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Heart failure

Heart failure

Also known as congestive heart failure, CHF

Overview

The first thought that comes to your mind when you hear about “heart failure” is that the heart is no longer working and you can’t do anything about it. But this is not true. In reality, heart failure is a condition in which the heart fails to pump enough blood to keep the body functioning.

To put it technically, heart failure is a complex condition that impairs the ability of the lower chambers of the heart (called ventricles) to fill or eject blood due to an underlying structural or functional heart problem. The condition develops over time as the heart muscle becomes weaker or stiffer, which ultimately affects the pumping capacity of the heart. 

 

While the risk of suffering from heart failure increases with age, there are certain factors that can put you at risk even at a young age. These include having a high BMI (body mass index), diseases that damage your heart, and leading an unhealthy lifestyle such as smoking tobacco, eating a high-fat diet, and being physically inactive.

 

Heart failure is a chronic condition which cannot be cured. However, it can be treated with medications which are aimed to manage the symptoms and improve the quality and increase your lifespan. In some cases, medical devices, surgery and even heart transplant is recommended to help the heart function better.



Key Facts

Usually seen in
  • Individuals above 65 years of age
Gender affected
  • Both men and women but common in men
Body part(s) involved
  • Heart
Mimicking Conditions
  • Acute Kidney Injury
  • Acute Respiratory Distress Syndrome (ARDS)
  • Bacterial Pneumonia
  • Cirrhosis
  • Community-Acquired Pneumonia (CAP)
  • Emphysema
  • Interstitial (Nonidiopathic) Pulmonary Fibrosis
  • Myocardial Infarction
  • Nephrotic Syndrome
  • Pneumothorax Imaging
  • Pulmonary Embolism (PE)
  • Respiratory Failure
  • Venous Insufficiency
  • Viral Pneumonia
Specialists to consult
  • Cardiologist
  • Cardiothoracic surgeon
  • Cardiovascular surgeon
  • Interventional cardiologist

Symptoms Of Heart Failure

Before knowing about the symptoms of heart failure, it is important to know what happens in heart failure. 

 

What happens in heart failure?

The heart, which is just the size of your fist, serves the action of continuously pumping blood over the body.  The heart has four chamber: two upper chambers called atria and two lower chambers called ventricles. For the heart to function properly, the four chambers must beat in an organized way.

But in some cases, the heart cannot pump blood with enough force to reach the rest of the organs, or the heart may not get filled with enough blood to meet the demands of other organs. Since the heart ‘fails’ to meet the body's needs for blood and oxygen, the condition is termed as heart failure.

Heart failure can affect the right or the left side of the heart, or even both sides. However, it usually affects the left side first. 


Right-side heart failure: It occurs if the heart is not able to pump adequate blood to the lungs for oxygenation.

Left-side heart failure: It occurs if adequate oxygen-rich blood cannot be pumped by heart to the rest of the organs.


Signs and symptoms to watch out for!

The symptoms of heart failure may start suddenly or progress gradually over weeks or months. The most common symptoms of heart failure and their reasons are listed below: 


Breathlessness: In left-sided heart failure, inefficient pumping of blood causes extra fluid to collect in your lungs, causing rapid and shallow breathing. 

Persistent cough and wheezing: The fluid build-up in lungs can also make you cough and wake up at night. The persistent cough may be accompanied by white or blood-tinged mucus.

Tiredness or fatigue: Since the heart is incapacitated to pump enough blood, the body diverts blood away from less vital organs, particularly muscles in the limbs leading to tiredness.

Swelling of feet, ankles and legs: In right-sided heart failure, fluid may back up into the abdomen, legs and feet, causing swelling.


In addition to the above-listed symptoms, other symptoms that can occur in patients with heart failure are:

  • Loss of appetite
  • Increased heart rate
  • Dizziness
  • Confusion 

In systolic heart failure (also called heart failure with reduced ejection fraction), the left ventricle can't contract vigorously, indicating a pumping problem. In heart failure with preserved ejection fraction, the left ventricle can't relax or fill fully, indicating a filling defect.

Types Of Heart Failure

There are four stages of heart failure, based on severity: 

  • Symptom-free (asymptomatic) heart failure: There are no symptoms, but certain tests can detect that the heart isn't performing as well as it should.

