Dr Aidin Rawshani

Heart failure: symptoms, causes, diagnosis, treatment and prognosis

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Heart failure or impaired heart function is a condition in which the heart can not pump enough blood to meet the needs of the body. In some cases, the heart is not filled with enough blood, and in other cases the heart can not pump blood to the rest of the body with sufficient force. Some people have both problems as the cause of heart failure. The term “heart failure” does not mean that your heart has stopped or is about to stop working, but heart failure is a serious condition requiring medical attention. In the majority of cases, heart failure leads to a continuous deterioration in heart function.

Brief overview of heart failure

Heart failure is a disease that usually develops over time when the pumping capacity of the heart is impaired. Heart failure is a disease that is usually due to another condition, such as old age, high blood pressure (hypertension), heart attack or diabetes. Both type 1 diabetes and type 2 diabetes present a markedly increased risk of heart failure.

People usually talk about the right and left halve of the heart. The right half of the heart pumps blood through the lungs, where the blood is enriched with oxygen. The left half of the heart pumps the oxygen-rich blood into the body so that all organs of the body can receive oxygen-rich blood. Sometimes heart failure can affect one side first, but usually both right and left heart halve are affected if you have heart failure. Right-sided heart failure occurs when the heart can not pump enough blood to the lungs to fetch oxygen. Left-sided heart failure occurs if the heart is unable to pump enough oxygen-rich blood to the rest of the body. Right-sided heart failure leads to fluid accumulation in the feet, around the ankles, lower limbs and possibly up the thighs and abdomen. All types of heart failure lead to shortness of breath, fatigue and loss of performance.

Symptoms of heart failure (symptoms)

  • Shortness of breath is the most common symptom of heart failure. Almost everyone with heart failure experiences shortness of breath.
  • Edema (fluid retention) is very common. Fluid most often accumulates in the feet and legs.
  • Cough is common in heart failure. Cough suggests that there is fluid in the lungs.
  • Orthopnea, which involves getting very shortness of breath when lying down, is typical for heart failure.
  • Chest pain is also common in heart failure. Chest pain is especially common if you have heart failure as a result of coronary heart disease.
  • Weakness.
  • Nausea vomiting.
  • Edema in the abdomen (ascites) occur.
  • Mental fatigue occurs.
  • Heart palpitations are common.
  • Weight gain is common and indicates accumulation of fluid.

How common is heart failure?

Heart failure is a very common condition. In Sweden, it is estimated that approximately 200,000 individuals suffer from heart failure. Most likely, there are as many people who have undiagnosed heart failure. Both children and adults can have the condition, although the symptoms and treatments differ. This chapter will focus on heart failure in adults.

Currently, there is no way to cure heart failure, except for heart transplantation. However, treatments such as medicines and lifestyle changes can result in a longer and healthier life, even if you have heart failure. Scientists continue to study new ways of treating heart failure and its complications.

Causes of heart failure

Conditions that damage or overwork the heart muscle can cause heart failure. Over time, the heart weakens so that it can not be filled with and/or pumped blood well enough. Because the heart weakens and blood circulation deteriorates, many organs can be affected in the long term. The most common causes of heart failure are as follows:

  • Ischemic heart disease (ischemic heart disease)
  • Diabetes mellitus
  • High blood pressure (hypertension)
  • Other heart diseases (valvular heart disease, heart muscle disease, kidney failure or chronic obstructive pulmonary disease)
  • Other factors (eg thyroid disease).

Ischemic heart disease (ischemic heart disease) causes heart failure

Ischemic heart disease is a condition in which fat accumulates in the vessels of the heart (coronary arteries). These blood vessels deliver oxygen-rich blood to your heart. Fat in the coronary arteries, called varicose veins, causes narrowing of blood vessels and reduces blood flow to the heart muscle. The build-up of varicose veins also makes it more likely that blood clots will form in your blood vessels. Blood clots can partially or completely block the blood flow and this leads to a heart attack (myocardial infarction). When you have varicose veins in the vessels of the heart, you get pain in the chest (chest pain), which is called angina. Chest pain is due to the fact that the fat of the veins leads to oxygen starvation of the heart. If the lack of oxygen becomes prolonged, it leads to a heart attack (myocardial infarction).

Diabetes type 1 and type 2 causes heart failure

Diabetes is a disease in which the body’s blood sugar level (blood glucose) is too high. In diabetes, the body does not produce enough insulin or does not use its insulin correctly. Over time, high blood sugar levels can damage and weaken the heart muscle and blood vessels around the heart, leading to heart failure. Here at diabeteson.com we have written many articles about type 1 diabetes and type 2 diabetes, some of which follow here:

High blood pressure causes heart failure

Blood pressure is the pressure inside the blood vessels. If this pressure rises and remains high over time, it can lead to loads that weaken the heart. High blood pressure also causes varicose fat in the heart.

