Dr. Gonzalez Cocina is a specialist in cardiology in Malaga. He is the director of the Cardiovascular Medical Center of Malaga and Marbella. He also has an extensive professional background, both in teaching and medicine.
What is heart failure?
A patient is considered to have heart failure when there is an increase in venous pressure in the cardiovascular system. When the increase in venous pressure occurs in the lungs the patient will notice dyspnea or shortness of breath. If the increase occurs in the systemic venous system, congestive symptoms of fluid retention in the abdomen or legs, such as ascites and edema, will appear.
What causes this problem?
Almost all heart diseases can cause heart failure at some point in their course. The most frequent are ischemic heart disease, especially in patients who have had a myocardial infarction, and arterial hypertension. Heart valve diseases, cardiomyopathies and some arrhythmias can also cause symptoms of heart failure.
Are there different types of heart failure and what are they?
Yes, from the clinical point of view, we classify heart failure as left-sided, right-sided or congestive. In the first case the predominant symptom is dyspnea, in the second the appearance of edema or both in congestive heart failure.
From a functional point of view, it is classified into heart failure with preserved or depressed ejection fraction, depending on whether the pump function of the left ventricle is intact or impaired, which has implications for the patient’s prognosis.
What aspects motivate or facilitate the onset of failure?
In patients with heart disease predisposing to heart failure, the triggering factors can be hygienic-dietary factors such as salt consumption, poor compliance with pharmacological therapy, poor blood pressure control, cardiac arrhythmias, anemia, intercurrent infections such as influenza and/or bacterial infections and hyperthyroidism, among the most frequent.
Can it be prevented in any way? What risk factors should we avoid?
The prevention of heart failure has two aspects. One is to prevent the disease that can predispose to its appearance, such as primary prevention of coronary disease through good control of the known risk factors such as hypertension, diabetes, obesity, sedentary lifestyle, and smoking, and two is to prevent the appearance of left ventricular dysfunction through early repercussions in acute myocardial infarction, or good control of hypertension.
In patients with chronic heart failure it is important to prevent episodes of decompensation by reducing salt intake, optimizing pharmacological treatment by adjusting diuretic doses according to body weight, or other drugs such as beta-blockers, to achieve an optimal heart rate according to scientific evidence.
Can heart failure lead to other coronary problems? Which ones?
No, it is the other way around. Coronary problems can lead to heart failure as explained in the previous section.
Can heart failure be treated and what does the treatment consist of?
The treatment of heart failure has two main objectives. The first is to improve the patient’s symptoms, derived from fluid retention and increased pulmonary venous pressure such as dyspnea and edema, and the second is to increase survival.
Diuretics are the most effective drugs in achieving a rapid effect in improving symptoms, increasing diuresis and decreasing congestive symptoms. Renin-angiotensin-aldosterone system inhibitors improve symptoms in the long term and also prolong survival.
Beta-blockers, drugs that block the effect of catecholamines on the heart, are the latest additions to the therapeutic armamentarium against heart failure, and are recommended for use at the maximum tolerable dose, given their beneficial effect in increasing life expectancy.
It is common for patients with chronic heart failure to present a deficit of iron deposits, which leads to worsening of symptoms, and it is necessary to replenish them through the administration of intravenous iron.
There is a subgroup of patients with severe left ventricular dysfunction who have asynchrony in the contraction of the ventricles due to a delay in the conduction of the electrical stimulus, and who improve significantly with the implantation of a pacemaker that resynchronizes the functioning of the heart.
Patients with heart failure and high risk of sudden death due to severe ventricular arrhythmias should be treated with implantation of an automatic defibrillator (ICD), which reduces this risk.
Finally, patients who persist with advanced heart failure despite the aforementioned optimal treatment should be included in a cardiac transplantation program. Ventricular assist devices (artificial heart) are being used in critically ill patients as a bridge to transplantation.