Heart failure is a chronic medical disorder that arises from the heart’s inability to adequately pump blood. As a result, the heart is unable to meet the demands of the body. This happens when the heart muscle weakens or is injured. This issue will force the body to obtain insufficient oxygen and nutrients, resulting in a variety of symptoms and complications. In most cases, heart failure affects either the left or right side of the heart, or both. Left-sided heart failure, the most common type, occurs when the left side of the heart is affected. It results in fluid buildup in the lungs, causing symptoms of tiredness, shortness of breath, and coughing. When the right side of the heart is unable to properly pump blood to the lungs to receive oxygen, this is referred to as right-sided heart failure. This result in fluid retention in the legs, ankles, and abdomen, causing swelling and discomfort. Heart failure develops gradually over time, known as chronic heart failure, or it can occur suddenly, referred to as acute heart failure. It is often caused by other underlying conditions that damage or weaken the heart muscle, such as coronary artery disease, high blood pressure (hypertension), heart valve disease, previous heart attacks, congenital heart defects, infections, or certain medications.
Types of Heart Failure
There are two main types of heart failure:
- Systolic Heart Failure: This type of heart failure occurs when the heart muscle becomes weakened, leading to a reduced ability to contract and pump blood effectively. As a result, the heart’s pumping or ejection fraction, which represents the percentage of blood pumped out of the heart with each beat, is lower than normal. Typically, a healthy heart ejects around 50-70% of the blood with each contraction, while in systolic heart failure, the ejection fraction is below 40%.
- Diastolic Heart Failure: Diastolic heart failure, also known as heart failure with preserved ejection fraction (HFpEF), is characterized by a stiffening of the heart muscle, impairing its capacity to relax and fill with blood during the resting phase between contractions. In this case, the pumping or ejection fraction may be preserved, but the overall function of the heart is compromised.
Risk Factors of Heart Failure
Heart failure can affect individuals of any age, but certain factors increase the risk of developing the condition. These risk factors include:
- Age: The risk of heart failure increases with age, particularly in individuals over 65 years old.
- High Blood Pressure: Uncontrolled hypertension puts strain on the heart and increases the risk of heart failure.
- Coronary Artery Disease: Narrowed or blocked blood vessels can lead to reduced blood flow to the heart muscle, causing damage and increasing the likelihood of heart failure.
- Previous Heart Attack: A previous heart attack can weaken the heart muscle and contribute to heart failure.
- Diabetes: Diabetes, especially if poorly controlled, increases the risk of developing heart failure.
- Obesity: Excess body weight puts additional strain on the heart and can lead to heart failure.
- Smoking: Smoking damages blood vessels and increases the risk of heart disease, including heart failure.
- Family History: A family history of heart failure or other heart conditions can increase an individual’s risk.
Stages of Heart Failure
The stages of heart failure are commonly defined using the New York Heart Association (NYHA) functional classification or the American College of Cardiology (ACC)/American Heart Association (AHA) stages.
In this stage, individuals are considered to be at high risk for developing heart failure but do not have structural heart disease or symptoms. They may have underlying conditions such as high blood pressure, diabetes, or a family history of heart failure. The focus at this stage is on identifying and managing risk factors through lifestyle modifications and medical interventions to prevent the onset of heart failure.
At this stage, there is a presence of structural heart diseases, such as a previous heart attack, heart valve disease, or cardiomyopathy, but individuals still do not have symptoms of heart failure. The goal is to prevent the progression of heart failure through medical treatments and lifestyle changes to manage the underlying heart condition.
Stage C is characterized by the presence of structural heart disease along with symptoms of heart failure, such as fatigue, shortness of breath, and exercise intolerance. These symptoms may occur during normal activities, and individuals may experience limitations in their daily lives. Treatment strategies at this stage focus on managing symptoms, improving heart function, and preventing further deterioration through a combination of medications, lifestyle modifications, and possibly medical devices.
This stage represents advanced heart failure, where individuals experience severe symptoms even at rest and are significantly limited in their physical activities. They may require specialized interventions, such as advanced medical therapies, implantable devices (e.g., ventricular assist devices), or heart transplantation. Palliative care or hospice services may also be considered to improve the quality of life and manage symptoms.
Symptoms of Heart Failure
- Feeling short of breath, especially when exercising or lying flat.
- Fatigue and weakness.