Blood pressure is considered high if it is 140/90 mmHg or higher (mmHg is the unit with which the pressure in the blood vessels is measured). If you have diabetes or chronic kidney disease, it is considered that blood pressure is high already at 130/80 mmHg or higher. Therefore, you should have a blood pressure lower than 130 in excess pressure and 80 in suppression pressure. You can read more about blood pressure here: Blood pressure and hypertension.

Other heart diseases or diseases that cause heart failure

Various heart diseases that can lead to heart failure

  • Rhythm disorders (arrhythmias): Each heartbeat is controlled by the electrical system of the heart and when this system does not function normally, heart rhythm disturbances occur. The most common rhythm disturbance is atrial fibrillation. People with atrial fibrillation have high and irregular heart rate and they have up to 5 times increased risk of heart failure.
  • Cardiomyopathies: When the heart muscle becomes enlarged, thick or numb, it leads to heart failure.
  • Congenital heart defects (congenital heart malformation): Problems with heart structure at birth can cause heart failure.
  • Heart valve disease: This occurs if one or more of your heart valves are not functioning properly, which can occur at birth or be caused by infection, other heart diseases and age.

Other factors

Other factors that can damage the heart muscle and lead to heart failure

  • Alcohol abuse and drugs can cause heart failure.
  • High consumption of alcohol over longer periods leads to cardiomyopathy and heart failure.
  • HIV/AIDS thyroid disorders (hyperthyroidism, hypothyroidism)
  • Treatments for cancer, such as radiation and chemotherapy

Risk factors for heart failure

  • High blood pressure
  • Ischemic heart disease (ischaemic heart disease)
  • Myocardial infarction
  • Diabetes type 1, diabetes type 2
  • Some diabetic drugs
  • Sleep apnea
  • Valve disease
  • Congenital heart failure
  • Virus
  • Alcohol
  • Tobacco
  • Obesity/overweight
  • Various medications and drugs
  • Renal failure
  • Liver failure
  • High age

Groups with a particularly high risk of heart failure

The function of the heart becomes worse with age. Older people have a higher risk of heart failure, compared to younger people. Elderly people also more often have other diseases and risk factors that cause heart failure.

People who are overweight have a greatly increased risk of heart failure. Obesity burdens the heart and the entire blood circulation. Being overweight also increases the risk of heart disease and type 2 diabetes, which in turn can lead to heart failure.

People who have suffered a heart attack (myocardial infarction) have an increased risk of heart failure. The heart attack itself causes part of the heart muscle to stop working, and if that part is large, it can lead to heart failure.

Children who have congenital heart defects may also develop heart failure. These defects occur if the heart, heart valves or blood vessels near the heart are not formed correctly during fetal life.

Screening for heart failure

You can take many measures to prevent heart failure. The sooner you detect risk factors for heart failure, the sooner you can start treatment and thus reduce the risk of developing heart failure. It is extremely important to make regular health check-ups and have a healthy lifestyle.

For people who have healthy hearts

If you have a healthy heart, you can take measures to prevent heart disease and heart failure. To reduce the risk of heart disease, you should do the following:

  • Avoid drugs and drink moderately with alcohol.
  • Start and maintain healthy habits (diet, exercise, etc.).
  • Treat risk factors (high blood pressure, high cholesterol, etc.).

To put the diagnosis of heart failure

As your heart gets weaker, the symptoms get worse. You can begin to feel tired and shortness of breath already just by walking indoors. The doctor diagnoses heart failure based on your medical history, heredity, a physical medical examination, blood tests and X-rays.

Your doctor will ask if you or others in your family have or have had a disease or condition that can cause heart failure. Your doctor will also ask about your symptoms. The doctor wants to know what symptoms you have, when they occur, how long you have had them and how serious they are. It is important that your answers are accurate and detailed.

Medical examination

During the physical examination, your doctor will:

  • Listen to your heart to identify noises that are not normal.
  • On your lungs to hear if there is fluid in the lungs (pulmonary edema).
  • Look for swelling around the ankles, feet, legs, abdomen and veins in the neck.
  • Diagnostic tests

Your doctor can also refer you to a cardiologist (cardiologist, cardiologist). A cardiologist is an expert in diagnosing, treating and monitoring people with heart failure. However, in many cases, primary health care (general practitioner) can handle heart failure treatment.

