Heart failure is a condition in which the heart fails to pump blood adequately throughout the body. In most cases it does not simply mean that the heart has stopped altogether, but rather the heart cannot keep up with the workload required of it. The weakening of the heart’s pumping ability may result in reduced blood flow to the rest of the body, congestion of blood in the veins and lungs, tiredness and tightness of the chest, along with a myriad of other problems that may further weaken the heart. Heart failure can occur in people of any age, even in young children (especially those born with a heart defect). However it is much more common among the elderly because older people are more predisposed to disorders or risk factors that damage the heart (such as smoking, high blood pressure, and high fat diet).
CAUSES OF HEART FAILURE
Any disorder that directly affects the heart can lead to heart failure, as can some disorders that indirectly affect the heart. The leading causes of heart failure include:
- High blood pressure
- Diabetes
- Coronary artery disease can impair large areas of heart muscle because it reduces the flow of oxygen-rich blood to the heart muscle, which needs oxygen for normal contraction. Blockage of a coronary artery can cause a heart attack, which destroys an area of heart muscle. As a result, that area can no longer contract normally.
- Myocarditis (inflammation of heart muscle) caused by a bacterial, viral, or other infection can damage all or part of the heart muscle, impairing its pumping ability.
- Heart valve disorders - narrowing (stenosis) of a valve, which hinders blood flow through the heart, or leakage of blood backward (regurgitation) through a valvecan cause heart failure.
- Disorders that affect the heart's electrical conduction system, producing changes in heart rhythms, (especially if heartbeats are fast or irregular), can cause heart failure.
- Some lung disorders, such as pulmonary hypertension may alter or damage blood vessels in the lungs. As a result, the heart has to work harder to pump blood into the arteries that supply the lungs.
- Sudden, usually complete blockage of a pulmonary artery by several small blood clots or one very large clot (pulmonary embolism) also makes pumping blood into the pulmonary arteries difficult. A very large clot can be immediately life threatening.
- Kidney failure strains the heart because the kidneys cannot remove excess fluid from the bloodstream, so the heart has to pump more blood. Eventually, the heart cannot keep up, and heart failure develops.
WHAT ARE THE SIGNS AND SYMPTOMS OF HEART FAILURE?
Symptoms of heart failure may begin suddenly, especially if the cause is a heart attack. However, in most people, symptoms develop over days to months. People with heart failure feel tired and weak when performing physical activities, because their muscles are not receiving enough blood. In older people, heart failure sometimes causes vague symptoms such as sleepiness, confusion, and disorientation, as well as weakness and fatigue.
The main symptoms of right-sided heart failure are fluid accumulation and swelling (edema) in the feet, ankles, legs, liver, and abdomen.
Left-sided heart failure leads to fluid accumulation in the lungs, which causes shortness of breath. Fluid build-up in the lungs can also cause a cough that is generally worse at night or when lying down.
Some people have severe spasms of the airways (bronchospasms) and wheezing; this condition is called cardiac asthma, which resembles asthma but has a different cause.
Acute pulmonary edema is a life-threatening emergency. When the heart cannot pump a normal amount of blood out of its chambers, blood clots can form because blood flow within the chambers is sluggish. Clots may break loose (becoming emboli), travel through the bloodstream, and partially or completely block an artery elsewhere in the body. If a clot blocks an artery to the brain, a stroke may result.
HOW IS HEART FAILURE TREATED?
The goals of treatment are to: Treat the underlying cause of heart failure Improve the symptoms and quality of life Stop the progression of heart failure Treatment primarily involves the use of medicines and lifestyle changes.
Medicines
Angiotensin-Converting enzyme (ACE) Inhibitors lower the blood pressure and cause blood vessels to widen, thus decreasing the amount of work the heart has to do. These medications may also reduce the risk of a future heart attack. Beta-Blockers slow the heart rate and block excessive stimulation of the heart. These are sometimes used in combination with ACE inhibitors. Cardiac Glycosides increase the force of each heartbeat and slow a heart rate that is too fast. Diuretics help reduce fluid build-up in the lungs and swelling in the feet and ankles. Anticoagulants may be given to prevent clots from forming in the heart chambers. Positive ionotropic drugs may be given intravenously to people with severe symptoms to stimulate heart contractions and help keep blood circulating.
Lifestyle Changes
There are things that can be done to accompany drug treatment.
- Follow a diet low in salt. Salt can cause extra fluid to build up in your body, making your heart failure worse
- Limit the amount of fluids that you drink
- Weigh yourself every day, and let your doctor know right away if you have a sudden weight gain. This could mean you have extra fluid building up in your body.
- Exercise as directed to help build your fitness level and ability to be more active.
- Lose weight if you are overweight.
- Quit smoking if you smoke.
- Limit the amount of alcohol that you drink.