Heart Failure

The term “heart failure” means that the heart cannot keep up with its workload. Your body depends on the heart’s pumping action to deliver oxygen- and nutrient-rich blood to the body’s cells. When the cells are nourished properly, the body can function normally. With heart failure, the heart muscle is unable to pump enough blood to meet the body’s needs for blood and oxygen.

Heart Failure

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At first the heart tries to make up for this by enlarging, developing more mass and pumping faster. The body also tries to compensate by narrowing its blood vessels and by diverting blood away from less important tissues and organs. These temporary measures mask the problem of heart failure, but they don’t solve it. Heart failure continues and worsens until these compensating processes no longer work. Eventually the heart and body just can’t keep up, and the person experiences the fatigue, breathing problems or other symptoms that usually prompt a trip to the doctor.

Types of Heart Failure

  • Left-sided heart failure: The heart's pumping action moves oxygen-rich blood as it travels from the lungs to the left atrium (heart’s upper chamber) then on to the left ventricle (heart’s lower chamber) which pumps it to the rest of the body. The left ventricle supplies most of the heart's pumping power, so it's larger than the other chambers and essential for normal function. In left-sided heart failure, the left side of the heart must work harder to pump the same amount of blood. There are two types:
    • Heart failure with reduced ejection fraction (HF-rEF):Also called systolic failure,happens when the left ventricle loses its ability to contract normally. The heart can’t pump with enough force to push enough blood into circulation.
    • Heart failure with preserved ejection fraction (HF-pEF): Also called diastolic failure, happens when the left ventricle loses its ability to relax normally. The heart can’t properly fill with blood during the resting period between each beat.
  • Right-sided heart failure: The heart's pumping action moves "used" blood that returns to the heart through the veins through the right atrium into the right ventricle. The right ventricle then pumps the blood back out of the heart into the lungs to be replenished with oxygen. Right-sided heart failure usually occurs as a result of left-sided failure. When the right side loses pumping power, blood backs up in the body's veins. This usually causes swelling or congestion in the legs, ankles and swelling within the abdomen.
  • Congestive heart failure (CHF): A type of heart failure which requires seeking timely medical attention. As blood flow out of the heart slows, blood returning to the heart through the veins backs up, causing congestion in the body's tissues. This is often present as swelling (edema). Most often there's swelling in the legs and ankles, but it can happen in other parts of the body, too. Sometimes fluid collects in the lungs and interferes with breathing, this is called pulmonary edema.

Prior to moving forward, an important term needs to be addressed:

Ejection fraction (EF) refers to how well your left ventricle (or right ventricle) pumps blood with each heartbeat. A normal heart’s left ventricular ejection fraction (LVEF) ranges from 55% to 70%. Your EF can go up and down, based on your heart condition and how well your treatment works.

Ejection fraction by the numbers

  • Ejection fraction (55% to 70%): This percentage shows that your heart’s pumping ability is normal. However, even though your heart function is normal, you may have heart failure with preserved EF (HF-pEF).
  • Ejection fraction (40% to 54%): This percentage shows that your heart’s pumping ability is slightly below normal.
  • Ejection fraction (35% to 39%): This percentage shows that your heart’s pumping ability is moderately below normal. This could mean that you have heart failure with reduced EF (HF-rEF).
  • Ejection fraction (Less than 35%): This percentage shows that your heart’s pumping ability is severely below normal. Severe HF-rEF increases risk of life-threatening conditions.

Causes of Heart Failure

Most people who develop heart failure have (or had) another heart condition first. The most common conditions that can lead to heart failure are coronary artery disease, high blood pressure and previous heart attack. However, other conditions, traits or habits may play a role in raising your risk for this disease. These conditions are known as risk factors and include:

Non-modifiable risk factors: These factors are irreversible and cannot be changed. The more of these risk factors you have, the greater your chance of developing heart failure.

  • Family history/Genetics
  • History of heart attacks

Modifiable risk factors: These factors can be modified, treated or controlled through medications or lifestyle changes.

