Heart Failure

(Contributed by Ammara Usman Paracha and Usman Zafar Paracha)

Symptoms of Heart Failure

Heart failure (HF), also known as Congestive Heart Failure (CHF), is a condition in which heart cannot pump sufficient blood to meet the needs of the body.

It is estimated that about 300,000 people die of HF each year. It is found that HF occurs in about 1% of people younger than 50 years of age, 85% of people are above 65 years of age and 10% of people aged 80 years and older.

HF is one of the most common and costly causes of hospitalization.

Various heart conditions can cause heart failure. It may be fatal sometimes but it can be controlled by appropriate health care.

Fluid retention, breathlessness and tiredness are its common symptoms.  Sometimes symptoms are quick and obvious and this type of heart failure is known as “Acute heart failure” but sometimes the symptoms develop slowly and this type of heart failure is known as “Chronic heart failure“.

It is more common in men than in women. Adults also suffer from heart failure more often, than younger, but their age is less as compared to those over the age of 65. New informations tell us that the effects and treatment of heart failure may be different in different persons depending on their racial, ethnic and genetic background. Rate of heart failure depend on the lifestyle of a person. So a healthy lifestyle and healthy diet is very important for every person.

Synonyms:

Other names of Heart Failure are cardiac failure, cardiac insufficiency, congestive heart failure, myocardial insufficiency.Heart failure, other names

Causes and rate of occurrence:

Resulting clinical syndromes:

Following clinical syndromes may occur:

1. pitting edema

2. engorged neck veins (Engorge refers to filling with blood untill it is congested.)

3. shortness of breath

4. enlarged tender liver (Tender refers to unusual sentivity to touch) and

5. pulmonary rales (Rale refers to symptomatic chest sound indicating fluid in the air passages)

These may occur in any combinations.

Heart failure may results in...

 

Symptoms:

Some common symptoms are shown in the figure above and are also listed as follows:

1. Cough

2. Shortness of breath

3. Swelling of ankles and feet

4. Swelling of the abdomen

5. Irregular or rapid pulse

6. Sensation of feeling the heartbeat

7. Weight gain

8. Weakness, fatigue, difficulty in sleeping, faintness

9. Loss of appetite and indigestion

Some other symptoms relating to heart failure include:

1. Decreased urine production or need to urinate at night

2. Nausea and vomiting

3. Decreases concentration or alertness

Signs that may help to detect heart failure:

Following signs may help to know (to some extent) that the subject has (the possibility of) heart failure:

1. Irregular heartbeat

2. Leg swelling

3. Swelling of the liver

4. Fluid around the lungs (a condition known as pleural effusion)

5. Neck veins that stick out

6. Ventricular gallop sound (S3) is positively predictive of heart failure.

Abnormal heart sounds or lung crackles will be listened on listening to the chest with the help of stethoscope.

There are four stages of heart failure as described by The American College of Cardiology (ACC)/ American Heart Association (AHA). These four stages along with their signs are as follows:

1. Stage A HF:

Patients in Stage A HF have Coronary artery disease, hypertension, diabetes mellitus, alcohol abuse, a history of cardiotoxic drug therapy, a family history of cardiomyopathy or a history of rheumatic fever.

2. Stage B HF:

Patients with Stage B HF have structural heart disease, history of myocardial infarction (MI), Left ventricular (LV) hypertrophy or fibrosis, asymptomatic valvular heart disease or LV hypocontractility or dilatation.

3. Stage C HF:

Patients with Stage C HF have symptoms of HF along with structural heart disease.

4. Stage D HF:

Patients with Stage D HF have advanced structural heart disease and clearly shown symptoms of HF even at rest despite medical therapy. They require special and advanced treatments in every way of life.

Tests for heart failure:

Following tests may help to check the heart failure:

1. ECG

2. Cardiac stress tests

3. Chest X-ray

4. Echcardiogram

5. Heart Catheterization

6. MRI of the heart

7. Heart CT scan

8. Nuclear heart scans

Treatment strategies:

Treatment starts with self care and monitoring. A constant visit to doctor is essential for close monitoring. One visit every 3-6 months have to be done. An echocardiogram (i.e. an ultrasound of the heart) is often done to check the proper pumping function of the heart.

