Causes and Management for Heart Failure

What Is the Function of Blood?

Every organ of our body needs the energy to work. This energy is provided by our food and the oxygen we inhale. Food and oxygen are carried to every organ through a medium called blood.

How Is Blood Circulated Throughout the Body?

The heart is an organ that pumps blood to the whole of our body, including the brain, lungs, intestines, kidneys, muscles, skin, and itself. Blood carries nutrients and oxygen that are used by these organs to survive.

There are two sides of the heart, which work independently. The left side pumps blood to the whole body through channels called arteries. After providing nutrients and oxygen to organs, this blood returns to the heart's right side through channels called veins. The right side pumps blood to the lungs to get oxygen; after taking oxygen, blood returns to the heart's left side, and the cycle repeats.

What Is Heart Failure?

Due to any cause, if the heart's muscles become weak, the heart cannot pump blood to the whole body or lungs properly, and the requirements of the body and organs are not met. This condition is called heart failure.

What Are the Types of Heart Failure?

1. Left Heart Failure:

If the left side of the heart fails, blood cannot be pumped forward to the body. It pools up in the heart, exerts a backward pressure to the lungs, and blood accumulates in the vessels of the lungs. This increases the pressure of lung vessels, and fluid leaks from vessels and pools outside the vessels. This causes the symptoms of shortness of breath, cough, and frothy secretions on coughing.

2. Right Heart Failure:

In the same way, if the right side of the heart fails, it cannot pump blood to the lungs, and blood pools up in backward vessels in the limbs and other organs. When pressure increases, it causes fluid to leak out of vessels, and thus it causes swelling of legs, swelling of internal organs such as liver, intestines, etc.

3. Heart Failure with Preserved Ejection Fraction:

In this type, there is a problem with the left ventricle's relaxation, resulting in incomplete filling of the left ventricle.

4. Systolic Heart Failure:

A problem with pumping in the left ventricle due to inadequate contraction of the left ventricle is called systolic heart failure. It is also known by the name heart failure with reduced ejection fraction.

What Causes Heart Failure?

1. The most important and common cause of the weakness of the heart is when the heart itself cannot get enough blood, as in the case of a heart attack.

2. Other causes include any leakage of heart valves or blockage. Sometimes, this condition runs in families; children may get it if parents or relatives have it. It may also be due to any defect in the development of the heart in the womb and thus present since birth; it may manifest soon after birth or later. These are congenital heart defects.

3. Inflammation of the heart due to infection with a virus is called myocarditis, resulting in left-sided heart failure.

4. Increased blood pressure also poses a problem. When there is a raised pressure, the exertion of the heart also increases, meaning that your heart has to pump harder. Thereby leading to stiffening or weakening of heart muscles.

5. An irregularity in the heart rhythm (arrhythmia) can bring about extra work for your heart, thus resulting in heart failure.

6. Damage in the heart valves causes the heart to work harder and might end up in heart failure. An infection to the heart, coronary artery disease, and a defective valve can damage a heart valve.

7. Certain chronic medical conditions like diabetes, thyroid disorders, HIV (Human immunodeficiency virus), or the build-up of protein or iron can cause heart failure.

8. In addition to this, allergic reactions, intake of certain drugs, and blood clots in the lungs can also cause heart failure, but this type of heart failure is acute in onset.

How Is Heart Failure Manifested?

• Weakness.

• Shortness of breath with exertion or at rest.

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• Nausea.

• Appetite loss.

• Irregular heart rate.

• Swelling involving the lower extremities.

• Abdominal swelling.

• Persistent cough, sometimes accompanied by a white or pink blood-tinged mucus.

• Difficulty concentrating.

• Doing exercises becomes difficult.

• When caused by a heart attack, chest pain is seen in heart failure.

What Increases the Risk of Developing Heart Failure?

• Cardiac arrhythmia.

• Diabetes.

• Obesity.

• Smoking.

• Hypertension.

• Coronary artery disease.

• Sleep apnea.

• Certain drugs like non-steroidal anti-inflammatory drugs, anesthetics, antihypertensive drugs, and drugs used to treat inflammatory diseases, mental health disorders, blood disorders, nervous dysfunctions, infections, cancer, etc.

• Alcoholism.

• Valvular heart diseases.

• Heart attack.

• Congenital heart defects.

• Viral infection.

How Can We Diagnose Heart Failure?

1. Medical History:

The medical history of the patient aids in determining the causes. Therefore a complete medical history is taken.