ECG (Electrocardiogram)

An ECG is a simple and painless test that analyzes the electrical activity of the heart. The test shows how quickly your heart beats and its rhythm. ECG can also show how the heart muscle works, but ECG is not the best method for clarifying this. Ultrasound of the heart is even better than ECG in terms of heart function mapping.

Chest X-ray

With a perfectly normal X-ray image, you can see the chest, lungs and heart. This examination will show whether your heart is enlarged, whether you have fluid in your lungs and sometimes you can see some lung diseases.

Blood test (NT-pro-GDP)

This blood test checks the level of a hormone called NT-pro-BNP. The level of this hormone rises in heart failure. Normal NT-pro-BNP (most often defined as values of 300 ng/L) means that one does not have heart failure. At higher values, the probability of having heart failure rises.

Ultrasound examination (echocardiography)

Echocardiography (heart ultrasound) uses sound waves to create a moving image of your heart. The test shows the size, shape and function of the heart. You can illustrate both the heart muscle, the valves and the large vessels. Echocardiography is currently the best method for detecting whether you have heart failure and the cause of the disease.

Tape player ECG (Holter ECG)

Holter ECG means having an ECG device connected to you and then going home and recording the ECG for 24 to 48 hours. The device is small and easy to include in everyday life.

Myocardial scintigraphy

Myocardial scintigraphy shows how well the blood flows through the heart and how much blood reaches the heart muscle. In myocardial scintigraphy, a radioactive substance (so-called trace element) is injected into the blood. The trace element ends up in the heart and stays there. From there, the trace element sends radiation that can be recorded with apparatus outside the body. In this way, images can be created from heart bleeding.

A positron emission tomography (PET) examination is similar to myocardial scintigraphy. It shows the level of biochemical activity in areas of your heart. This examination can help your doctor to see if enough blood flows to these areas. A PET examination may show blood flow problems that other tests may not detect.

Cardiac catheterization

During cardiac catheterization, a long, thin, flexible tube called a catheter is inserted into a blood vessel in the arm, groin (upper thigh) or neck. This allows your doctor to look inside your coronary arteries. During this procedure, your doctor can check the pressure and blood flow in the heart chambers, collect blood tests and use X-rays to look at your coronary arteries.

Coronary angiography (coronary angiography)

Coronary angiography is done with cardiac catheterization. A dye that can be seen on the X-ray is injected into the blood through the tip of the catheter. The color allows your doctor to see the blood flow to your heart muscle. In the case of constriction, you can directly inflate the blood vessel with balloon angioplasty and implant a metal mesh (stent) that holds up the blood vessel, known as PCI (percutaneous coronary intervention), or in popularly balloon blasting.

Work test (Work ECG)

Some heart problems are easier to diagnose when your heart is working. During the test you should ride a bike or walk (on a treadmill) while keeping different values recorded by the health care staff.

MRI of the heart (MRI of the heart)

MRI uses radio waves (magnets) and an advanced computer to create images of your heart when it beats. The test produces both static and moving images of your heart and larger blood vessels. MRI heart can show if parts of your heart are damaged.

Thyroid function tests

Thyroid function tests show how well your thyroid gland works. These tests include blood tests, imaging tests and tests to stimulate the thyroid gland. Having too much or too little thyroid hormone in the blood can lead to heart failure.

Medicines

Your doctor will prescribe medicines based on what type of heart failure you have, how serious it is and how you respond to certain medicines. The following drugs are often used to treat heart failure:

  • ACE inhibitors lower blood pressure and reduce the burden on your heart. They can also reduce the risk of a future myocardial infarction.
  • Aldosterone antagonists ensure that the body removes excess salt (sodium) through urine. This lowers the volume of fluid in the blood that the heart has to pump.
  • Angiotensin receptor blockers (ARB) relax blood vessels and lower blood pressure to reduce heart workload.
  • Beta-blockers lower heart rate and lower blood pressure to reduce heart workload, these drugs also have a protective effect in heart failure by reducing the negative conversion of heart muscle cells.
  • Digoxin makes the heart beats stronger and pumps more blood.
  • Diuretics (diuretics) helps reduce fluid retention in the lungs and the swelling of the feet and ankle joints.
  • Isosorbide dinitrate/ hydralazine hydrochloride helps to relax your blood vessels so that your heart does not work so hard to pump blood.

Take all medicines prescribed by your doctor on a regular basis. Do not change the amount of your medicine or skip a dose unless your doctor tells you to. You should still adhere to a healthy lifestyle for the heart, even if you take medicines to treat heart failure. Many believe that physical activity is bad for people who have heart failure but studies show that light exercise is likely positive for people with existing heart failure.

