Heart Failure: Symptoms, Causes, and Treatment
The heart is the organ responsible for pumping oxygen and nutrients to all our tissues, which is why cardiovascular disease is one of the leading causes of death worldwide. Among these diseases, heart failure stands out.
Heart failure occurs when the myocardium or heart muscle is unable to pump enough blood to the tissues. This generates an imbalance between the supply and demand of oxygen and nutrients, producing failure in multiple organs.
This cardiovascular condition can manifest itself in any age group, however, it’s estimated that the prevalence increases in the elderly. Although heart failure doesn’t have a definitive cure, it’s possible to slow its progression and offer a better quality of life to people who suffer from it.
Symptoms of heart failure
The clinical manifestations of heart failure usually appear gradually as a result of degenerative processes of the heart muscle. So most people tend to notice limiting symptoms in activities that didn’t cause them any problems previously.
The symptoms of the disease are very varied and depend on the severity of the insufficiency. In addition, it’s a reflection of the damage in the heart cavities and the bronchial tree, within which the following symptoms stand out:
- Shortness of breath
- The feeling of tiredness and muscle weakness
- Symptoms of fluid retention
- The feeling of lack of air that forces the patient to wake up at night
- Increased urinary frequency
- Sudden weight gain
- Tiredness when performing moderate intensity exercises
- Confusion, nausea, and dizziness
Risk factors
Heart failure is associated with a variety of external and internal agents that act by weakening and damaging the muscles of the heart. From a medical point of view, the factors that increase the risk of developing this condition are divided into modifiable and non-modifiable.
Modifiable risk factors
These are the factors associated with the patient’s lifestyle and the underlying pathologies that they suffer from. They can be prevented, corrected, and treated, all in order to reduce the risk of suffering from this cardiovascular condition. Among these risk factors are the following:
- High cholesterol
- Obesity and sedentary lifestyle
- Uncontrolled diabetes
- Uncontrolled hypertension
- Stress
- Consumption of tobacco or cigarettes
- Excessive alcohol consumption
Non-modifiable risk factors
These are a small group of factors associated with genetics and the family history of each individual. These can’t be corrected, but they can be considered to prevent the development of heart failure. Within this group are the following:
- Being over 55 years old
- Being a man or woman in the postmenopausal stage
- Having a close relative who has had a coronary artery disease or a stroke before the age of 55, in the case of men, or 65 in the case of women
Causes of heart failure
Heart failure is usually the result of underlying pathologies that weaken the heart muscles and other uncontrolled risk factors. The end product is a rigid or dilated heart that loses its ability to contract properly and thereby pump enough blood into the bloodstream.
Diseases that can affect the heart’s pump function include the following:
- Ischemic heart disease: This is the most common cause of heart failure, with a prevalence of 50 to 65%. It’s produced by an alteration in the blood flow of the coronary arteries responsible for nourishing the heart. This can be the result of a partial or total obstruction of the flow.
- High blood pressure: This condition increases the force that the heart must exert to pump enough blood to the tissues, and, over time, the heart can become stiff or very weak, triggering heart failure.
- Cardiomyopathies: These are a varied group of alterations, typical of the cardiac musculature, the result of basic diseases such as diabetes and arterial hypertension.
- Valvular heart disease: This occurs when the heart valves don’t work properly. This means that the cardiac muscle must increase its pump function in order to compensate for this alteration.
- Arrhythmias: These are conditions of the electrical conductivity of the heart. They generate disorders in the rhythm and frequency of the normal contraction of the heart.
On the other hand, there are situations that increase the oxygen demands of the tissues in the presence of a healthy heart and that trigger heart failure. Among them, anemia, hyperthyroidism, and generalized infections stand out.
Diagnosis
A clinical and comprehensive assessment by the specialist doctor is essential in the diagnosis of heart failure. In order to do this, a complete medical history must be taken, detailing the suspected symptoms, associated risk factors, and the patient’s cardiovascular and systemic history.
The physical examination allows the doctor to identify indicative signs of heart failure. These include swelling of the legs and feet, changes in the pulse and heart rate, distention of the vessels in the neck, and abnormal heart murmurs.
Similarly, the specialist can rely on different paraclinical methods that will allow them to confirm the diagnosis, among which we can find the following:
- Chest X-ray: With this study, the doctor can recognize typical cardiopulmonary patterns that point to heart failure. Among them, the enlargement of the silhouette of the heart and the presence of fluid in the pleural cavity.
- Electrocardiogram: This allows the doctor to record and measure the electrical activity of the heart. The presence of an abnormal electrocardiogram facilitates the identification of cardiovascular pathologies that could be causing heart failure and its symptoms.
