Heart failure is a leading cause of mortality all over the world. It is estimated that around 64.3 million people around the world live with heart failure. The incidence of heart failure is increasing rapidly in Asian countries owing to lifestyle changes. The hectic urban lifestyle coupled with lack of physical activity, unhealthy diet, and use of tobacco and drinks are major reasons for the increase of heart failure in Asian countries.
World Heart Day falls on 29 September this year. Other than coronary artery disease, let’s also look at another fairly common heart disease: heart failure!
What is heart failure?
Heart failure occurs when the heart is too weak to pump enough oxygen-rich blood to all parts of the body, and is unable to meet the body’s requirements.
When heart failure occurs, compensatory mechanisms kick into place to maintain blood flow. The heart stretches more to pump more blood. Pumping also happens at a faster rate to increase the output. The kidneys retain more fluid in an effort to bump up blood volume.
In due course however, these beget progression and complications. The overworked heart enlarges, which may result in arrhythmias, further inefficiency in pumping, risk of blood clot formation. Fluid retention can cause more congestion in the lungs besides manifesting as lower limb oedema (swelling).
Heart failure is a serious medical condition; early treatment increases the chances of long-term recovery with fewer complications. It is thus important to recognise common symptoms.
What are the symptoms of heart failure?
For some people, heart failure may be acute, where the symptoms appear suddenly but go away fairly quickly; for the vast majority of heart failure cases however, they are chronic, and symptoms are continuous. Below are a few of the symptoms of heart failure:
- Irregular or rapid heartbeat in an effort to pump more blood.
- Chest pain if the cause of failure is a heart attack.
- Breathing difficulty
- Blood often backs up from weak heart and fluid can build up in the lungs (congestion)
- Insufficient supply of oxygen-rich blood also causes shortness of breath
- General tiredness and difficulty in concentrating.
- Swelling in legs and feet caused by water and fluid retention in the body.
- Swelling of the abdominal area.
- Cough with white or blood-stained mucus caused by lung congestion.
- Lack of appetite and nausea as a result of bloating in the stomach.
Consult a doctor immediately If you experience sudden heart pain or shortness of breath that does not subside even after taking a rest, or if you have fainting spells and sudden weakness resulting in inability to move your limbs.
What are the causes of heart failure?
Coronary artery disease and heart attack
Coronary artery disease (CAD) is a narrowing of the arteries that carry blood and oxygen to the heart, usually due to build-up of fatty deposits, thus less oxygen and nutrients reach the heart. If the arteries are blocked, it leads to a heart attack and damage to heart muscle may result in heart failure.
High blood pressure
With high blood pressure, the heart has to work harder to circulate blood. Over time, this extra exertion can make the heart muscle too stiff to pump blood efficiently, leading to heart failure.
Cardiomyopathy
This is the weakening of the heart muscles due to various causes e.g. toxicity from drugs, alcohol abuse, or infection.
Other conditions like diabetes, kidney disease, congenital heart defects (valve abnormalities), overactive or under-active thyroid can all cause heart failure.
How is heart failure diagnosed?
When you present with symptoms of heart failure, the doctor will review your medical history for risk factors predisposing to heart failure e.g. high blood pressure, diabetes.
The doctor will then carry out a thorough physical examination e.g. listen to your lungs for signs of fluid buildup (lung congestion) and your heart for whooshing sounds (murmurs) that may suggest heart failure. The doctor may also examine the veins in your neck and check for fluid build-up in your abdomen and legs.
A few other tests may be ordered to aid in diagnosis:
Blood test
A blood test helps determine the cholesterol level in your body and the proper functioning of the kidney and thyroid.
Chest X-ray:
A chest x-ray reveals any fluid build-up in the heart and lungs or enlargement of the heart.
Echocardiogram
This is an ultrasound of the heart that reveals the pattern of heartbeat, its structure and blood flow through it. It is also used to measure ejection fraction (EF), which shows how much blood is pumped out with each beat. In a healthy heart, the EF is ≥50% — meaning that more than half of the blood that fills the ventricle is pumped out with each beat. EF helps classify heart failure and guides treatment.
Stress test
This is a non-invasive test that shows the probability of coronary artery disease; an ECG machine monitors the heart function as the patient runs on a treadmill.
What are the treatments available for heart failure?
The advancement in the field of medical science has brought in different types of treatment for heart failure. The treatment can vary from lifestyle changes and medications to implanting devices and surgery depending on the condition.
Lifestyle changes
Eating a well-balanced diet and engaging in moderate exercise to maintain a healthy weight are the main lifestyle changes recommended by doctors. Besides, you will also be asked to stay away from using tobacco and alcohol.
Medications
Medications can help to alleviate symptoms, improve the heart’s function and prolong life. Commonly used medications are listed below:
- Blood-thinners
- These prevent blood clots from forming in blood vessels
- Some examples include: antiplatelet aspirin, anticoagulant rivaroxaban for patients with concomitant atrial fibrillation (irregular heart beat)
- Angiotensin-converting Enzyme Inhibitors (ACE-Is) /Angiotensin II Receptor Blockers (ARBs)/Angiotensin Receptor-Neprilysin Inhibitors (ARNIs)
- These open up narrowed blood vessels to improve blood flow, reduce blood pressure, resistance and strain on heart
- Some examples of ACE-Is include Captopril, Enalapril, Lisinopril;
- Some examples of ARBs include Losartan, Irbesartan, Candesartan
- E.g. of ARNI: Sacubitril/valsartan (Entresto)
- Beta-blockers
- These reduce blood pressure and slow heart rate, thus decreasing the work the heart has to do.
- Some examples include Bisoprolol, Carvedilol, Nebivolol.
- Diuretics
- These reduce the body’s excess fluid and sodium through urination, relieving congestion.
- Some examples include Frusemide, Spironolactone, Bumetanide
- Ivabradine
- Helps to slow heart rate
- Useful alternative for patients who cannot tolerate beta blockers
- Hydralazine with nitrate
- Can help relax and open up the blood vessels
- Useful for patients who cannot tolerate ACE-Is, ARBs
- Cholesterol-lowering medications
- Reduce cholesterol levels and prevent further narrowing of arteries (in cases of CAD)
- Some examples include statins (atorvastatin, rosuvastatin), ezetimibe
Surgery
If medicines are not of much help, surgery may be prescribed. Different types of operations performed include:
- Heart valve surgery if faulty valves are causing abnormal blood flow
- Angioplasty or bypass to circumvent blockage in coronary arteries,
- Pacemaker placement to control heart rate
- An Implantable Cardioverter Defibrillator (ICD) is a battery-powered device that will shock your heart if it detects an abnormal heart rhythm. This shock restores the heart rate back to a normal rhythm. An ICD is suggested for people with an EF<35%.
- Heart transplant if all other treatments fail
Conclusion
Maintaining a healthy lifestyle is the best way to prevent heart failure. People with heart failure can go on to lead near-normal lives with medication to manage symptoms and slow disease progression.