2. Physical Examination:

The build-up of fluid in the lungs or heart murmurs can be identified by physically examining the patient with the help of a stethoscope. Also, swelling in the legs and abdomen are checked.

3. Blood Examination:

It helps in identifying the underlying cause of heart failure.

4. Echocardiogram:

With sound waves, the heart and heart valves are checked for their size and structure, and blood flow within the heart is checked.

5. Electrocardiogram:

This test displays the length and timing of the heartbeat to look for any abnormality by recording the heart's electrical signals.

6. Cardiac CT Scan:

In a cardiac computerized tomography scan, the picture of the heart and chest is obtained that helps in diagnosis.

7. Stress Test:

It is also called the treadmill test. In this test, the patient is asked to walk on a treadmill, and the heartbeats are simultaneously recorded with an ECG.

8. Magnetic Resonance Imaging:

It is an imaging test that produces a picture of the heart to help in diagnosis.

9. Myocardial Biopsy:

To diagnose heart failure caused by any heart muscle disease, a small tissue of the heart muscle is removed. The tissue is removed by inserting a small cord into the vein.

10. Coronary Angiogram:

Any blockage in the coronary arteries supplying the heart is identified with a coronary angiogram by inserting a catheter through a blood vessel in the groin.

What Is the Management of Heart Failure?

A. Symptomatic Treatment:

1. Gravity exerts a detrimental effect, so doctors advise keeping affected organs propped up.

2. Lying straight on the bed will cause increased blood pooling in the lungs, and symptoms will worsen. Legs hanging down will also cause increased swelling in case of right heart failure. So, lying at 45 degrees and keeping legs above the heart level will decrease symptoms.

3. Moreover, doctors give some oral or IV medicines that cause increased urination, and negative water balance occurs in the body. The fluid leaks outside the vessels, moves inside and gets excreted in the urine.

4. Salt increases the osmolality of body fluids; thus, the body retains more water instead of excreting it into the urine. So, doctors advise decreasing liquid and salt intake.

B. Medical Treatment:

The following list of medications are used in the treatment of heart failure:

• Angiotensin-converting enzyme inhibitors like Captopril, Enalapril, and Lisinopril.

• Beta-blockers like Metoprolol, Carvedilol, and Bisoprolol.

• Angiotensin II receptor blockers like Losartan, Candesartan, and Valsartan.

• Aldosterone antagonists like Eplerenone and Spironolactone.

• Diuretics like Furosemide.

• Digoxin.

• Combination of Hydralazine and Isosorbide dinitrate.

• Positive inotropes.

• Vericiguat.

• Blood thinners can be given to reduce cholesterol levels.

C. Surgical Treatment:

1. Coronary Bypass Surgery:

When there is a blockage in several arteries, coronary artery bypass surgery is recommended. A blood vessel from the arms, legs, or chest is taken and is connected above and below the blocked part of the artery. This helps in bypassing the blockage.

2. Repair or Replacement of Heart Valves:

A defect in the heart valves can either be repaired or replaced. It can be done through cardiac catheterization or open-heart surgery.

3. Cardiac Resynchronization Therapy:

When there is a non-coordination between the ventricles in pumping, a biventricular pacemaker is placed to correct it in a procedure called biventricular pacing or cardiac resynchronization therapy.

1. In addition, ventricular assistive devices and implantable cardioverter-defibrillators are also used to treat heart failure.

2. When all other treatment modalities fail, then a heart replacement is recommended.

What Are the Complications of Heart Failure?

The following are the complications of heart failure:

• Renal failure.

• Problems with heart rhythm.

• Improper working of heart valves.

• Damage to the liver.

What Lifestyle Changes Help Prevent Heart Failure?

Preventing risk factors plays a crucial role in reducing the risk of developing heart failure. Below are the preventive measures that can be followed to prevent heart failure:

1. Avoid smoking.

2. Only take medications that your physician prescribes.

3. Be physically active.

4. Avoid alcohol.

5. Reduce stress.

6. Maintain healthy body weight.

7. Eat a nutritious and healthy diet.

8. Keep your blood pressure and blood glucose level in control.

Conclusion:

Heart failure can be fatal if not appropriately managed and intensively. Severe patients may need admission in a ward or ICU (intensive care unit) for mechanical ventilation. However, heart failure can be managed effectively when prompt treatment is sought. Also, following the preventive measures can help reduce the chance of developing heart failure.