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What is Heart Failure? - Symptoms, Causes & Treatment

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Heart failure differs from a heart attack, and is not a disease in itself. It involves various signs and symptoms that occur due to numerous disorders involving valvular diseases, heart muscle disorders, pericardial (covering layer of heart) diseases and other non-cardiac (unrelated to heart) diseases. The occurrence and severity of heart failure symptoms is determined by the specific nature of the underlying cardiac problems and the rate in which they develop.

Heart failures are an increasingly common diagnosis (the most common diagnosis for patients over 65), due to a trend of an ageing population, an improvement in public awareness and diagnostic capacity, and the ability of cardiac patients to survive for longer periods of time.

 

How severe and life threatening is heart failure?

Heart failures can occur suddenly (acute), or develop over a longer period of time (chronic). They can occur when the heart fails to relax normally (diastolic heart failure) or when there is poor pumping capacity (systolic heart failure).

A heart failure can escalate into an emergency when a patient develops an acute heart failure alongside a pattern of heart attacks and/or a history of severe high blood pressure.

 

What are the symptoms of heart failure?

Symptoms involve the congestion of fluids in the lungs, legs, and abdomen, as well as the heart’s inability to circulate sufficient blood to the organs and tissues in the body. Patients can exhibit fatigue, impaired effort capacity, abdominal fullness, leg swinging, nausea, the loss of appetite, and breathlessness, which is often described as ‘a shortness of breath’, ‘tightness in the chest’, ‘a choking sensation’ or ‘air hunger’. These symptoms manifest after a period of exertion during the early stages of the disease, but can also occur when patients are resting during the advanced stages. Patients have reported feeling breathless while lying down, or having to sleep on three or more pillows to feel comfortable.

Symptoms can also involve Paroxymal Nocturnal Dyspnoea (PND), which usually occurs 2 -4 hours after the patient sleeps. This involves coughing, sweating and breathlessness, which stops after the patient gets out of bed.

 

How does heart failure get diagnosed?

Physicians diagnose heart failure according to the symptoms presented by the patient. This may include prominent neck veins, leg swelling, breathlessness, an increased heart and respiratory rate, cold, clammy hands and feet, the enlargement of liver, and wheezing.

 

Once of the possibility of heart failure emerges, tests are perform to confirm its presence and determine the relevant causes. A blood test is done to assess BHP (Brain Natriuretic Peptide) levels. If it is above 100 pg/ml, there is a strong possibility of heart failure. ECG and Chest X ray are typically performed, while an echocardiogram can reveal the how the heart is currently functioning. A nuclear scan of the heart (the MUGA scan) can be used to assess the heart’s pumping efficacy. An evaluation for precipitating factors is conducted, with specific tests to rule out reversible causes such as metabolic or hormonal disturbances and infection.

 

What are the modalities of treating heart failure?

Effective treatment of heart failure involves the removal of the underlying cause, precipitating factors and containment of the disease. Patients are encouraged to rest, and are provided with oxygen, sedatives, and salt and fluid restriction.

The following drugs may be administered:

  • Diuretics (decreases fluid overload)
  • Nitroglycerine (decreases the filling pressures in the heart)
  • Vasodilators (reduces the stress on the heart)
  • Digoxin & inotropes (strengthens heart muscle performance)
  • ACE inhibitors and AT II blockers (prevents adverse changes in the heart)
  • B blockers (improves survival, decreases the need for hospitalization, prevents sudden death)
  • Antiarrhythmic agents(prevents dysrhythmic)
  • Antiplatelets, anticoagulants (prevents blood clotting)
  • Drugs to treat Hypertension, Diabetes and Coronary artery disease (if necessary)

 

Surgical treatment for heart failure includes treatment for ischemia (Coronary Artery Bypass Graft surgery), valvular disease surgery (to restore heart size and geometry), ventricular assist devices, and heart transplantation (as a last option).

 

Can pacemakers help in this condition?

Patients who have experienced the loss of synchronized contraction of the left and right ventricle of the heart can be treated by implanting a pacemaker (Triple chamber pacemaker) which improves the overall pumping efficacy of the heart by restoring the synchronization of the right and left sides of the heart. This cardiac resynchronization therapy (CRT) provides symptom relief, improves survival rates and reduces the number of hospitalizations.

The treatment of heart failure is multidisciplinary, involving patient education, dietary advice, reviews by cardiologist, medication dose adjustment and home visits to be truly effective.

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