Heart failure occurs as a result of the heart not pumping enough blood to supply the entire body. Depending on the type of heart failure and its origin, the symptoms of the pathology will be different. Hence the importance of correctly diagnosing the type of heart failure in order to administer appropriate treatment.
Heart failure: what it is
Heart failure is the result of an imbalance between the heart’s ability to pump blood and the body’s need to supply it.
Consequently, heart failure occurs primarily in two situations:
- When the cardiac muscle has an insufficient pumping capacity as a result of heart disease: valvular disease, arrhythmia, cardiomyopathy (which can be of various origins) and coronary heart disease, fundamentally.
- The second situation is due to circumstances in which the body’s demand for blood is high even for a healthy heart. These circumstances include: infections, anemia and thyroid disease, mainly.
At present, heart failure is a syndrome that plagues a large part of the population, especially the elderly. This is due, on the one hand, to the aging of the population in the developed world which, in turn, is more exposed to risk and, on the other hand, to the high prevalence of risk factors in today’s society, such as arterial hypertension, diabetes, sedentary lifestyle, obesity, alcohol or smoking, among others.
Types of heart failure
This insufficient pumping of the heart may come from the right ventricle (right heart failure), the left ventricle (left heart failure) or both (biventricular heart failure), depending on the cause of the heart failure. This will cause different symptoms in each case.
There is also a second type of heart failure, when the cardiac muscle becomes rigid, with difficulty in relaxing and filling adequately; this is called diastolic heart failure (filling) as opposed to the previously mentioned systolic heart failure (pumping or ejection).
On the other hand, heart failure can present, depending on the cause that triggers it, in two ways, acute and chronic.
Symptoms of heart failure
The symptoms of heart failure will depend on whether it is right heart failure or left heart failure, but, over time patients with left heart failure may also develop right heart failure, being then in a situation of biventricular heart failure.
The main symptom of left heart failure is dyspnea or shortness of breath. This is due to fluid pooling in the lungs. In an initial phase, this shortness of breath will be present when making important efforts and, if the disease progresses, it will increasingly appear with less effort or even at rest. It may also cause the need to sleep on more than one pillow or to wake up suddenly with a feeling of suffocation or coughing. Other symptoms of heart failure are due to insufficient pumping and, consequently, less blood reaching the rest of the organs and apparatuses of the organism, causing fatigue, asthenia, renal involvement, with less urine production, liver, digestive, cerebral, etc.
In right heart failure the main symptoms are due to an accumulation of fluid in the venous system, as it is difficult to empty it in the right heart, which causes:
- Swelling (edema) in the feet and ankle.
- Swelling in the neck veins (jugular ingurgitation).
- enlargement of the liver (hepatomegaly)
- Fluid retention in the peritoneal cavity (ascites), in advanced cases
- Abdominal swelling
Other symptoms include increased urine output during the night, rapid and irregular pulse, and often unwarranted weight gain, which would correspond to the retained fluid.
How heart failure is diagnosed
The diagnosis of heart failure is based, fundamentally, on carrying out an exhaustive interrogation of the patient, finding out if he/she presents the symptoms described above, as well as discovering the risk factors referred to above. A physical examination is also necessary to look for the aforementioned clinical signs. In principle, this would be sufficient to make a diagnosis of heart failure. However, in Cardiology we have complementary tests that will help us to confirm the diagnosis, find out the cause and assess its severity.
Among these complementary explorations, we have some simple tests to be performed initially, such as an electrocardiogram, a chest X-ray and a blood test. Nowadays it is essential to have a Doppler echocardiogram, a simple and bloodless technique that will give us information on the state of the heart valves, the size of the chambers, the thickness of their walls or the pump function of the heart.
Other possible diagnostic techniques are
- stress test, to obtain information on the deterioration of functional capacity.
- Holter monitoring, to detect the presence of cardiac rhythm disturbances
- cardiac catheterization, which will allow us to know the state of the coronary arteries, the functioning of the valves and to take pressure measurements inside the heart.
- cardiac magnetic resonance imaging, which is playing an increasingly important role today.
Prognosis of heart failure
The prognosis of heart failure depends fundamentally on the cause that originates it, whether it is adequately and optimally treated and the time at which it is diagnosed. If too much time elapses between the appearance of the first symptoms, the establishment of the cause and the start of treatment, the prognosis worsens considerably.
The prognosis is also directly related to the general health of the patient, especially the existence of other concomitant diseases. A very important prognostic factor is the scrupulous follow-up of the medication and the hygienic-dietary measures advised by the physician, as well as the control of risk factors that may aggravate the patient’s condition. In this sense, the support that the patient receives from his or her environment, especially the family, is of vital importance.
Treatments for heart failure
There are multiple treatments depending on the cause that originated the heart failure.
However, it is necessary to refer, in the first place, to those general and hygienic-dietary measures that every patient should keep in mind, such as: weight control, a diet low in salt, adjusting fluid intake to the patient’s needs, physical exercise (as recommended by the cardiologist), sufficient rest, control of alcohol consumption or elimination of alcohol (if advised), smoking cessation, reduction of cholesterol and other fat levels, control of other concomitant diseases such as diabetes and arterial hypertension, among other measures.
The therapeutic arsenal currently available to us is multiple, and must be individualized according to each case. Thus, we have digoxin, diuretics, vasodilators, beta-blockers, aldosterone inhibitors, inotropic agents, etc.
On the other hand, depending on the cause responsible for the heart failure, the patient may require some type of surgical intervention such as valve replacement or reconstruction, coronary bypass, correction of congenital defects… or even, in certain cases, a heart transplant.
Nowadays, more and more patients can benefit from percutaneous treatments that can resolve the cause of heart failure, such as coronary angioplasty and stent implantation or valvuloplasty. There are also other procedures, such as pacemaker implantation, ventricular resynchronization devices and implantable defibrillators.
In conclusion, two aspects should be emphasized:
- the importance of instructing and involving the patient and his or her environment in the knowledge of heart failure, warning signs and symptoms, the need for a cardio-healthy lifestyle, and the need to carry out the prescribed treatment correctly.
- insist on the need to fight against cardiovascular risk factors that can increase the incidence of heart failure in the population.