Category Archives: Heart Failure
Acute Heart Failure
Acute heart Failure is an emergency situation requiring immediate medical intervention. The symptoms of heart failure are very severe and develop in a short period of time. Acute heart failure can be seen in heart attacks involving a big portion of the heart muscle and in heart attacks where the papillary muscles rupture leading to acute severe mitral incompetence .
If acute pulmonary edema (accumulation of fluid in the air sacs of the lungs) develops, supplementary oxygen should be given through a face mask. Diuretics and other drugs such as nitroglycerin are given intravenously. Nitroglycerin kept under the tongue can be a life-saver. Morphine helps to reduce the anxiety that accompanies acute pulmonary edema. It also slows the heart rate and the rate of breathing, dilates blood vessels, thus reducing the load on the heart. A mechanical ventilator can assist breathing in acute conditions.
Short time measures that improve the condition of the heart temporarily include drugs such as dopamine or dobutamine, which make the heart to contract forcefully but they have poor long term outcome.
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Prevention And Treatment Of Heart Failure
Prevention Of Heart Failure
Heart failure can be prevented by treating the disorders that lead to heart failure before they actually cause it.
- Heart valve disorders and septal defects can be treated surgically.
- Coronary artery blocks can be treated with drugs or minimally invasive procedures.
- High blood pressure can be managed with appropriate medication.
- Infections, thyroid disorders and anemia can be reversed by rectifying their root causes.
- Lifestyle changes can prevent unhealthy habits like alcoholism from taking their toll on the heart.
Treatment Of Heart Failure
Heart failure can be treated by a multi-pronged approach, as listed below:
General Measures: Heart failure tends to be a chronic disorder for most people. The main focus however, should be to improve the patient’s quality of life as much as possible. Physical activity is required, but care must be taken to ensure that the exercises performed have received the prior approval of the doctor, with a sufficient amount of breaks for rest in between. The family must be well aware of the patient’s heart disorder, and must be informed enough to recognize any sign of degradation in the patient’s condition, and when to seek medical intervention. Immediate action, like the administration of diuretics, can make all the difference between life and death.
Regular heart check-ups and medical examinations by health care professionals are important for keeping a tab on the progress of the disease.
Special heart clinics which have trained professionals including dietitians, and social workers, can provide further care and support to persons suffering from heart failure. These clinics can help decrease symptoms, and result in the patient having to be hospitalized less frequently. They can greatly improve the quality of life and extend the patient’s life span. However, such clinics merely augment the care provided by primary care doctors and cannot replace them.
Heart failure is a disorder which requires constant monitoring. Any drug taken by the patient must first be approved by the doctor, including non-prescription drugs. This is due to the fact that certain drugs have an adverse effect on those suffering from heart failure. It is also very important that the patient take the correct dose of prescribed medication on time, as failure to do so can result in a severe and possibly life-threatening condition.
Treatment of the Cause: Treatment varies based on the root cause of the heart disorder.
If the cause of heart failure is a valve disorder or a septal defect, surgery can correct the problem.
In the case of a coronary artery being blocked, treatment can be in the form of blockbusting drugs like nitroglycerin, or surgery. Angioplasty can also provide a solution.
High blood pressure on the other hand, can be treated by the use Antihypertensive drugs. Infections too can be curbed by the use of antibiotics.
Anemia due to stomach ulcers can be improved by giving iron supplements. A hyperactive thyroid gland can be managed with help of drugs or radiation therapy, and in extreme cases, surgery. Hypothyroidism is relatively easier to treat, with thyroid hormones or iodine supplements (except in the case of autoimmune thyroiditis) providing an effective solution.
Lifestyle Changes: Lifestyle changes go a long way in improving the quality of life of a person with heart failure.
Exercise should form a very important part of the daily routine, although vigorous exercise should be avoided. People who have mild heart failure should follow safe exercise as prescribed by the doctor. In case of severe heart failure any exercise should be closely monitored, and preferably conducted in a closely monitored environment, under the supervision of trained health professionals.
Overweight people with heart failure should reduce their weight with a weight loss diet before starting an exercise routine, otherwise the additional effort can overload their heart.
Smoking should be avoided, as this can damage the blood vessels, worsening heart failure. Alcohol consumption should also be limited, as is toxic to the heart in large amounts.