  • Mild heart failure: Strenuous exercises like walking up the stairs causes symptoms like extreme tiredness or shortness of breath. However, mild activity doesn't cause any symptoms.

  • Moderate heart failure: Even everyday activities and light physical exercise, like walking on a level surface, can cause symptoms.

  • Severe heart failure: Symptoms occur at rest or during even the minor physical activity. You can only lie down if your upper body is elevated. Some people with severe heart failure are bedridden.

 

Your heart along with the blood vessels that feed it is one big muscular structure. So, when this structure starts to fail, you can get signs and symptoms anywhere in the body. Here are seven surprising clues that your heart needs a check.


Causes Of Heart Failure

Most people who develop heart failure have (or had) another heart condition first. The most common conditions that can lead to heart failure are:

  • Coronary artery disease: It causes build-up of plaque (fatty deposits) in the arteries that supply blood to your heart muscle leading to narrowing of the blood vessels. 

  • Heart attack (myocardial infarction): It reduces/blocks blood flow to the heart muscle and impacts the heart’s ability to pump blood.

  • Cardiomyopathy (heart muscle disease): These diseases of the heart muscle may lead to left ventricle dysfunction and damage the heart muscles and change the structure of your heart making it harder for your heart to pump blood.

  • Valvular Heart Disease (Disease of heart valves): Rheumatic fever may permanently damage the heart valves leading to heart failure.

  • Hypertension (High blood pressure): When the blood pressure is high, your heart has to pump harder than normal to maintain blood circulation. 

  • Atrial fibrillation (AF): It refers to the irregular and rapid beating of the heart. It is both a cause and consequence of heart failure. 

  • Untreated congenital heart defects: Although rare, it is a condition in which the heart and its chambers may not be formed correctly at birth.

  • Anemia: Anemia can worsen cardiac function and add further stress to the heart, which may lead to heart failure.

  • Infections: Infections activates the body’s immune response, generating inflammation that causes rupture and blockages that lead to heart failure.

#Factcheck
Heart failure should not be confused with cardiac arrest.
#Factcheck

Risk Factors For Heart Failure

You can know your risk of having heart failure by taking a look at the following modifiable and non-modifiable risk factors.

Non-modifiable factors

Age: By the time you get older, diseases you may have been suffering from for many years like coronary artery disease, diabetes, hypertension, etc. might have damaged your heart, increasing the risk of heart failure.

Gender: Women are at a higher risk of heart failure if they have hypertension, while men are greatly impacted if they have coronary artery disease.

Race/ethnicity: Race/ethnicity can be a risk factor for heart failure. Heart failure strikes young in black-skinned people, particularly men, and people of Hispanic (Spanish) origin. 

Genetic predisposition: Growing numbers of Indians are being afflicted and genetic predisposition is one of the reasons. Indians have high levels of lipoprotein (a), a type of cholesterol, which is reported to accentuate the risk associated with other risk factors of heart failure.

Modifiable factors
Some of the conditions that can up your risk of heart failure (but can be managed) include:

  • Heart disease
  • Diabetes mellitus
  • Sleep apnea
  • Obesity
  • Lifestyle factors such as smoking

Diagnosis Of Heart Failure

To diagnose heart failure, your doctor will take a careful medical history, review your symptoms and perform a physical examination. Your doctor will also check for the presence of risk factors, such as high blood pressure, coronary artery disease or diabetes. Tests you may have to undergo to diagnose heart failure include:

1. Blood tests: Some of the common blood tests that can help determine heart failure and its impact on other organs include

  • Electrolytes (sodium, potassium)
  • Blood glucose test
  • Serum creatinine
  • Albumin
  • BUN (blood urea nitrogen)
  • Estimated glomerular filtration rate (eGFR)
  • Thyroid-stimulating hormone (TSH) tests


2. Chest X-ray: It shows accumulation of fluid in the lungs & and enlargement of heart in patients with heart failure. 


3. Electrocardiogram (ECG): It is an important diagnostic method for determining heart failure associated with conditions like myocardial infarction, atrial fibrillation, abnormalities in heart rhythm, or acute ischemia. 


