and feet with soft tissue swelling.
3. Heart Failure with Reduced Ejection Fraction (HFrEF) (Systolic Heart Failure): This condition occurs when the left ventricle is incapable of contracting sufficiently. Consequently, the heart cannot pump adequate blood to meet the body's demands.
4. Heart Failure with Preserved Ejection Fraction (HFpEF) (Diastolic Heart Failure): In this condition, the left ventricle struggles to expand adequately during the heart's relaxation phase, preventing blood from entering the left ventricle ventricle.

How many stages of heart failure?

(Ref: New York Heart Association (NYHA) classification)

• Class 1 heart failure: Asymptomatic
• Class 2 heart failure: Patients can do everyday activities with no difficulty. However, physical exertion leads to tiredness and shortness of breath.
• Class 3 heart failure: It is challenging to do everyday activities.
• Class 4 heart failure: This is the most severe heart failure. Patients experience shortness of breath at rest.

What are the causes of heart failure?

• Your heart is damaged or weakened, causing your heart chambers to expand in size and fail to pump enough blood.
• Your heart ventricles become stiff and cannot fill with enough blood between the heartbeats.

What are the symptoms of heart failure?

When you have heart failure, you may develop symptoms acutely or gradually as follows:

• Difficulty breathing or dyspnea with activities or when lying down.
• Tiredness.
• Swollen abdomen, ankles, legs, and feet.
• Rapid or irregular heartbeats.
• Low exercise tolerance.
• Wheezing, persistent coughs with mucus.
• Fluid retention.
• Loss of appetite.
• Nausea.
• Decreased alertness.
• Confusion, difficulty concentrating.
• Chest pain.

When should one seek medical attention for symptoms of heart failure?

See your doctor if your symptoms aggravate, you have a new symptom, or you gain 2.3 kilograms or more within 2-3 days. These are signs that your heart disease condition is worsening.

Call 1669 or ask someone nearby to take you to the hospital immediately to see an emergency room doctor. if you have severe chest pain, weakness, syncope, irregular heartbeat, and shortness of breath

What are the risk factors for developing heart failure?

• Age. The older you become, the higher the risk.
• Alcohol consumption. 
• Smoking.  
• Health conditions such as:
  
  • Blood clots in the lungs.
  • Congenital heart defect.
  • Coronary artery disease.
  • Diabetes.
  • Heart arrhythmia. 
  • Heart attack or myocardial ischemia. 
  • Heart valve disease. 
  • Hypertension. 
  • Obstructive sleep apnea. 
  • Obesity. 
  • Viral infections such as HIV.
• Medications:
  
  • Diabetes medications such as rosiglitazone and pioglitazone increase the risk of heart failure in some cases. 
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) 
  • Certain cancer medications, blood conditions, hypertension, irregular heartbeats, neurological diseases, mental health conditions, lung and urinary problems, and infections.

What are the complications of heart failure?

• Kidney failure.
• Liver damage. 
• Sudden cardiac death.

How is heart failure diagnosed?

• Inquire about medical history of preexisting risk factors such as hypertension, diabetes, and coronary artery disease.
• Physical exam to detect heart murmurs, swollen abdomen, or legs. 
• Blood tests to assess if you have higher levels of specific proteins known as B-type natriuretic peptide (BNP) or N-terminal pro-BNP (NT-proBNP) produced by the heart. High plasma levels of these proteins indicate heart failure.
• Chest CT-scan / Chest X-ray
• Electrocardiogram (ECG or EKG) to record the rhythm and electrical activity of the heart.
• Echocardiogram to image your heart and measure the size of the heart chambers, how well the heart is pumping, and how well the heart valves are functioning.
• The ejection fraction measures the percentage of blood pumped by the heart with each heartbeat. The fraction ejected should be 50% or higher.
• Exercise stress tests. 
• Cardiac CT scan
• Cardiac MRI scan
• Coronary angiogram to locate the site of coronary artery blockages.  
• Myocardial biopsy to ascertain the type of heart muscle disease.

How is heart failure treated?

Lifestyle modification and medications

Lifestyle modification and medications can improve your symptoms. You may need to take a combination of medicines, depending on the symptoms and causes of your heart failure. Your doctor may adjust the appropriate dosage from time to time. If you have a flare-up of heart failure symptoms, seek immediate medical care. 

Surgery and other procedures

• Coronary artery Bypass Surgery
  If the cause of the heart failure is due to blocked arteries, coronary bypass surgery may be advisable. The surgeons may use blood vessels from the chest, arm, or leg to establish a new pathway to the heart, improving blood flow to the heart muscle.
• Heart Valve Repair or Replacement
  If the heart failure is due to a damaged heart valve, your doctor might suggest repairing or replacing the diseased valve through open-heart surgery or minimally invasive surgery. 
• Implantable Cardioverter-Defibrillator (ICD)
  An ICD can prevent complications related to heart failure, monitor the heart's rhythm, detect irregular heartbeat, and restore a normal heartbeat. 
• Cardiac Resynchronization Therapy (CRT)
  Cardiac Resynchronization Therapy (CRT) or Biventricular Pacing is a device for patients whose lower heart chambers do not contract synchronously. The device sends electrical signals to the lower heart chambers to help coordinate their contractions for improved blood pumping efficiency. Doctors may implant a CRT in combination with an ICD device.
• Ventricular Assist Device (VAD)
  It helps pump blood from the lower heart chambers to the rest of the body and can serve as a bridging device for individuals waiting for a heart transplant or for those who are not suitable candidates for transplantation.
• Heart Transplant
  In severe heart failure, where medications and other treatment methods prove ineffective, physicians may consider performing a heart transplant using a donated organ. Doctors must assess the risks and benefits before proceeding with the surgery, as not everyone is a suitable candidate for heart transplantation.

How can heart failure be prevented?

• Monitor your symptoms. 
• Take medication as prescribed.
• Maintain a healthy body weight. Your heart must work harder when you gain more weight. If you gain 1 kilogram in a day or two kilograms within one week, you have body fluid buildup and may need to adjust or change your medications. 
• Quit smoking and drinking alcoholic beverages.
• Be physically active.
• Always discuss with your doctor before taking new medications or dietary supplements.

Lifestyle management when having heart failure.

• Maintain open communication with the doctor. If there are concerns or you feel worse, inform the doctor for treatment adjustment.
• Take medication as prescribed by the doctor. If there are side effects, inform the doctor and do not discontinue medication yourself.
• Avoid using nonsteroidal anti-inflammatory drugs (NSAIDs) and naproxen, as they may increase the risk of heart failure.
• Regularly check your weight after waking up, having breakfast, and urinating. An increase in weight may be a sign of fluid retention.
• Monitor blood pressure regularly, as it helps assess the effectiveness of the treatment.
• Seek assistance from family and friends in performing daily tasks such as cooking and driving.

Preparation before the doctor’s appointment

• Bring a family member or friend to help you remember the doctor’s explanation.
• Write down your current symptoms, family history of stroke, heart disease, hypertension, diabetes, medications you are taking, recent stress or life changes, and questions you would like to ask your doctor.  
  Example of questions:
  • What is the cause of the symptoms?
  • Is further examination necessary?
  • What types of treatments are available?
  • Are there any dietary restrictions?
  • Can physical activity or sexual relations continue?
  • Is the condition hereditary?
  • If there are existing chronic conditions, how should the symptoms be managed?

You can also prepare some answers to questions your doctor may ask.

• When did the symptoms first occur?
• Are the symptoms constant or intermittent?
• What makes your condition better or worse?