Heart Failure

What is Heart Failure?

Heart failure is a common cardiovascular disease characterized by an impaired ability of the heart to adequately supply blood to other organs in the body.  The most common cause is a heart attack (ischemic cardiomyopathy), but there are a host of other conditions that can lead to heart failure, including high blood pressure and chronic alcohol use.

Patients may experience difficulty breathing, exercise intolerance, and swelling in the legs – but one of the most dreadful complications is death.

It is important for patients to recognize the symptoms, causes, and treatment of heart failure due to the serious nature of this condition.

What Causes Heart Failure?

It can be categorized into two general types – systolic heart failure and diastolic heart failure.  Systolic heart failure is characterized by an impaired ability of the heart to contract and pump blood to other vital organs and tissues.  In contrast, diastolic heart failure is considered a reduced capacity of the heart to relax and fill with blood - this can also lead to impaired perfusion of vital organs and tissues.

The most common cause of systolic heart failure is ischemic cardiomyopathy, or heart failure due to heart attack.  Other causes include alcoholic cardiomyopathy and viral myocarditis (viral infection of the heart muscle).

The most frequent cause of diastolic heart failure is high blood pressure (hypertension).  Infiltrative diseases such as sarcoidosis and hemochromatosis can also cause diastolic heart failure.  These diseases lead to infiltration of the heart tissue with substances that make the heart less compliant.

How Common is Heart Failure?

Heart failure currently affects more than 5.8 million people in the United States alone.  Furthermore, there are more than >550,000 new cases diagnosed each year.  This condition is one of the leading causes of death and contributes to a tremendous amount of the health care costs in the United States.  The disease is especially problematic in the elderly population (individuals age >65 years).

Signs and Symptoms

The most common symptoms include:

  • Shortness of breath
  • Difficulty breathing when lying flat on one’s back
  • Gasping for air at night
  • Swelling in the legs
  • Reduced exercise capacity

The reason why these symptoms occur is because the heart cannot adequately get blood to other organs and essentially “backs up” like a plumbing system.  This backup of blood can lead to fluid in the lungs – which causes difficulty breathing, especially at night.  It can also result in pooling of blood and fluid in the legs – which is responsible for leg swelling.

When you have fluid in the lungs, not only do you become short of breath, but you also have difficulty exerting yourself and performing exercise – this is one of the most disabling features.

On physical examination, your doctor may look for “pitting edema” such that when he or she presses on your swollen legs, it forms “pits” that can last for seconds.  Your doctor will also listen to your heart and lungs, and observe for abnormal sounds.  Lastly, they may lie you down at an incline and check your neck veins to see if they are distended – another sign of heart failure.

Severe cases can manifest as shock, which is a life-threatening condition characterized by very low blood pressure and multi-organ failure.

Diagnosis

It is diagnosed based on your symptoms, physical examination, and laboratory tests.  There is no single test that can be used to diagnose heart failure.

Besides evaluating for the symptoms and signs that were mentioned, your doctor will likely order blood tests such as a comprehensive metabolic panel, complete blood count, and urine analysis.  They may also order a test called BNP (brain natriuretic peptide), which is a good marker for this condition.

Additionally, you doctor will likely obtain an EKG to evaluate the electrical activity of your heart and help determine the cause of the medical condition.  They may order a chest x-ray to evaluate your heart size and to see if there is fluid in your lungs.  Lastly, they will probably obtain an ultrasound (echocardiogram) to assess the structure and function of your heart.

Occasionally, if your condition is very severe, your cardiologist will perform a test called a “right heart catheterization.”  During this study, they will introduce a catheter into a large vein in your groin and advance the catheter until it reaches the right side of your heart.  Throughout the procedure, they measure various parameters such as the pressures in the chamber of the heart to better understand the severity of disease and determine if your treatment is effective.

Heart Failure Treatment and Medication

The treatment of heart failure includes dietary changes such as restricting the amount of sodium and fluids you ingest.  It is also generally recommended that you avoid significant alcohol use, especially if the cause of your heart failure is due to alcohol.

Medications are typically prescribed to improve symptoms and sometimes improve life expectancy.  Drugs that are commonly prescribed include:

Patients with severe cases may require the use of surgical interventions to prolong their life.  This may include a left ventricular assist device, which mechanically helps your heart pump more efficiently.  In some cases, patients may be candidates for heart transplantation.

 References:

  1. Armstrong C. ACCF and AHA Release Guidelines on the Management of Heart Failure. Am Fam Physician. 2014 Aug 1;90(3):186-9. - https://www.acc.org/~/media/Non-Clinical/Files-PDFs-Excel-MS-Word-etc/Tools%20and%20Practice%20Support/Quality%20Programs/Heart%20Failure%20Roundtable%202016/Heart%20Failure%20Guidelines/HFG%203%202013%20ACCFAHA%20Guideline.pdf
  2. Inamdar AA, Inamdar AC. Heart Failure: Diagnosis, Management and Utilization. J Clin Med. 2016 Jun 29;5(7). - https://www.ncbi.nlm.nih.gov/pubmed/27367736
  3. Roger VL. Epidemiology of heart failure. Circ Res. 2013 Aug 30;113(6):646-59. - https://www.ncbi.nlm.nih.gov/pubmed/23989710

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.