4. Echocardiogram: An echocardiogram is a diagnostic test, which is used to determine the function of the lower chambers of the heart and differential diagnosis of acute heart failure. This test is for emergency purposes, where it is used to determine volume of the blood in the heart, mass, and valve functioning of the heart. 

Prevention Of Heart Failure

Prevention of diseases that damage the heart is the best way to keep heart failure at bay. If you suffer from any of the conditions that cause heart failure, then prompt, optimal management of the condition is important. Recognizing and avoiding all the factors that may lead to or contribute to heart failure can help prevent the development of the condition. 

 

  • Eat healthy

  • Maintain a healthy weight

  • Quit tobacco use

  • Limit your alcohol intake

  • Keep yourself physically active

 

For patients at risk of developing heart failure, screening for natriuretic peptide biomarkers and early intervention may prevent the condition.

 

To help you prevent heart disease and lead a healthy life, here are a few tips that every cardiologist wants you to know.

Specialist To Visit 

If you experience any symptoms of heart failure, do not take them lightly. It is best to consult a doctor who will evaluate the underlying cause of these problems and also assess the functioning of your heart. Any of these signs, particularly two or more together, should send you to the doctor for further assessment and tests. 

In addition to a general physician, specialists who can help to diagnose and treat heart failure include:

  • Cardiologist
  • Cardiothoracic surgeon
  • Cardiovascular surgeon
  • Interventional cardiologist

We all know that a heart specialist is an expert who specializes in diagnosing, treating and preventing heart-related illness and complications. However, not all cardiologists or heart specialists are the same. Here’s more on the types of heart specialists and who you should consult for various heart problems.



Treatment Of Heart Failure

The risk of heart failure can definitely be lowered by home-based lifestyle modifications like diet and exercise, but once you have been diagnosed with heart failure, it may become necessary to take certain medications or go for a surgery.

Medications: People suffering from heart failure may need multiple medications for their condition. These medications are beneficial in treating and preventing heart failure. Whereas some of the medications help in improving sodium excretion, exercise tolerance, and cardiac function. The medicines that are commonly used in congestive heart failure are:

  • Diuretics:Also known as water pills, these  drugs work by removing extra water and certain electrolytes from the body thereby increasing the amount of urine produced & aiding in controlling hypertension and treating heart failure. Examples of drugs that belong to this class include:Furosemide, Hydrochlorothiazide.
  • Angiotensin-converting enzyme inhibitor (ACE inhibitors):They work by reducing stress on the heart and relaxing blood vessels so that blood flows more smoothly and the heart can pump blood more efficiently. Examples includes Captopril, Enalapril.
  • Beta-blockers : These work by affecting the body’s response to nerve impulses, especially in the heart. It slows down your heart rate and makes it easier for the heart to pump blood around the body. This prevents arrhythmia, stabilizes blood pressure and prevents a heart attack. It also widens the blood vessels in the body for better blood flow, thereby preventing angina as well as migraine. Some of the common drugs include:Propranolol, Metoprolol & Atenolol.
  • Aldosterone antagonists: Also known as water pills or diuretics, it lowers blood pressure and swelling by removing the extra water and electrolytes from the body without loss of potassium. The more you pee, the more excess salt and water you flush out of your body. This makes it easier for your heart to pump. These drugs are used to treat high blood pressure and heart failure. Some of the common examples include: Spironolactone & Eplerenone.
  • Angiotensin II receptor blockers (ARBs): This class of drug relaxes blood vessels by blocking the action of a chemical that usually makes blood vessels tighter. This lowers the blood pressure, allowing the blood to flow more smoothly to different organs and the heart to pump more efficiently. Examples of the common medicines in this category are: Telmisartan, Losartan & Olmesartan.

Other drugs

  • Sacubitril+valsartan is an angiotensin receptor neprilysin inhibitor (ARNI). This combination treats heart failure by relaxing the blood vessels and making it easier for your heart to pump blood throughout your body. 
  • Ivabradine reduces the heart rate which lowers the oxygen requirement of the heart. As a result, the heart works more efficiently.
  • Isosorbide Dinitrate + Hydralazine is a combination drug. Isosorbide dinitrate relaxes the blood vessels and decreases the oxygen demand of the heart whereas hydralazine lessens tolerance to isosorbide dinitrate, thereby preserving its capacity to relax blood vessels. 
  • Dapagliflozin is commonly used to treat diabetes but recently this medicine is also used in patients with heart failure and reduced ejection fraction. It is also known to reduce cardiovascular events and deaths due to heart failure.Surgical process & devices for heart failure. 