Self checking of weight is essential i.e. weight must be checked on daily basis and must be in control. Weight gain may indicate the increases chances of heart failure. Doctor must be consulted in this case.

Patients of HF must be avoided from heavy air pollution.

Other self monitoring issues may include:

1. Low salt intake

2. Prohibit smoking

3. Medicines must be taken as directed

4. Lose extra weight

5. Exercise on regular basis but remember exercise on the day of not feeling well is not good

6. Keep feet at an elevated level so that the swelling is reduced

7. Go to rest after exercise, diet or some other activity as this will give rest to your heart.

In one study, it has been found that Hawthorn extract, as an additional treatment, is very beneficial for chronic heart failure. Hawthorn is a tree having thorns and small reddish fruits.

Beriberi heart disease should be treated with thiamine.

1. Treatment strategies of Stage A HF:

Hypertension and lipid disorders must be treated. Regular exercise must be encouraged. Alcohol, smoking and illegal drug use must be avoided. Ventricular rates must be controlled in patients with supraventricular tachyarrhythmias.

2. Treatment strategies of Stage B HF:

Treatment strategies of Stage A HF are to be followed according to ACC/AHA guidelines.

3. Treatment strategies of Stage C HF:

Hypertension and Myocardial Ischemia must be treated.

Salt or sodium intake can be lowered by the following tips:

Sodium intake in patients with HF must be lowered to 1.6 – 2.0 gm of sodium (4 – 5 gm of sodium chloride). Following points can help in decreasing the intake of salt or sodium:

1. Take foods which are labelled as “low-salt” or “Salt free” or “low sodium” or “sodium free”.

2. Make less use of salt in food.

3. Avoid foods that are high in sodium content.

4. Avoid food containing cheese or sauce and go for the foods which steamed, baked, boiled or grilled.

5. Oil and vinegar are to be used on salads.

6. Fresh fruits must be eaten in dessert.

7. Herbs and spices should be used to flavor food instead of sodium.

Other related terms:

1. Forward heart failure:

It is a phenomena of congestive heart failure that is resulted from inadequate cardiac output. In this, there is inadequacy of renal blood flow and resulting retention of sodium and water.

2. Backward heart failure

The phenomena of congestive heart failure resulting from passive engorgement of the veins caused by a “backward” rise in pressure proximal to the failing cardiac chambers.

3. Right ventricular failure

Congestive heart failure manifested by distention of the neck veins, enlargement of the liver, and dependent edema due to pump failure of the right ventricle.

4. Left ventricular failure

Congestive heart failure manifested by signs of pulmonary congestion and edema, i.e., dyspnea, rales, pulmonary edema, etc.

Medications:

ACE inhibitors like enalapril, captopril and lisinopril, Diuretics such as chlorthalidone, hydrochlorothiazide and furosemide and Digitalis glycosides can be prescribed by physician.

References and Further Reading:

Aronow, W. S. et. al. (2006). Epidemiology, Pathophysiology, Prognosis, and Treatment of Systolic and Diastolic Heart Failure. Cardiology in Review, 14(3), 108-124.

Cowie, M. R. et. al. (1997). The Epidemiology of Heart Failure. European Heart Journal, 18, 208-225.

Moss, A. J. et. al. (2009). Cardiac Resynchronization Therapy for the prevention of Heart Failure Events. The New England Journal of Medicine, 361(14), 1329-1338.

Pittler, M. H. et. al. (2003). Hawthorn extract for treating chronic heart failure: meta-analysis of randomized trials. The American Journal of Medicine, 114(8), 665-674.

Slaughter, M. S. et. al. (2009). Advanced Heart Failure treated with Continuous-Flow Left Ventricular Assist Device. The New England Journal of Medicine.

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001211/ accessed June 27, 2011.

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