Decompensated Heart Failure - Causes, Diagnosis, and Treatment

Introduction

Decompensation is a medical term that refers to the destruction of a structure or organ system that was functioning previously. Decompensated heart failure is when the heart can no longer compensate for its defects. It stops functioning properly and cannot manage the amount of blood in the circulatory system. This results in pressure buildup and fluid retention in and around the heart. The pressure buildup, in turn, can cause severe stress on the heart that requires immediate medical intervention.

What Is Decompensated Heart Failure?

Decompensated heart failure is also called acute decompensated heart failure. It occurs in patients with pre-existing heart failure and left ventricular dysfunction. The symptoms of heart failure worsen due to fluid retention. These worsened symptoms can impact the patient's quality of life and day-to-day activities. For example, excess fluid accumulation in the lungs can cause congestion, coughing, wheezing, and an inability to lie down. Patients also develop fatigue and breathing difficulties, making it difficult to perform even daily activities without discomfort.

How Is It Classified?

According to New York Heart Association classification, this scale groups heart failure into four categories:

• Class 1 Heart Failure: There are no heart failure symptoms.

• Class 2 Heart Failure: Day-to-day activities can be done without difficulty, however exertion causes shortness of breath.

• Class 3 Heart Failure: It is difficult to complete everyday activities.

• Class 4 Heart Failure: Shortness of breath is experienced by patients even at rest. This group includes the most severe heart failure.

What Are the Causes of Decompensated Heart Failure?

Chronic heart failure can rapidly deteriorate for many reasons:

• Heart attack.

• A severe illness.

• Patients not being unable to comply with treatment for heart failure.

• Changes in diet like eating more salt,and increasing fluid intake.

• Not taking the prescribed medications properly.

• Worsening of other chronic conditions like high blood sugars in diabetics, chronic obstructive pulmonary disease (a set of lung disease that causes breathing difficulties), infections, or kidney problems.

• Underlying cardiac conditions can worsen and contribute to decompression, such as poorly controlled blood pressure, heart attack, or arrhythmias (heartbeats become irregular).

What Are the Symptoms of Decompensated Heart Failure?

Symptoms of decompensated heart failure include

• Shortness of breath.

• Fluid retention.

• Fatigue.

• Exertional dyspnea (difficulty in breathing during physical activity).

• Orthopnea (difficulty in breathing while lying flat).

• Paroxysmal nocturnal dyspnea (sudden shortness of breath that starts soon after falling asleep).

• Edema (increased swelling).

The other symptoms include

• Chest pain.

• Arrhythmias.

• Nausea.

• Weight loss.

• Change in urinary output.

• Anxiety and confusion.

• Memory problems.

These symptoms may conclude advancing heart failure.

How Can It Be Diagnosed?

To diagnose, the doctor will note the medical history, review the symptoms and perform a physical examination. After the physical examination, the doctor may also order some of the below tests:

• Blood Tests: Blood tests assess the parameters of heart diseases.

• Natriuretic peptide tests (NP Tests): In cases where the lower chambers of the heart are under severe stress, there is a release of BNP (brain natriuretic peptide) and NT-pro BNP into the blood. NT-pro BNP levels above 450 pg/mL (picograms per milliliter) in people below 50 and above 900 pg/mL in people over 50 suggests heart failure.

• Chest X-ray: X-ray images help determine the condition of the lungs and heart.

• Electrocardiogram: This quick and painless test records the electrical signals of the heart and can show the timing and length of the heartbeats.

• Echocardiogram: This test uses sound waves to produce heart images during function. It also shows the heart's size, structure, valves, and blood flow through the heart.

• Stress Test: Stress tests measure the heart's health during activity. The patient will be asked to walk on a treadmill when connected to an ECG (electrocardiogram) machine or may receive an intravenous drug that stimulates the effect of exercise on the heart. Some get oxygen and breathe out carbon dioxide.

• Cardiac Computerized Tomography: In this, the patient lies on a table, and a machine rotates around the body that collects images of the heart and chest.

• Magnetic Resonance Imaging (MRI): Patients lie on the table inside a long tubelike machine in cardiac MRI. Radio waves create images of the heart and are performed by using a dye.

• Coronary Angiogram: A test in which a thin and flexible tube is inserted into a blood vessel and guided towards the heart vessels. A dye is injected into the catheter, making the heart's arteries visible on an X-ray.

• Myocardial Biopsy: An invasive procedure in which the doctor obtains a small piece of heart tissue with a specialized instrument called a bioptome and sends it to the laboratory for further analysis.

• Pulse Oximetry: Pulse oximetry determines the oxygen levels in the blood. An oxygen saturation level, lower than 90 percent indicates heart failure and less oxygen supply to various body parts.

How Is Decompensated Heart Failure Treated?

Patients with decompensated heart failure require immediate medical attention. The treatment options include

1. Oxygen - Supplemental oxygen may be administered if blood oxygen levels are low.

2. Medication - Medicines that can help regulate blood flow include angiotensin-converting enzymes, beta-blockers, inotropic agents, and opioids.

3. Vasodilators - Nitrates such as Nitroglycerin are often used as part of initial therapy.

4. Diuretics - Those with evidence of fluid overload should be treated initially with intravenous loop diuretics like Furosemide.

5. Ventilation - Continuous positive airway pressure may be applied using a face mask to improve symptoms more quickly than oxygen therapy alone.

6. Ultrafiltration - It removes the fluids in decompensated heart failure patients associated with kidney failure.

7. Surgery - Heart failure caused by acute aortic regurgitation is a surgical emergency that is associated with high mortality. The surgical process includes two types of surgery: Bypass surgery, which removes an artery from the chest or a vein from the arm or leg or and replaces the blocked artery in the heart. The other is a pacemaker, a small device placed in the chest or abdomen to control abnormal heart rhythm.

Conclusion:

Decompensated heart failure is a severe heart failure affecting patients with already existing heart failure. It can cause death if left unattended or untreated. The triggers and causes that can lead to the condition must be avoided with constant effort by the patient and their family. Apart from the medication, a few measures can prevent a person from getting into heart problems, including a healthy lifestyle like low salt intake, avoiding high-fat foods and snacks, and regular exercise with proper fluid intake.