Heart Failure

HEART FAILURE

Heart failure is a chronic, progressive condition in which the heart muscle is unable to pump enough blood to meet the body’s needs for blood and oxygen.

At first the heart tries to compensate this by:

Enlarging

The heart stretches to contract more strongly and keep up with the demand to pump more blood. Over time this causes the heart to become enlarged.

Developing more muscle mass

The increase in muscle mass occurs because the contracting cells of the heart get bigger. This lets the heart pump more strongly.

Pumping faster

This helps increase the heart’s output.

The body also tries to compensate in other ways:

  • The blood vessels narrow to keep blood pressure up, trying to make up for the heart’s loss of power.
  • The body diverts blood away from less important tissues and organs (like the kidneys), the heart and brain.
  • These temporary measures mask the problem of heart failure, but they don’t solve it. Heart failure continues and worsens until these compensating processes no longer work.

Eventually the heart and body just can’t keep up, and the person experiences the fatigue, breathing problems or other symptoms that usually prompt a trip to the doctor.

The body’s compensation mechanisms help explain why some people may not become aware of their condition until years after their heart begins its decline.

Epidemiology:

Heart failure affected about 40 million people globally. Overall around 2% of adults have heart failure and in those over the age of 65, this increases to 6–10%. Above 75 years old rates are greater than 10%.

Rates are predicted to increase.  Increasing rates are mostly because of increasing life span, but also because of increased risk factors (hypertension, diabetes, dyslipidemia, and obesity) and improved survival rates from other types of cardiovascular disease (myocardial infarction, valvular disease, and arrhythmias).  Heart failure is the leading cause of hospitalization in people older than 65.

TYPES

  • Left-sided failure

The left side of the heart is responsible for receiving oxygen-rich blood from the lungs and pumping it forward to the systemic circulation (The rest of the body except for the pulmonary circulation). Failure of the left side of the heart causes blood to back up into the lungs, causing respiratory symptoms as well as fatigue due to insufficient supply of oxygenated blood.

  • Right-sided failure

Right-sided heart failure is often caused by pulmonary disease (cor pulmonale), which is usually caused by difficulties of the pulmonary circulation. Such as pulmonary hypertension or pulmonic stenosis

  • Bi ventricular failure

In this condition both side of heart is involved and patients have symptoms of both left and right sided heart failure.

  • Congestive heart failure

Heart failure may also occur in situations of “high output” (termed “high-output heart failure”, where the amount of blood pumped is more than typical and the heart is unable to keep up. This can occur in overload situations kidney diseases, chronic severe anemia beriberi (vitamin B1/thiamine deficiency), hyperthyroidism, cirrhosis, Paget’s disease, multiple myeloma, arteriovenous fistulae, or arteriovenous malformations.

  • Acute decompensate heart failure

A condition in which there is sudden deterioration of symptoms in patients with chronic stable heart failure. This most commonly results from an inter-current illness (such as myocardial infarction (heart attack), pneumonia, abnormal heart rhythms, uncontrolled hypertension, or a patient’s failure to maintain a fluid restriction, diet, or medication.

  • Diastolic Heart failure

In this condition the patients have sign & symptoms of heart failure but heart Ejection Fraction (EF) remains normal. This occurs due to increased stiffness or decreased relaxation of heart muscle as a result of that patients have symptoms of low cardiac output.

  • Acute heart failure.

When symptoms appears within 6 weeks.

  • Chronic Heart Failure

When symptoms appears more than 6 weeks after onset of heart failure

CAUSES:

The most common cause is ischemic heart disease. The others causes include Myocarditis, Valvular  heart disease, Hypertension, DM, Cardiomyopathy, Arrhythmia, Vasculitis, Chronic kidney disease, Drugs, Pregnancy, Metabolic causes, Congenital heart disease, Pulmonary disease, connective tissue disorder, cardiac surgery & Trauma.

Heart Failure

Sign & Symptoms:

The most common symptom is difficulty in breathing. The others sign & symptoms include orthopnea, paroxysmal nocturnal dyspnea, weakness, fatigue, apprehension, palpitation, sweating, paler, cyanosis, cold peripheries, decrease urine output, pulmonary edema, peripheral edema, ascites, raised JVP, Tachycardia, tachypnea, hypotension, hypoxia etc.

Diagnosis:

Echocardiography, ECG ,Chest X ray, Holter monitoring,  Blood tests like BNP, Pro BNP, Cardiac biomarker Serum electrolytes , Renal function test, liver function tests, Thyroid function  tests, Complete blood count, CRP, Blood sugar level, ESR, Viral serology, Auto immune workup, Cardiac CT&MR , Cardiac catheterization and cardiac biopsy.

Management of Heart Failure

Treatment focuses on improving the symptoms and preventing the progression of the disease. Reversible causes of the heart failure also need to be addressed (e.g. Infection, alcohol ingestion anemia, thyrotoxicosis, arrhythmia and hypertension). Treatments include lifestyle and pharmacological modalities, and occasionally various forms of device therapy and rarely cardiac transplantation.

Acute decompensate heart failure management

In acute decompensate heart failure, the immediate goal is to re-establish adequate perfusion and oxygen delivery to end organs. This entails ensuring that, airway, breathing and circulation, breathing, are adequate. Immediate treatments usually involve some combination of vasodilators. Such as nitroglycerine, diuretics such as furosemide, and possibly noninvasive positive pressure ventilation (NIPPV). Supplemental oxygen is indicated in those with oxygen saturation levels below 90% but is not recommended in those with normal oxygen levels on room air.

Chronic heart failure management

The goals of treatment for people with chronic heart failure are the prolongation of life. The prevention of acute decompensation and the reduction of symptoms, allowing for greater activity.

It can result from a variety of conditions. In considering therapeutic options, it is important to first exclude reversible causes, including thyroid disease, anemia, chronic tachycardia, alcohol abuse, hypertension, and dysfunction of one or more heart valves. Treatment of the underlying cause is usually the first approach to treating heart failure. However, in the majority of cases, either no primary cause is found or treatment of the primary cause does not restore normal heart function. In these cases, behavioral, medication and device  treatment strategies exist. Which can provide a significant improvement in outcomes. Including the relief of symptoms, exercise tolerance, and a decrease in the likelihood of hospitalization or death.

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