Heart Failure

Heart failure, also known as congestive heart failure, is a disorder in which the heart loses its ability to pump blood efficiently.
 
When the heart muscle weakens, the amount of blood ejected with each heart beat declines. The type of heart failure is called systolic dysfunction.

Patients may have symptoms due to reduced function of the heart such as congestion (swelling of the feet and ankles; fluid in the lungs) or fatigue (shortness of breath, less stamina). In some cases, the heart may pump blood out to the body in a normal manner but have problems with filling between each heart beat. This type of heart failure is called diastolic dysfunction.

Risk factors

The risk factors for heart failure increase with advancing age. Additional risk factors for developing heart failure mayinclude:

  • alcohol abuse

  • use of cocaine

  • diabetes

  • excess weight

  • high blood pressure

  • lung disease

  • tobacco use

Symptoms

Patients with heart failure may present with one or several of the following symptoms:

  • cough

  • decreased alertness or concentration

  • decreased urine production

  • difficulty sleeping

  • fatigue, weakness, faintness

  • indigestion

  • irregular or rapid pulse

  • loss of appetite

  • nausea and vomiting

  • need to urinate at night

  • pronounced neck veins

  • sensation of feeling the heart beat (palpitations)

  • shortness of breath with activity, or after lying down for a while

  • swelling of feet and ankles

  • swelling of the abdomen

  • weight gain

Diagnostic Tools

There are many tests to diagnose congestive heart failure. More than one test is done before a definitive diagnosis can be made. These tests may include: 

  • physical examination and patient history   

  • blood tests (b-type naturetic peptide)

  • ECG 

  • chest X–ray  

  • echocardiogram 

  • cardiac catheterization and coronary angiography  

  • chest CT scan  

  • chest MRI  

  • myocardial biopsy

Treatment Options

Both medication and surgery is considered for patients with congestive heart failure. Medications, which are the first treatment considered, may include:

  • ACE inhibitors  

  • angiotensin receptor blockers (ARBS)

  • beta–blockers

  • digitalis glycosides

  • diuretics (furosemide)

  • aldosterone antagonists

If medications fail or in some cases, physicians may recommend one of the following treatment options:

  • bi-ventricular pacemaker/defibrillator (cardiac resynchronization therapy): a device which is placed in the heart chambers to help coordinate the pumping action of both sides of the heart 

  • heart transplant

  • surgical remolding of the heart muscle

  • temporary ventricular assist devices and semi–permanent ventricular assist devices

Prevention

Steps to prevent or to reduce the risk of heart failure may include:

  • avoiding alcohol

  • increasing exercise (as recommended)

  • quitting smoking

  • reducing salt intake

  • taking an ACE inhibitor or similar medication if you have heart disease, diabetes, or high blood pressure

  • treating an underlying thyroid disorder

  • treating arrhythmias (abnormal heart rhythms) and keeping your heart rate under control.

  • treating high blood pressure with diet, exercise, and medication if necessary

  • treating high cholesterol with diet, exercise, and medication if necessary

  • limiting fluid intake, if necessary monitoring daily weight

Diagrams:
Click images to enlarge

Normal Heart
Normal Heart 

 

 

Systolic Failure
Heart with Systolic Heart Failure 

 

Diastolic Failure
Heart with Diastolic Heart Failure

 

Resynchronization Therapy
Cardiac Resynchronization Therapy

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