Symptoms of Heart Failure And Methods Of Diagnosis

If heart failure is caused by a heart attack, the onset of symptoms may be sudden. However, symptoms of heart failure may be completely absent initially, but as the condition worsens, symptoms develop gradually over a period of time. Shortness of breath and fatigue are usually the most common first symptoms of heart failure. Drowsiness and disorientation could be signs of heart failure that go unnoticed in older people. Heart failure may be treated and managed for a considerable time but it is progressive in nature and steadily deteriorates.

Right-sided heart failure and left-sided heart failure exhibit different symptoms; and even when present together, the symptoms of one type of failure may be more prominent than the other. However, left-sided heart failure eventually leads to right-sided failure too.

Fluid accumulation and resultant swelling is the main symptoms of right-sided heart failure. The site of fluid accumulation depends on the volume of excess fluid and the effects of gravity. Legs and feet become swollen when a person is standing, and when lying down, fluid usually accumulates in the lower back. Fluid can accumulate in the internal organs such as the liver or stomach too, which results in nausea and loss of appetite. Absorption of food is affected, resulting in loss of weight and muscle mass giving rise to a condition called cardiac cachexia.

Left-sided heart failure makes a person feel tired and weak when performing everyday activities, as their muscles are deprived of oxygen. With accumulation of fluids in the lungs, shortness of breath develops; initially only exertion, but with the progress of heart failure, occurring even at rest. Severe left-sided heart failure may cause shortness of breath even when lying down, because of gravity causing fluid to move into the lungs. Paroxysmal nocturnal dyspnea is such a condition when people wake up from sleep, gasping for breath or wheezing. On sitting up, breathing becomes easier as gravity pulls the fluids to the bottom of the lungs.

When large amount of fluid accumulates in the lungs (acute pulmonary edema) it will cause extreme difficulty inbreathing. Skin becomes bluish due to lack of oxygenation. Rapid breathing, and restless feeling, anxiety develop. Bronchospasms and wheezing may occur. Acute pulmonary edema is a potentially fatal condition requiring immediate medical intervention.

In advanced heart failure, breathing pattern alters. Cheyne-Stokes respiration is such an altered pattern of periodic breathing, when a person first breathes rapidly and deeply, followed by slow breathing, then not at all for several seconds. This abnormal pattern of respiration develops because blood flow to the brain is reduced and parts of the brain that control breathing become deprived of oxygen and cannot function normally.

Slow and sluggish blood flow resulting from reduced functioning of the heart encourages blood clot formation. When these blood clots become free and move through the bloodstream, they can cause partial or complete block in an artery anywhere in the body. When artery supplying the brain becomes blocked, it may result in stroke. Depression and deteriorated mental function common in people with severe heart failure require medical attention.

Diagnosis of Heart Failure

Symptoms alone can help a doctor to diagnose heart failure.

A thorough physical examination can show some signs such as a weak pulse, low blood pressure, swollen neck veins and edema in the abdomen or legs. Abnormal heart sounds and fluid collection in the lungs are detected by a stethoscope. A chest x-ray can reveal an enlarged heart and fluid accumulation in the lungs.

Electrocardiography is performed to study the heart rhythms, assess the extent of thickening of the walls of the ventricles and to learn about the incidence of a heart attack.

Echocardiography uses sound waves to project an image of the heart and can show the following:

  • thickening of the walls of the heart and its ability to relax normally
  • functioning of the valves of the heart
  • contractions of the different parts of the heart
  • abnormalities in the contraction of the different areas of the heart.

The ejection fraction, a measure of heart function, is the percentage of blood pumped out by the heart with each beat. It helps to determine whether the heart failure is due to systolic heart failure or diastolic heart failure The normal value for the left ventricle is about 60%.a low ejection fraction indicates systolic heart failure a normal or high ejection fraction in a person exhibiting symptoms of heart failure, points to the likelihood of diastolic heart failure. Echocardiography can help estimate the thickness as well as the stiffness of the heart walls.

Diagnostic procedures, such as radionuclide, magnetic resonance, or computed tomography imaging and cardiac catheterization with angiography, may be used to determine the cause and extent of heart failure. When amyloidosis or myocarditis is suspected, a heart biopsy is taken for testing.

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Yasser Elnahas

MD, PHD, Professor Of CardioVascular Surgery
Dr. Yasser Elnahas, Is an associate Professor of Cardiovascular Surgery. Dr. Elnahas was trained as a fellow At Texas Heart Institute And Mayo Clinic Foundation.Dr. Elnahas is dedicated to educating the general public about different disease conditions and simplifying the medical knowledge in an easy to understand terminology.

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