Heart Failure: Symptoms, Causes, Treatment
Overview
Heart failure is a condition in which your heart can’t pump enough blood to make your body work well. It develops over time as your heart becomes weak or stiff to fill and pump efficiently step by step because of some conditions, such as high blood pressure. Preventing and controlling these conditions can help you prevent heart failure.
There’re three types of heart failure:
1. Left-sided heart failure
The heart’s pumping action moves oxygen-rich blood as it travels from the lungs to the left atrium, then on to the left ventricle, which pumps it to the rest of the body. The left ventricle supplies most of the heart’s pumping power, so it’s larger than the other chambers and essential for normal function. In left-sided or left ventricular (LV) heart failure, the left side of the heart must work harder to pump the same amount of blood.
There are two types of left-sided heart failure：
- Heart failure with reduced ejection fraction (HFrEF), also called systolic failure
- Heart failure with preserved ejection fraction (HFpEF), also called diastolic failure
Medications applied to the two types are different.
2. Right-sided heart failure
The heart’s pumping action moves “used” blood that returns to the heart through the veins through the right atrium into the right ventricle. The right ventricle then pumps the blood back out of the heart into the lungs to be replenished with oxygen.
Right-sided or right ventricular (RV) heart failure usually occurs as a result of left-sided failure.
3. Congestive heart failure
When heart failure occurs in both sides, it’s congestive heart failure. Congestive heart failure (CHF) requires timely medical attention.
Symptoms
Fluid buildup from heart failure may cause the following signs and symptoms:
- Shortness of breath (dyspnea) when you exert yourself or when you lie down
- Fatigue and weakness
- Swelling (edema) in your legs, ankles and feet
- Rapid or irregular heartbeat
- Reduced ability to exercise
- Persistent cough or wheezing with white or pink blood-tinged phlegm
- Increased need to urinate at night
- Swelling of your abdomen (ascites)
- Very rapid weight gain from fluid retention
- Lack of appetite and nausea
- Difficulty concentrating or decreased alertness
- Sudden, severe shortness of breath and coughing up pink, foamy mucus
- Chest pain if your heart failure is caused by a heart attack
Causes
Conditions that damage your heart muscle can result in heart failure. These conditions involve:
- Ischemic heart disease
Ischemic heart disease occurs when a waxy substance called plaque builds up in the arteries supplying oxygen-rich blood to your heart muscle (coronary arteries). Plaque not only narrows the arteries and reduces blood flow, but also makes it more possible for blood clots to take shape in your artery. Under this circumstance, you may have chest pain, angina, a heart attack and heart damage.
- Diabetes
If you have diabetes, it means your blood glucose (sugar) level is much higher than it should be. It can damage and weaken the heart muscle and the blood vessels around the heart, causing heart failure eventually.
- High blood pressure
Blood pressure refers to the force of blood pushing against the walls of the arteries. Similar to high blood glucose level, high blood pressure is also harmful to your heart.
- Other heart conditions or diseases
Other heart conditions or diseases may also cause heart failure, such as arrhythmia, cardiomyopathy, congenital heart defects and heart valve disease.
- Other factors
Other factors that do harm to your heart and possibly lead to heart failure include:
- Alcohol abuse or cocaine and other illegal drug use
- HIV/AIDS
- Thyroid disorders (having either too many or too few thyroid hormones in the body)
- Too much vitamin E
- Treatments for cancer, such as radiation and chemotherapy
Diagnosis
Heart failure will be diagnosed based on your medical and family histories, a physical exam, and test results. The doctor may perform some of these tests:
- Blood tests.
- Chest X-ray.
- Electrocardiogram (ECG).
- Echocardiogram
- Stress test.
- Cardiac computerized tomography (CT) scan.
- Magnetic resonance imaging (MRI).
- Coronary angiogram.
- Myocardial biopsy.
The severity of heart failure is measured with Ejection Fraction. Ejection fraction (EF) is a measurement, expressed as a percentage, of how much blood the left ventricle pumps out with each contraction.
- An EF under 40 percent may be evidence of heart failure or cardiomyopathy
- An EF from 41 to 49 percent may be considered “borderline.” It indicates either developing heart failure or heart damage probably from previous heart attack.
- In severe cases, ejection fraction can be very low.
- An EF higher than 75 percent may indicate a heart condition like hypertrophic cardiomyopathy.
Treatment
In some cases, patients may need a surgery to treat the underlying causes of heart failure. But for most people, their conditions are treated with medicines and sometimes use of devices.
Medications
Doctors usually recommend a combination of medicines to treat heart failure. You may be prescribed one or more of these medicines:
- Angiotensin-converting enzyme (ACE) inhibitors
Angiotensin-Converting Enzyme (ACE) Inhibitors: Uses & Side Effects
- Angiotensin II receptor blockers
- Beta blockers
- Diuretics
- Aldosterone antagonists
- Inotropes
- Digoxin (Lanoxin)
Surgery and devices
Surgery and devices that may be used involve:
- Coronary bypass surgery.
- Heart valve repair or replacement
- Implantable cardioverter-defibrillators (ICDs).
- Cardiac resynchronization therapy (CRT), or biventricular pacing
- Ventricular assist devices (VADs).
- Heart transplant
Lifestyle changes
Making some healthy lifestyle changes can help you manage and improve your condition. A low Ejection Fraction(EF) can get improved by doing lifestyle changes and taking prescription.
Lifestyle changes you can do are:
- Stop smoking
- Lose weight, maintain a healthy weight and BMI
- Check your legs, ankles and feet for swelling daily
- Eat a healthy diet
- Restrict sodium in your diet
- Consider getting vaccinations
- Limit saturated or ‘trans’ fats in your diet
- Limit alcohol and fluids
- Be active
- Reduce stress
- Sleep easy
Keyword: heart failure.
Latest
Aug 2, 2019
A UT Health San Antonio study found higher doses of spironolactone, a diuretic (water pill), can relieve fluid overload safely and effectively in patients who were not responding to conventional diuretics.
Spironolactone is usually given to these types of patients in doses of 25-50 milligrams. In this study, the dose was increased to 100 and, at some administrations, even 200 milligrams.
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