Surgical process & devices for heart failure

Heart transplantation
: You may need a heart transplant if your heart muscle function continues to deteriorate despite treatment. People with end stage heart failure and those with congenital heart disease require heart transplantation.

Angioplasty: Angioplasty is the procedure for opening up the blocked blood vessels that can restrict the blood supply to the heart muscle ( a major cause of heart failure).
 

Coronary artery bypass: The procedure of coronary bypass redirects a blood supply around a blocked artery. 

Valve replacement: A defective or diseased valve can be a major cause of heart failure. In valve replacement, a faulty heart valve is replaced by a mechanical valve made out of metal or plastic. 

Devices For Heart Failure

Implantable cardiac defibrillator (ICDs):
It is a small battery-powered device placed in your chest to detect and stop abnormal heartbeats. This device delivers electric shocks inside the heart to restore a normal heart rhythm. 

Cardiac resynchronization therapy (Biventricular Pacing): This is also called biventricular pacing, using a special kind of pacemaker.  It is a treatment for heart failure in people whose ventricles don't contract at the same time.

Ventricular assist devices (VADs): This is also known as  a mechanical circulatory support device, which is an implantable mechanical pump that helps pump blood from the lower chambers of your heart (the ventricles) to the rest of your body.  A VAD is used in people who have heart failure or temporarily by patients waiting for a heart transplant or heart recovery from injury.

Home Care For Heart Failure

Simple changes in your lifestyle can be a major contributing factor in alleviating the symptoms of heart failure. Some of the lifestyle changes are:

Quit smoking: Smoking is known to increase heart rate and blood pressure, so it is important to quit smoking in order to improve the symptoms of heart failure. 

Check out smoking cessation range

Limit your alcohol intake: Drinking excessive alcohol can increase the levels of certain fats known as triglycerides in your blood. This when combined with cholesterol tends to clog the arteries and increase the risk of heart failure. Thus, it is important to keep your alcohol intake moderate. 

 

Maintain a healthy weight: Obesity is a known factor that worsens heart failure. Hence, it is important to maintain a healthy weight. 


Keep a check on fluid intake: patients suffering from heart failure tend to retain fluid, therefore it is important to consult your doctor on how much fluid you can consume in a day.

 

Stay physically active: Moderate exercise is an integral part of a healthy heart regimen. You can consult your doctor on which exercise to do in case you are at risk of heart failure. 

Find out how yoga can keep your heart healthy.


Eat a heart-friendly diet:
While you are limiting your consumption of trans fat, saturated fats, cholesterol, red meat, and sugary foods, you must pay attention to heart-friendly foods. Foods that are good for your heart include green leafy vegetables, fruits, nuts, whole grains & low-fat dairy products. 


Keep stress at bay: For stress-relieving, you can try yoga and meditation or deep breathing exercises.

Did you know?
The risk of coronary heart disease reduces by 50% as compared to that of a smoker’s after a year you quit smoking. Moreover, after quitting smoking the blood circulation improves within 2 – 12 weeks. Click to know more about smoking & heart health.
Did you know?

Complications Of Heart Failure

Some of the common health complications of heart failure include:

  • Arrhythmias or conditions such as atrial fibrillation; ventricular arrhythmias (ventricular tachycardia, ventricular fibrillation) and bradyarrhythmias are quite common in people suffering from heart failure. Atrial fibrillation is present in about a third (range 10-50%) of patients with chronic heart failure and may represent either a cause or a consequence of heart failure.

  • Thromboembolism can also occur if heart failure is not treated. Conditions that fall under this category include stroke; peripheral embolism ; deep venous thrombosis and pulmonary embolism.

  • Gastrointestinal conditions such as hepatic congestion and hepatic dysfunction and malabsorption are also seen in people suffering from heart failure.

  • Muscle wasting is also a common complication seen in people suffering from heart failure.

  • Respiratory conditions such as pulmonary congestion; respiratory muscle weakness and pulmonary hypertension (rare) are also seen.

Living With Heart Failure

Here are a few ways how people suffering from heart failure can improve their quality of life and lead a healthy life.