Consumption of salt should be limited as excess salt increases fluid retention, worsening the heart failure. Diuretics are usually prescribed to people with heart failure to remove excess water from the body to reduce the load on the heart. Salt counteracts the effect of diuretics. Sodium content in the processed foods is indicated on the label. People with heart failure should carefully assess their total intake of sodium and keep it within the limits recommended by their doctors.
Checking body weight at the same time everyday helps to assess the amount of water retention. People with heart failure should develop the habit of weighing themselves very accurately as soon as they get up in the morning; on the same scale and wearing the same amount of clothing. The daily readings should be recorded and any increase in weight exceeding two pounds (or 1 kilogram), indicating fluid retention should be taken seriously and reported to the doctor.
Even with limited salt intake, swelling in the legs may persist. Using a foot stool to keep the feet raised help the reverse flow fluid, reducing swelling. Wearing full length stockings also help. When there is fluid retention in the lungs, raising the head on pillows make sleep more comfortable.
Drugs for Heart Failure: Diuretics, ACE inhibitors, angiotensin II receptor blockers, beta-blockers and digoxin are a few of the different categories of drugs used to treat heart failure.
Diuretics that help the kidneys flush out excess salt and water by increasing urine formation and decreasing amount of fluid in the body, is an important group of drugs in the treatment of heart failure.
Loop diuretics for moderate to severe heart failure are usually taken by mouth, but in an emergency, it can be administered intravenously.
Thiazides are milder diuretics, recommended for people with hypertension as they help reduce blood pressure.
Potassium-sparing diuretics such as spironolactone may be given in case of severe heart failure resulting from systolic heart failure. They prevent the loss of potassium in urine, unlike loop diuretics and thiazides.
Worsening of urinary incontinence is an unpleasant consequence of taking diuretics. Careful timing of doses can help avoid difficult situations when access to a bathroom is not feasible.
ACE inhibitors, is a group of drugs that is most important in heart failure treatment. They reduce symptoms of heart failure and help prolong life. They act by reducing the hormones angiotensin II and aldosterone which raise blood pressure. ACE inhibitors help dilate arteries and veins reducing blood pressure and helping the kidneys eliminate excess water, reducing the load on the heart. They may have a beneficial effect on the walls of the heart and blood vessels.
Angiotensin II receptor blockers are another group of drugs similar to ACE inhibitors. Some people with persistent symptoms of heart failure are advised both the drugs together. In people with poor tolerate for ACE inhibitors because of their side effects such as a persistent cough, Angiostenin ll receptor blockers are used alone.
Vasodilators such as hydralazine, isosorbide dinitrate and nitroglycerin are resorted to, in people who do not tolerate ACE inhibitors or angiotensin II receptor blockers. They help dilate the blood vessels, reducing blood pressure but are not as effective as the other drugs.
Beta-blockers act by blocking the action of the hormone norepinephrine (which causes the heart to pump faster and more forcefully), thus improving long-term functioning of the heart and prolonging life. They are used along with ACE inhibitors to treat heart failure. In heart failure due to diastolic heart failure, beta-blockers reduce the heart rate and help relax the stiff muscle allowing the heart to fill with more blood.
Digoxin: In patients with atrial fibrillation along with systolic heart failure, the drug Digoxin helps to increases the force of each heartbeat and slows heart rate. One of the oldest drugs for heart failure, it does not prolong life.
Anticoagulants such as Warfarin, prevent clot formation in the heart.
Abnormal heart rhythm is treated with antiarrhythmic drugs.
Other Measures:
A cardioverter defibrillator can be implanted, especially in people not responsive to the best medical treatment, as their risk of sudden death is great.
A pacemaker that stimulates both ventricles can provide better coordination of the heart muscles improving their function.
People who are generally healthy but for a damaged heart, and those with poor response to drugs can opt for a heart transplantation. Mechanical devices that help pump blood called artificial heart can help patients with very severe heart failure that does not respond to drug therapy.
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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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Systolic Heart Failure And Diastolic Heart Failure
Systolic heart failure and diastolic heart failure are the two main types of heart failure. A combination of the two is also seen.
In systolic heart failure, the less forceful contraction of the heart causes some of the blood in the heart to remain in the ventricles or the lower chambers of the heart. This leads to accumulation of blood in the lungs and in the veins.
