Heart failure, also known as congestive heart failure, is a condition in which the heart is unable to pump enough blood to the body’s organs and tissues. When it occurs, heart failure leads to pulmonary stasis with an accumulation of fluid in the lungs (pulmonary edema) and dyspnoea. Certain cardiovascular pathologies with chronic evolution such as hypertension and coronary artery disease can lead over time to the stiffening of the heart muscle or weakening of the muscle fibers that make up the heart muscle, with the main consequence of a decrease in pump function.
Risk factors and causes of heart failure
The risk factors involved in the development of heart failure are:
Heart Failure Tests | Investigations for diagnosing heart failure
How the diagnosis is established
Heart failure can cause systolic dysfunction (deficit of heart contraction) or diastolic dysfunction (deficit of heart relaxation), the two phases of cardiac activity that follow one another uninterrupted throughout life. During systole, the heart contracts and generates pressure within the chambers, thus pumping blood to the arteries, and during diastole, the myocardium relaxes, taking in oxygenated blood from the lungs. With each contraction, the heart ejects a certain volume of blood into the arteries, providing the optimal oxygen and nutrient requirements for the entire body.
Heart failure can be classified as follows: Left HF (causes fluid accumulation in the lungs with dyspnoea), right HF (causes fluid accumulation in the abdomen and peripheral lower limb edema), systolic HF (left ventricle does not contract properly) and HF with preserved ejection fraction (left ventricle does not relax properly in diastole).
Heart failure is a preventable condition that can be prevented by proper treatment of coronary heart disease, hypertension and diabetes, but also by giving up alcohol and tobacco consumption and maintaining a height-appropriate body weight.
Symptoms of heart failure
Heart failure can have a chronic course or it can start suddenly, frequently causing the following symptoms and manifestations:
- Dyspnea on exertion or at rest
- General weakness and marked fatigue
- Peripheral edema of the lower limbs
- Heart rhythm disturbances
- Persistent coughing with or without wheezing, through which airy pulmonary secretions with bloody streaks are expelled
- Fluid accumulation in the abdominal cavity
- Lack of appetite
- Difficulty concentrating
- Precordial pain if acute heart failure is caused by an acute coronary event (myocardial infarction)
Risk factors and causes of heart failure
The main causes of systolic heart failure are:
- Smoking
- High blood pressure
- Diabetes mellitus
- Myocardial infections
- Primary cardiomyopathies of genetic cause
- HIV infection
- Thyroid diseases.
- As a result of the action of these factors, pump failure occurs, causing a decrease in the volume of ejected blood/blood beats and a reduction in the perfusion of organs with oxygenated blood. Secondarily, pulmonary stasis occurs due to decreased blood uptake by the heart, followed by pulmonary and then systemic congestion
Diastolic dysfunction in patients with heart failure is less common in medical practice and is due to insufficient blood filling of the heart chambers, occurring in the context of a reduced capacity for cardiac distension caused by infiltrative diseases, untreated hypertension that over time causes stiffening of the heart muscle or pericardium (lining that covers the heart) diseases that exert cardiac constriction, preventing adequate cardiac filling in diastolic.
The risk factors involved in the development of heart failure are:
Chronotropic dysfunction and desynchronization: dysfunction of the electrical system of the heart manifested by tachycardia or bradycardia together with inefficient electrical conduction at the cardiac level, causes over time a decrease in cardiac performance with the progressive onset of specific pump failure.
Valvular dysfunction: inadequate opening and closing of valves secondary to acute joint rheumatism, endocarditis or congenital anomalies leads to congestive heart failure.
Acute heart failure can be caused by severe allergic reactions, thrombus formation in the lungs, sepsis, viral infections with cardiac tropism and the administration of certain drugs.
Heart Failure Tests | Investigations for diagnosing heart failure
Paraclinical investigations that can be used to diagnose heart failure are:
- Laboratory investigations for the determination of atrial natriuretic peptide ANP and brain natriuretic peptide BNP – serum markers are useful in the assessment of heart failure due to their natriuretic and diuretic properties that influence the body’s electrolyte water balance.
- Pro BNP (B-type natriuretic peptide BNP) and NT pro-BNP – serum markers with prognostic value in left ventricular heart failure due to their good correlation in clinical studies with the severity of left ventricular dysfunction. These markers can be used as recommended by the cardiologist to monitor the therapeutic response of the heart failure patient and to assess the degree of vascular remodeling.
How the diagnosis is established
The diagnosis of heart failure is established by the specialist based on the information obtained from the patient’s history, clinical examination and paraclinical investigations, which may include: electrocardiogram, echocardiography, stress echocardiography, HOLTER monitoring, myocardial perfusion scintigraphy, cardiac computed tomography, cardiac magnetic resonance, coronary angiography or cardiac catheterization.
After the investigations, the doctor may classify the heart failure into one of 4 stages as follows:
- Grade I heart failure with asymptomatic evolution
- Grade II heart failure with limitation of the patient’s effort capacity by the appearance of dyspnea and marked fatigue
- Heart Failure grade III daily activities are performed with difficulty
- Grade IV heart failure the most severe type of heart failure causes dyspnea at rest
Treatment of heart failure
Treatment of heart failure includes as a first step lifestyle modification which involves:
- Dietary adjustment to prevent weight gain or normalize it
- Smoking cessation
- Limiting excessive alcohol consumption
- Limiting salt consumption
- Avoiding physical exertion is recommended
- Taking certain medicines (non-steroidal anti-inflammatory drugs) which are contraindicated in certain forms of heart failure
- Limiting fluid intake to less than 2 litres per day is recommended in selected cases of advanced heart failure
Drug treatment of patients with heart failure is mainly aimed at lowering blood pressure, achieving vasodilation and salt and water removal by increasing diuresis with antihypertensives, vasodilators, angiotensin-converting enzyme inhibitors and diuretics. In certain situations where heart failure is accompanied by heart rhythm disturbances, antiarrhythmics and beta-blockers may be administered while severe HF requires mandatory hospitalization for close monitoring and intravenous treatment.
Interventional and surgical treatment options for patients with heart failure are aimed at correcting the cause of specific symptoms and include:
- Cardiac pacemaker implantation, electrical resynchronization and the use of a defibrillator to correct the electrical dysfunction of the heart.
- Stenting, bypass surgery to restore coronary blood flow in ischemic heart disease leading to HF
- Replacement or reconstruction of damaged heart valves in case of valve dysfunction
Severe cases that do not respond to the previously mentioned interventional and/or surgical treatment methods may currently benefit from heart and/or lung transplantation if the patient is eligible for this type of major intervention.
If you have symptoms associated with cardiovascular disease, contact your doctor for a specialist consultation!
References:
- Clinical epidemiology of heart failure, Arend Mosterd, Arno W. Hoes, BMJ Journals | Heart
- Epidemiology of heart failure, Amy Groenewegen, Frans H. Rutten, Arend Mosterd, Arno W. Hoes
- The Management of Chronic Heart Failure, Jay N. Cohn, The New England Journal of Medicine
- The pathophysiology of heart failure, Clinton D. Kemp, John V. Conte
