Heart failure

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What is heart failure?

A normal healthy heart fills and pumps blood through the circulatory system continuously. The heart has four chambers which all need to function for the heart to pump blood through the body properly. Heart failure refers to a condition which occurs when the heart is either not able to pump (systolic) or fill (diastolic) adequately. Having heart failure does not mean that the heart stops beating, but rather that the heart isn't working to its optimum capability. Therefore, heart failure means that the heart isn't circulating blood and oxygen throughout the body properly and thus causing uncomfortable symptoms, which affect the quality of life, and can lead to serious heart conditions. Heart failure is assessed by a cardiac specialist, and treatment options are evaluated based on each patient's symptoms and clinical situation.

What causes it?

Heart failure is caused by and linked to various heart conditions that damage the heart and its chambers, such as:

Conditions that overwork the heart including high blood pressure, primary heart muscle disease, i.e. hypertrophic cardiomyopathy or dilated cardiomyopathy.   Valve disease, i.e. severe aortic stenosis can lead to left ventricular hypertrophy, or mitral regurgitation /aortic regurgitation can lead to left ventricular dilatation

Heart diseases such as coronary artery disease cause a problem with the arteries and block the flow of blood to and from the heart, starving the heart of oxygen and nutrients. If the artery is completely blocked, a heart attack can occur.

Coronary artery disease can also cause systolic or diastolic dysfunction and which in turn leads to heart failure.

Cardiomyopathy may also be caused by alcohol and drug abuse.

Types of Heart Failure

Left-sided heart failure

The heart is responsible for pumping oxygen-rich blood through the body. The oxygen-rich blood moves from the lungs to the left atrium, then to the left ventricle which pumps it to the rest of the body. When the left side of the heart has to work harder to pump oxygenated blood to the body, we call this left-sided heart failure. There are two types namely, systolic heart failure, which is when the left side fails to pump, and diastolic heart failure, which is when the left side is unable to fill with blood. It is essential that you contact Dr Thomas if you experience any of the above symptoms as left-sided heart failure, if left untreated, can cause kidney-, liver disease or a heart attack. This condition also worsens over time and causes damage such as rapid heart rate, your heart to enlarge, high blood pressure and lead to less blood flowing to the arms and legs.

Right-sided heart failure

When the heart beats, it pumps blood in and out. ‘Old' oxygen-less blood is pumped into the heart through the right atrium into the right ventricle, after which the right ventricle oxygenates the blood and pumps it out into the lungs. The right side of the heart usually fails if the left side of the heart has failed and pressure is added to the right side. If this occurs, the right side loses its ability to pump, and the oxygen-less blood backs up in the body's veins, causing swelling or congestion in other organs. A common mechanism of pure right heart failure is pulmonary hypertension which may be primary or secondary, i.e. underlying pulmonary pathology (cor- pulmonale), left to right shunts (atrial septal defects, ventricular septal defects, patent ductus arteriosus etc.), severe mitral stenosis or left heart failure.

Congestive heart failure

If the lower chambers (ventricles) of the heart is affected, and the ventricles lose its ability to pump, the oxygen-less blood backs up in the body's veins, causing swelling or congestion in the body's tissues. This congestion of fluids can lead to more complications in the lungs and kidneys. Therefore, congestive heart failure (CHF) requires immediate medical attention.

What are the symptoms?

The signs and symptoms of all types of heart failure include:

Shortness of breath during exercise or when lying flat on your back

  • Waking up at night with shortness of breath
  • Persistent coughing and wheezing
  • Issues with concentration
  • Dizziness
  • Fatigue
  • Swelling in your ankles, legs or feet
  • Nausea
  • Lack of appetite
  • Sudden weight gain
  • Coughing or wheezing, sometimes with white or pink phlegm
  • Fast or irregular heartbeat

Chronic systolic or diastolic heart failure, if left untreated can cause other secondary complications and conditions such as angina (severe chest pain), anemia, atrial fibrillation, cardiac cachexia, impaired kidney function, leg venous stasis and ulcers due to poor circulation, liver disease or damage, heart valve issues and even strokes and heart attacks.

However, when it comes to the heart, Dr Thomas takes your symptoms seriously. If you experience sudden chest pain, severe shortness of breath, fast or irregular heart rate, coughing up white or pink phlegm, severe weakness or fainting, it is vital that you seek emergency care.

What is the treatment for heart failure?

Depending on whether you have systolic or diastolic heart failure, your cardiologist may prescribe you medication to strengthen your heart, as well as water pills to help your body get rid of excess fluids and swelling. Ask your doctor about the benefits of each type of medication, and to help you find one, which can be tailored to your needs. There are also many lifestyle changes you can make to help treat the symptoms of heart failure, such as following a low-sodium diet, limiting alcohol and caffeine intake, tracking your daily fluid intake, losing weight, exercising regularly and monitoring your blood pressure daily. Depending on your symptoms and the severity of your condition, your cardiologist may recommend a coronary angiogram (and other percutaneous interventions), heart surgery or cardiac devices including a biventricular pacemaker or cardiac resynchronisation therapy.