In diastolic heart failure, the stiffness of the heart prevents it from relaxing after each contraction, which decreases its capacity to fill with blood. If the contraction of the heart is normal, it keeps pumping out the normal amount of blood, making up for its decreased capacity to fill up. But, gradually, the blood returning to the heart gets accumulated in the lungs and veins. Often, both types of heart failure occur concurrently.
Causes
Any heart disorder, previously existing or which has developed over a period of time can cause heart failure. Some disorders that have an indirect effect on heart function can also result in heart failure. It can develop gradually over a period of time or it can happen all of a sudden. It could be either systolic heart failure or diastolic heart failure or, as in the case of high blood pressure and heart valve disorders, it can be both type of heart failure.
Systolic Heart failure: Disorders that cause systolic heart failure may damage the entire heart or a portion of it, so that, the heart cannot contract normally. Usually, several factors work together to precipitate heart failure.
Coronary artery disease reduces the flow of oxygen-rich blood to the heart muscle. Since oxygen is required for normal contraction of the heart, its deprivation leads to systolic heart failure. Blockage of an artery supplying blood to the heart muscles (coronary artery) can cause a heart attack that destroys an area of heart muscle. That area becomes unable contract normally. Damage caused to large areas of heart muscle due to coronary heart disease or a heart attack can be the cause of heart failure.
Myocarditis, in which heart muscles become inflamed due to bacterial or viral infection can damage them, adversely affecting the heart’s ability to pump blood. Certain drugs used in treatment of cancer and substances like alcohol can also damage heart muscles. Some drugs, such as NSAIDs (nonsteroidal anti-inflammatory drugs), may cause to fluid retention in the body, increasing the workload of the heart resulting in heart failure.
A congenital defect in the connections between the chambers of the heart, causing abnormal recirculation of blood within the heart, increases its workload resulting in heart failure. Heart valve disorders such as stenosis or narrowing of valve, obstruct smooth flow of blood, and cause regurgitation or backward leakage of blood through a valve. It can be stressful to the heart, causing enlargement over a period of time and subsequently, heart failure.
When heart rhythm changes due to faulty electrical conduction system, the heart is unable to pump blood efficiently. Fast or irregular heart rhythms over an extended period can result in heart failure.
A large blood clot (pulmonary embolism), or many smaller blood clots in the pulmonary artery can block it, resulting in sudden heart failure. The blockage in the artery makes it hard for the heart to pump blood into the pulmonary arteries difficult. The extra effort required to pump blood into the blocked pulmonary arteries can result in the enlargement the right side of the heart and causing the walls of the right ventricle to become thick and stiff. It results in right-sided heart failure. A very large clot is a life threatening situation requiring immediate intervention.
Certain disorders of the lung, such as pulmonary hypertension which damages pulmonary arteries, increasing the load on the heart. This forces the right side of the heart to work harder to pump blood into the lungs. The person develops a condition called cor pulmonale resulting in enlargement of the right ventricle. This causes right-sided heart failure.
Disorders that indirectly cause systolic heart failure are severe anemia, hyperthyroidism, hypothyroidism, and kidney failure. Anemia is the deficiency of hemoglobin, the oxygen carrying substance in the Red blood cells. Anemia can occur due to many reasons such as chronic bleeding from a stomach ulcer. Anemia reduces the amount of oxygen the blood carries, requiring heart to work harder to supply same amount of oxygen to tissues. In hyperthyroidism, the overactive thyroid gland stimulates the heart excessively, making it to pump too fast resulting in incomplete emptying with eah beat, eventually tiring it out. In hypothyroidism, the underactive thyroid gland, fails to produce enough thyroid hormones. Since muscles depend on thyroid hormones for normal functioning, the low levels of thyroid hormones make all muscles, including the heart muscles weak. In kidney failure, when kidneys do not filter out excess fluid from the blood, the resultant larger volume of blood overloads the heart causing heart failure eventually.
Diastolic Heart failure: High blood pressure which is not correctly treated is the usual cause of diastolic heart failure. High blood pressure requires the heart to pump with extra force to push blood into the arteries against the higher pressure existing there. This causes thickening of the heart’s walls (hypertrophy), which eventually becomes stiff. When the walls of the heart lose their elasticity, heart does not get filled quickly and sufficiently. When an inadequately filled heart contracts, less blood gets pumped. Diabetes also stiffens the walls of the ventricle. Natural ageing of the heart too makes the heart’s walls stiff. Diabetes and high blood pressure, combined with age-related stiffening makes heart failure extremely common among the older people.