Care for people with heart failure

You should pay attention to signs that speak for the fact that the heart failure is getting worse. For example, weight gain can mean that fluids build up in the body. Ask your doctor how often to monitor your weight and when to report weight changes.

Getting medical care for other related conditions is important. If you have diabetes or high blood pressure, work with your healthcare team to control these conditions. Control blood sugar level and blood pressure. Talk to your doctor about when to give blood tests and how often to take measurements at home.

Try to avoid respiratory infections such as influenza and pneumonia. Talk to your doctor or nurse about getting flu and pneumonia vaccines. Many people who have severe heart failure may need treatment in a hospital. Your doctor may recommend oxygen therapy, which can be given in a hospital or at home.

Medical interventions and surgery

When heart failure worsens, lifestyle changes and medicines can no longer control your symptoms. You may need a medical intervention or surgery.

In heart failure, the right and left sides of the heart usually do not contract synchronously. If the left side of the heart is sick (left-sided heart failure) this side usually contracts shortly after the right side of the heart. This disrupts the pumping ability of the heart. To fix this problem, your doctor may implant a cardiac resynchronization therapy (a type of pacemaker, CRT) near your heart. This device helps both sides of your heart to contract (contract) at the same time, which can reduce heart failure symptoms.

Some people who have heart failure have very rapid, irregular heartbeats. Without treatment, these heartbeats can cause sudden cardiac arrest. Your doctor may implant an implantable “cardioverter-defibrillator” (ICD) near your heart to solve this problem. An ICD checks your heart rate and uses electrical pulses to correct irregular heart rhythms.

People who have severe symptoms of heart failure at rest, despite other treatments, may need the following:

A mechanical heart pump, such as a left ventricular assistance device. This device helps to pump blood from the heart to the rest of the body. You can use a heart pump until surgery or as a long-term treatment.

Heart transplant

A heart transplant is an operation in which a person’s sick heart is replaced with a healthy heart from a deceased donor. Heart transplants are made as a life-saving measure for heart failure at the final stage, when medical treatment and other surgery have failed.

Currently, heart failure has no cures. You will probably need to take medication and follow a treatment plan for the rest of your life.

Despite the treatment, the symptoms may become worse over time. You may not be able to do many of the things you did before you had heart failure. But if you take all the steps your doctor recommends, you can stay healthier longer.

Researchers can also find new treatments that can help you in the future.

Follow your treatment plan

Treatment can alleviate your symptoms and make daily activities easier. It can also reduce the risk that you will have to go to the hospital. Therefore, it is important that you follow your treatment plan.

Take your medicines as prescribed by your doctor. If you have side effects of any of your medicines, tell your doctor. He or she can adjust the dose or type of medication you are taking to relieve side effects.Make all lifestyle changes that your doctor recommends. Get advice from your doctor on how active you can and should be. This includes advice on daily activities, work, leisure and exercise. Your level of activity depends on the severity of your heart failure (how severe it is).

Do not miss any doctor’s appointments or blood test measurements, your doctor will need the results of these tests to adjust your drug doses and help you avoid harmful side effects.

The following measures can exacerbate your heart failure

  • Forget about taking your medications
  • Not following your diet plan (for example, eating foods with a lot of salt)
  • Drinking alcohol

These measures can lead to hospitalization. If you have problems following your diet, talk to your doctor. He or she can help arrange visits to a dietician.

People who have heart failure often have other serious conditions that require ongoing treatment. If you have other serious conditions, you most likely take medications for them and for heart failure.

Taking more than one medicine increases the risk of side effects and other problems. Make sure your doctors and pharmacists have a complete list of all medicines and over-the-counter products that you are taking.

Tell your doctor immediately about any problems with your medicines. Also talk to your doctor before taking any new medicine prescribed by another doctor or any new medicines obtained without a prescription or herbal supplements.

Planning Forward

If you have heart failure, it is important to know:

  • When to seek help.
  • Ask your doctor when to make an office visit or get emergency care.
  • Phone number of your doctor and hospital.
  • Directions to your doctor’s office and hospitals and people who can take you there.
  • A list of medications you take.
  • Emotional problems and support.
  • Living with heart failure can cause fear, anxiety , depression and stress.
  • Talk about how you feel with your care team.
  • Talking with a professional advisor can also help. If you are very depressed, your doctor may recommend medicines or other treatments that can improve your quality of life.

Join a patient support group can help you adapt to living with heart failure. You can see how other people who have the same symptoms have coped with them. Talk to your doctor about local support groups or check with a medical center.

Support from family and friends can also help relieve stress and anxiety. Let your loved ones know how you feel and what they can do to help you.

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