- Persistent coughing or wheezing.
- Swelling in the ankles, legs, abdomen, or veins in the neck.
- Rapid or irregular heartbeat.
- Reduced ability to exercise.
- Weight gain due to fluid retention.
- Loss of appetite and nausea.
Treatment Options for Heart Failure
Lifestyle changes: Making certain lifestyle modifications can help manage heart failure. These include maintaining a healthy weight, exercising regularly, reducing salt intake, limiting fluid intake, quitting smoking, and avoiding excessive alcohol consumption.
Medications: Several medications may be prescribed to manage heart failure, such as:
ACE inhibitors or ARBs: These help relax blood vessels, lower blood pressure, and reduce strain on the heart.
- Beta-blockers: These slow down the heart rate and decrease blood pressure.
- Diuretics: This help eliminate excess fluid from the body and reduce swelling.
- Aldosterone antagonists: These medications help reduce fluid retention.
- Digoxin: It helps strengthen the heart’s contractions and regulate the heartbeat.
- Angiotensin receptor-neprilysin inhibitors (ARNIs): These are a newer class of medication that combine the benefits of an ACE inhibitor and a neprilysin inhibitor to improve heart function.
Devices and surgical interventions:
- Implantable cardioverter-defibrillator (ICD): It helps regulate abnormal heart rhythms.
- Cardiac resynchronization therapy (CRT): This involves the placement of a special pacemaker to coordinate the heart’s contractions.
- Ventricular assist devices (VADs): These mechanical devices help support the pumping function of the heart.
- Heart transplant: In severe cases, a heart transplant may be considered when other treatment options are not effective.
- Cardiac rehabilitation: This program involves supervised exercise, education, and counseling to improve cardiovascular health and manage heart failure symptoms.
Monitoring and self-care: Regular monitoring of weight, blood pressure, and symptoms are important in managing heart failure. It’s crucial to follow a recommended diet, take medications as prescribed, and seek medical attention if symptoms worsen or new symptoms develop.
How to Prevent Heart Failure?
Maintain a Healthy Lifestyle:
Adopting a healthy lifestyle can significantly reduce the risk of developing heart failure. Focus on eating a nutritious diet: Include plenty of fruits, vegetables, whole grains, lean proteins, and healthy fats in your diet. Saturated and trans fats, cholesterol, salt, and added sugars should all be avoided. Aim for 150 minutes of moderate-intensity aerobic exercise each week or 75 minutes of strenuous exercise. Consult your doctor before starting any exercise program. Strive to achieve and maintain a healthy weight range by balancing your calorie intake with physical activity. If you smoke, quit as soon as possible. Using cigarettes is a significant risk factor for cardiac disease, including heart failure. Consume alcohol in moderation, which is no more than one drink per day for women and no more than two drinks per day for men.
Manage Underlying Conditions:
Certain medical conditions increase the risk of developing heart failure. Take steps to effectively manage these conditions, such as: Monitoring your blood pressure regularly and following your doctor’s recommendations to keep it within a healthy range; Control your blood sugar levels through a combination of medication, diet, exercise, and regular monitoring; Follow your doctor’s advice regarding medications, lifestyle changes, and procedures (if necessary) to manage blockages in your heart’s arteries; If you have sleep apnea, seek appropriate treatment as it can contribute to heart problems.
Regular Health Check-ups:
Schedule regular check-ups with your healthcare provider to monitor your overall health. They can assess your risk factors, perform necessary tests, and provide guidance on managing your health effectively.
If you have been prescribed medications for conditions like high blood pressure, diabetes, or other underlying issues, take them as directed by your doctor. Adhering to prescribed medications can help control these conditions and reduce the risk of heart failure.
Keep up-to-date with the latest research, guidelines, and recommendations related to heart health and heart failure prevention. Educate yourself through reliable sources such as medical journals, reputable websites, and trusted healthcare organizations.
Recognize Symptoms and Seek Prompt Medical Attention:
Be aware of the signs and symptoms of heart problems, such as chest pain, shortness of breath, fatigue, and swelling in the legs and ankles. If you experience these symptoms, especially if they are sudden or severe, seek immediate medical attention.
Find healthy ways to manage stress, as chronic stress can contribute to heart disease. Engage in activities that help you relax and unwind, such as exercise, meditation, hobbies, or spending time with loved ones.