  • Excessive consumption of alcohol over the years
  • Smoking and/or drug use
  • Obesity or having a body mass index “BMI” of 30 or greater.
  • Diabetes

Other conditions that contribute to developing heart failure

Symptoms of Heart Failure

There may be times that your symptoms are mild or you may not have any symptoms at all. This does not mean you no longer have heart failure. Symptoms of heart failure can range from mild to severe, and they may come and go. In general, heart failure gets worse over time. As it worsens, you may have more or different signs or symptoms. It is important to let your doctor know if you have new symptoms or if your symptoms get worse. Common signs and symptoms of heart failure include:

  • Confusion or impaired thinking
  • Fatigue
  • Decreased appetite
  • Persistent cough or wheezing with white or pink blood-tinged phlegm.
  • Rapid weight gain from fluid retention.
  • Rapid heart rate (tachycardia) of more than 100 beats per minute.
  • Shortness of breath
  • Swelling of the legs, ankles, feet and abdomen

Diagnosis of Heart Failure

To diagnose heart failure, your doctor will take a careful review of your medical history, symptoms and perform a physical examination. Using a stethoscope, your doctor can also listen to your lungs for signs of congestion and for any abnormal heart sounds. The doctor may examine the veins in your neck and check for fluid buildup in your abdomen and legs as well. After that, you may have:

Diagnostic tests and procedures

Classifications of Heart Failure

According to The American College of Cardiology/American Heart Association guidelines, there are 4 stages of heart failure. The different stages are:

  • Stage A: This stage reflects patients who have several risk factors for heart failure but show no signs or symptoms.
  • Stage B: This stage includes patients who have been diagnosed with heart failure but without any prior symptoms.
  • Stage C: This stage includes patients who have been diagnosed with heart failure and had or have signs and symptoms.
  • Stage D: This stage reflects a patient with advanced symptoms that does not get better with treatment.

According to the New York Heart Association, there are four classes of heart failure. This symptom-based scale classifies heart failure into four categories. The categories are:

  • Class I: Patients in this category show no limitation of physical activity.
  • Class II: Patients in this category show slight limitation of physical activity. No symptoms of heart failure at rest.
  • Class III: Patients in this category show great limitation of physical activity. No symptoms of heart failure at rest.
  • Class IV: Patients in this category are unable to carry on any physical activity without discomfort. There are symptoms of heart failure at rest.

These different classifications are not independent of each other. Your doctor often will use them together to help decide your most appropriate treatment options.

Treatment of Heart Failure

Heart failure is a chronic disease needing lifelong management. However, with treatment, signs and symptoms of heart failure can improve, and the heart sometimes becomes stronger. Treatment options include:

Lifestyle changes

  • Avoid alcohol
  • Avoid smoking
  • Eat a heart-healthy diet
  • If you are overweight, talk to your doctor about weight-loss options.
  • Track your daily fluid intake
  • Participate in a cardiac rehabilitation program.
  • No more than 7 to 8 hours of sleep per night.
  • Avoid or limit caffeine consumption
  • Keep track of your symptoms.
  • Manage stress
  • Make and keep appointments to see your doctor for routine check-ups and follow-up tests.

Medications

  • ACE inhibitors will help blood vessels relax and open up, which in turn, lower blood pressure.
  • Angiotensin II receptor blockers will help blood vessels open up and blood pressure is reduced.
  • Angiotensin receptor neprilysisn inhibitors will help treat those heart failure patients with reduced ejection fraction.
  • Beta blockers will help reduce your blood pressure.
  • Anticoagulants “blood-thinners” will help treat, prevent, and reduce blood clotting.
  • Statins will help reduce the level of cholesterol in the blood.
  • Diuretics “water pills” will help reduce the amount of fluid retention in your body.

Medical and surgical procedures

Clinical trials

DAPA-HF

GALACTIC-HF

GUIDE-HF

CONNECT-HF

HEARTMATE 3 / MOMENTUM 3

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