Heart failure occurs when your heart is unable to pump sufficient blood to meet the demands of the body. Conditions such as narrowing of blood vessels supplying the heart and high blood pressure gradually weaken your heart and impair its capacity to pump blood. Heart failure is one of the commonest causes of hospital admission in people over the age of 65. In India, the prevalence rate of heart failure ranges from 1.3 to 4.6 million.
High blood pressure, diabetes, obesity and coronary artery disease are the most common causes of heart failure.
Signs and symptoms
The symptoms of heart failure may vary from mild to severe. The following are the signs and symptoms of heart failure:
- Fatigue and excessive tiredness
- Shortness of breath (dyspnoea)
- Loss of appetite and nausea
- Exercise intolerance
- Swelling in your legs, ankles, and feet
- Rapid or irregular heartbeats
- Dizziness or light-headedness
- Sudden weight gain due to fluid retention
- Increased urge to urinate at night
- Swelling of your abdomen
Diagnosis of heart failure
The following are the tests used to diagnose heart failure:
A sample of your blood is collected to check for cholesterol and to obtain a complete blood picture. High cholesterol may indicate coronary artery diseases, which is the most common cause of heart failure. Blood test is also required to assess the levels of cardiac enzymes such as troponinT and creatine phosphokinase(CPK). High levels of these enzymes in blood is indicative of heart muscle damage. Complete blood picture can help to rule out anemia, which may exhibit certain symptoms similar to heart failure. Blood tests are also used to assess kidney and thyroid function. Abnormal kidney and thyroid function impairs the heart function.
B-type natriuretic peptide (BNP) blood test
BNP is a protein that is released in the blood when there is heart failure. Levels of BNP increases as your heart function worsen, and decreases when the heart function improve.
A chest X-ray helps in determining the condition of your heart and lungs. Findings such as heart enlargement and fluid in lungs on X-ray are indicative of heart failure.
An electrocardiogram is used to assess the electrical activity of the heart. Electrodes or sensors are attached to your skin, which record the heart impulses and display them on the monitor as waves or print them on a graph paper. This test helps in diagnosing abnormal rhythms of the heart that may have caused heart failure.
An echocardiogram is an important test to diagnose heart failure. The test helps to determine how well the heart is pumping blood and assess valve function. This test also determines the ejection fraction (EF) which refers to the amount of blood which is pumped out from the heart with each beat. Normal EF is 50%, any decrease in the EF indicates heart failure.
Stress tests help in analyzing your heart function in response to exertion. Decreased heart function in response to exercise indicates heart failure.
A coronary angiography helps in locating the blocked areas in the coronary arteries. During the procedure, a thin hollow tube (catheter) is passed through an artery. A special dye known as a contrast medium is injected into the catheter, which highlights the narrowed or blocked blood vessels on X-ray.
This is an invasive procedure and is used to look for the blockages in the coronary arteries. It is used to determine if these blocked arteries can increase your risk of congestive heart failure. A small tubes (catheter) is inserted into your blood vessel (artery) and an X-ray video is recorded, which allows the doctor to visualize the heart valves, heart chambers and blocked coronary arteries.
How to treat heart failure?
Treatment of heart failure focuses on treating the underlying cause of heart failure and its symptoms.
ACE inhibitors work by widening your blood vessels. Beta-blockers and angiotensin receptor blockers reduce the blood pressure. Diuretics and aldosterone antagonists help in decreasing the fluid in your lungs and relieves symptoms like breathlessness and ankle swelling caused by heart failure. Digoxin helps in improving the strength of the heart muscle and reduces the chance of heart failure.
In some patients, surgery such as heart valve repairs and coronary artery bypass surgery may be prescribed to correct the underlying cause of heart failure.
Complications of heart failure
If heart failure is left untreated, it can eventually lead to the following complications:
- Impaired kidney function: Decreased blood supply to the kidney can eventually lead to kidney failure. Decreased kidney function can be assessed by kidney function tests.
- Arrhythmia: Heart failure may cause irregular heart rhythm, which may further can worsen the heart failure and increase the risk of stroke. Heart rhythm abnormalities can be assessed with the help of ECG.
- Heart valve problems: The increased workload on your heart may lead to the improper functioning of your heart valves. This can be assessed by echocardiogram.
- Liver damage: Heart failure may cause fluid build-up that can impose extra pressure on the liver and deteriorate liver function. Liver function can be assessed by taking liver function tests.
- Lung problems: Decreased ability of the heart to pump out blood would cause back-flow of the blood in the lung vessels. This may cause high blood pressure in the lungs (pulmonary hypertension)
Prevention of heart failure
The following are the measures that can reduce the risk heart failure:
- Have a healthy balanced diet. Avoid taking trans-fat and limit the use of salts and sugars.
- Avoid smoking as it can damage your heart and increase your risk of developing coronary heart disease.
- Monitoring your blood pressure and cholesterol levels regularly help to reduce the risk factors of heart failure.
- Doing a moderate physical exercise regularly is beneficial to your heart.
- Being overweight or obese can contribute to heart problems.
- Prolonged use of alcohol increases the blood pressure.
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- What is heart failure? https://www.webmd.com/heart-disease/guide-heart-failure#1 . Accessed on 24-10-2017
- Huffman MD1, Prabhakaran D. Heart failure: epidemiology and prevention in India. Natl Med J India. 2010 Sep-Oct;23(5):283-8.
- Symptoms. https://www.mayoclinic.org/diseases-conditions/heart-failure/basics/symptoms/con-20029801 . Accessed on 24-10-2017
- Tests and diagnosis. https://www.mayoclinic.org/diseases-conditions/heart-failure/basics/tests-diagnosis/con-20029801 . Accessed on 24-10-2017
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- Treatments for heart failure. https://www.nhs.uk/Conditions/Heart-failure/Pages/Treatment.aspx . Accessed on 24-10-2017
- Complications. https://www.mayoclinic.org/diseases-conditions/heart-failure/basics/complications/con-20029801 . Accessed on 24-10-2017
- How does heart failure affect your body? https://www.webmd.com/a-to-z-guides/tc/heart-failure-complications-topic-overview . Accessed on 24-10-2017
- Heart failure – Prevention. https://www.webmd.com/heart-disease/heart-failure/tc/heart-failure-prevention . Accessed on 24-10-2017