Amyloidosis, characterized by the presence of an abnormal protein called amyloid, when present in the heart, stiffens the walls of the heart. Some tropical parasites enter into the heart muscle causing stiffening which results in heart failure even in young people.
Constrictive pericarditis is a condition where the double-walled fluid filled pericardium that envelopes the heart has become stiff preventing the normal functioning of the heart.
Compensatory Mechanisms
The body combats heart failure through various mechanisms. The body’s initial response to stress caused by heart failure is the release of hormones Epinephrine and norepinephrine. They make the heart to pump faster and more forcefully, thus increasing the amount of blood pumped out by the heart (cardiac output), this compensatory mechanism helps to make up for the decreased pumping ability of the heart at least temporarily. This is beneficial to a healthy people, enabling them to perform extra work when required. However, this additional demand on the heart, further deteriorates the condition of those who are already suffering from heart failure.
When less amount of blood is pumped out by the heart due to heart failure, body tries to maintain the blood pressure by increasing the amount of salt and water retained in the body by decreasing the urine output by the kidneys. Salt and water retention increases the volume of blood in the bloodstream and helping maintain blood pressure. However, the larger volume of blood stretches the heart muscle, enlarging the ventricles. Initially, when the heart muscle is stretched, it contracts more forcefully, improving the heart function temporarily. But, continued stretching weakens the heart’s muscles, worsening the heart failure.
Ventricular hypertrophy or enlargement of the walls of the ventricles is an important compensatory mechanism. Thicker walls can contract with more force helping to pump out more blood, but, eventually they become stiff, further worsening heart failure.
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What Is Heart Failure
What is heart failure ? Heart failure is a disease which occurs due to the insufficient capacity of the heart to pump blood efficiently, resulting in reduced blood supply and accumulation of blood in the lungs and veins.
- Heart failure may be caused by several heart disorders.
- Symptoms of heart failure may be absent initially but over a period of time, shortness of breath and fatigue develops.
- Heart failure is often noticed by doctors from the symptoms, but diagnostic tests such as an ECG (echocardiography) help to assess the function of the heart.
- Treatment includes drugs and surgical interventions to treat the cause of the heart failure as well as its effects. life style changes are also prescribed to the patients
Heart failure is not limited to any age group, but is more prevalent in older people, who may have developed several heart disorders such as damaged heart valves and muscles. Ageing of the heart makes it less efficient. General increase in the life span has made heart failure a very common. Other high risk factors are lifestyle issues and diseases such as smoking, diet high in fats, diabetes and high blood pressure. Children born with congenital heart defects are also prone to heart failure.
Heart failure is a very complex condition. It does not mean that the heart has completely stopped, but that heart is unable to pump enough blood to meet the body’s demand for blood supply.
The heart works like a pump, pushing fluid out of one place and into the next. Blood is pumped out when the heart muscle contracts (systole), and during diastole, when the heart muscle relaxes, the chambers of the heart get filled up with blood. Heart failure occurs when the heart muscles are weak and cannot pump blood with enough force. Also, if the muscles have lost their tone and have become stiff, heart loses the ability to return to relaxed condition after each contraction, causing blood accumulation and congestion in the tissues. So, heart failure is sometimes known as congestive heart failure.
Generally both sides of heart are involved in a heart failure but often one side could be more defective than the other. The left side of the heart pumps blood from the lungs into the arteries. When the blood coming to the left side of the heart gets accumulated and it causes congestion in the lungs resulting in breathing difficulty, this condition can be called left sided heart failure.
The right side of the heart pumps blood from the veins into the lungs and when there is congestion, blood accumulates in the tissues and veins of other body parts, causing swelling of the legs and fluid accumulation in the liver. This can be termed right sided heart failure.
When blood supply is inadequate due to heart failure, the tissues become starved of oxygen and nutrients normally supplied by blood. This makes the muscles in the limbs tire quickly and the person feels fatigued at the slightest exertion. When the heart does not pump blood with enough force, the kidneys become unable to filter excess fluid and waste products from the blood into the urine. This increases the volume of circulating fluid in the body, giving more exertion to heart making the situation worse.