- Echocardiography: This is a fairly effective test that offers live images of the entire heart structure. This allows the doctor to evaluate the function of the heart, confirm the diagnosis of heart damage, and even determine the severity of the damage.
- Blood tests: In patients with heart failure, natriuretic peptides are usually increased, and if doctors can determine this situation, it will favor the confirmation of the disease and rule out other similar cardiac events.
The treatment of heart failure
The treatment of this disease is aimed at reducing the symptoms, thus improving the hemodynamic status and the patient’s quality of life. At present, there are several forms of treatment and these will be prescribed by the specialist according to the type and degree of the condition.
Changes in lifestyle
The heart failure patient will need to make major changes in their lifestyle. To do this, they must introduce healthy habits and diets, controlling and ruling out any factor that may be harmful and complicate the disease. Recommendations include the following:
- Decreasing the consumption of salt and sugar
- Weight control
- Increased physical activity
- Not consuming alcohol, drugs, or cigarettes.
Drugs
The drugs prescribed seek to create a protective effect for the heart, thus reducing the progression of the disease. In this way, there will be a great improvement in the patient’s symptoms and quality of life. Some medications that are usually indicated are the following:
- Angiotensin converting enzyme (ACE) inhibitors: These block the action of angiotensin II, a vasoconstrictor hormone, allowing blood vessels to dilate and reducing stress on the heart.
- Beta-blockers: Lowers blood pressure and heart rate, improving blood circulation.
- Diuretics: These remove excess sodium and fluids from the body through urine, reducing stress on the heart.
- Digital: This increases the contraction force of the heart and reduces the accumulation of fluid in the chambers. These are usually used in patients with advanced conditions.
Devices
There are some small electronic devices that can connect to the heart and transmit electrical impulses to regulate heart activity.
- Pacemakers: This is a small metal device that is implanted under the skin and connected to the heart, guiding the heart rhythm.
- Implantable Cardioverter Defibrillator (ICD): A device that identifies heart rhythm disturbances and delivers small electrical shocks to the heart to keep it working.
- Cardiac resynchronization: A device that’s used to generate electrical stimuli that are transmitted to the heart and regulate the heartbeat.
- Modulation of cardiac contractility: This is achieved thanks to electrical equipment that sends electrical stimuli to the heart muscle to improve its ability to contract.
Surgery
Surgical procedures aimed at correcting structural and functional abnormalities of the heart. In this way, it seeks to reduce mortality in patients with heart failure.
- Myocardial revascularization: This is considered the procedure par excellence for patients with coronary disease. This method removes any blockage in coronary blood flow and improves heart muscle perfusion.
- Valve replacement: This is used in patients with valvular diseases that affect the heart’s pump function. It must be carried out before the dilation and injury of the cardiac muscle is irreversible.
- Heart transplantation: This is the most frequent treatment in patients under 60 years of age with severe heart failure that doesn’t respond to treatment, as long as the patient doesn’t have other underlying pathologies that put their life at risk.
Prevention is the key
Currently, most people underestimate the symptoms associated with heart failure, considering it as something fleeting or temporary. However, the progression of this disease can offer a worse prognosis than that of many cancers.
Early detection and management of this pathology are essential. In this way, the doctor will be able to prevent any complications that may be associated with it, offer the correct therapy, provide follow-up and thus greatly improve the patient’s quality of life.
- Soler Morejón C, Mesquia de Pedro N. Insuficiencia cardíaca: una causa importante de muerte. Rev cubana med. 2014; 53( 4 ): 359-362.
- Burguez S. Insuficiencia cardíaca aguda. Rev.Urug.Cardiol. 2017; 32( 3 ): 370-389.
- González R, Seguel E, Stockins A, Campos R, Neira L, Alarcón E. Cirugía Coronaria: Revascularización miocárdica sin circulación extracorpórea. Rev Chil Cir. 2009; 61( 6 ): 578-581.
- Rodríguez-Artalejo F, Banegas Banegas J, Guallar-Castillón P. Epidemiología de la insuficiencia cardíaca. Revista Española de Cardiología. 2004;57(2):163-170.
- Sayago-Silva I, García-López F, Segovia-Cubero J. Epidemiología de la insuficiencia cardiaca en España en los últimos 20 años. Revista Española de Cardiología. 2013;66(8):649-656.
- Ponikowski P, Jankowska E. Patogenia y presentación clínica de la insuficiencia cardiaca aguda. Revista Española de Cardiología. 2015;68(4):331-337.