Track and manage your symptoms: Patients with heart failure present with a variety of symptoms, most of which are non-specific. The common symptoms of congestive heart failure include fatigue, dyspnoea, swollen ankles, and exercise intolerance, or symptoms that relate to the underlying cause. So if you experience any symptoms of heart failure or worsening of the symptoms, then do report to your doctor. Also, keep a tab of your symptoms to understand how your condition is faring with time.

Coordinate with your doctor: The way in which heart failure continues to develop over time varies from person to person, depending on things like what is causing it and whether they have other medical conditions. In some people the symptoms can be kept under control for many years. But sometimes the heart becomes weaker after a short amount of time. 

Follow a proper medication regimen: It is a good idea to develop a medication regimen together with your doctor, to avoid interactions between different drugs. Non-prescription medications should be included too. For instance, non-prescription painkillers like diclofenac and ibuprofen aren’t suitable for people who have heart failure because they add to the burden on the kidneys.

Be physically active: There are special heart exercise programs for people with heart failure, with a focus on individually adjusted training to build up their stamina and muscles. These programs can improve physical fitness and quality of life. 

Learn about your condition: Patients need to be educated on the importance of maintaining a healthy body weight, discontinuation of smoking, controlling blood pressure and ensuring normoglycemia. Get in touch with experts as heart failure is a serious disorder that is best managed by an interprofessional team. For example, dietitians can help educate the patient on the importance of a low salt diet and limiting fluid intake. Healthcare professionals can advise the patient on the importance of exercise, avoiding stress, and ensuring follow-up with the cardiologist.

Keep a watch on your diet and weight: Restrict your fluid intake to 1.5 L/day. Weigh yourself daily at the same time each day. See your doctor immediately if you gain weight >2kg/week. Limit alcohol intake. Quit smoking as the chemicals in tobacco can damage the function of your heart and blood vessels. Here is a sample diet chart to get an idea.


Get vaccinated: Flu and pneumonia pose greater dangers for people who have heart failure (or any heart condition) than for healthy people. Ask your doctor about getting a yearly influenza (flu) vaccine and a one-time pneumococcal vaccine. Pneumonia is a lung infection that keeps your body from using oxygen as efficiently as it should. Your heart has to work harder to pump oxygenated blood through the body. If you have heart failure, you should avoid putting this extra stress on your heart.

Celebs affected

Elizabeth Taylor
The legendary American actress was diagnosed with congestive heart failure in 2004, however she breathed her last in the year 2011 at the age of 79 years.

Frequently Asked Questions

References

  1. Malik A, Brito D, Chhabra L. Congestive Heart Failure. [Updated 2021 Feb 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan.External Link
  2. What is Heart Failure? The American Heart Association (AHA). External Link
  3. InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Heart failure: Overview. 2006 Feb 14 [Updated 2018 Jan 25].External Link
  4. Anter E, Jessup M, Callans DJ. Atrial fibrillation and heart failure: treatment considerations for a dual epidemic. Circulation. 2009 May 12;119(18):2516-25. External Link
  5. Devices and Surgical Procedures to Treat Heart Failure. The American Heart Association (AHA). Last Reviewed: May 31, 2017. External Link
  6. Gomberg-Maitland M, Baran DA, Fuster V. Treatment of Congestive Heart Failure: Guidelines for the Primary Care Physician and the Heart Failure Specialist. Arch Intern Med. 2001;161(3):342–352. External Link
  7. Medications Used to Treat Heart Failure. The American Heart Association (AHA). Last Reviewed: May 31, 2017. External Link
  8. Ural D, Çavuşoğlu Y, Eren M, et al. Diagnosis and management of acute heart failure. Anatol J Cardiol. 2015;15(11):860-889. External Link
  9. Lifestyle Changes for Heart Failure. The American Heart Association (AHA). Last Reviewed: May 31, 2017. External Link
  10. Is drinking alcohol part of a healthy lifestyle? The American Heart Association (AHA). Last Reviewed: May 31, 2017. External Link
  11. McMurray JJV, Solomon SD, Inzucchi SE, et al; DAPA-HF Trial Committees and Investigators. Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction. N Engl J Med. 2019 Nov 21;381(21):1995-2008.External Link
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