The Failing Heart
Heart failure is a condition that occurs when the heart cannot pump blood as well as it should; this leads to inadequate blood flow to vital organs such as the kidneys and congestion (build-up of fluid) in other vital organs such as the lungs. The term “heart failure” is a misnomer because the heart does not completely fail or stop beating.
The main symptoms of heart failure include breathless on exertion, feeling fatigued all the time, swollen ankles and abdomen, being unable to lie flat or waking up and having to sit upright at night due to breathlessness. Some patients may experience heart palpitations and dizziness. It’s worth noting that these symptoms can develop over a short period of time (acute heart failure), or gradually over weeks and months (chronic heart failure).
Heart failure is caused by conditions that make the heart muscle too weak or too stiff. An ultra sound scan of the heart is done to assess how the left side of the heart is functioning to eject blood (ejection fraction). Heart failure is then classified as heart failure with reduced or preserved ejection fraction.
Hypertension puts a strain on the heart and eventually causes weakening of the heart muscle and heart failure. Coronary artery disease can cause heart attacks which leads to part of the heart muscle dying and weakening. Other causes of heart failure include diabetes, heart rhythm abnormalities, diseases of the heart valves, diseases of heart muscles, excessive alcohol intake and an over active thyroid.
The diagnosis of heart failure is based on a comprehensive history, physical examination and a series of tests. These tests determine how well the heart is working as well as what is the cause of the heart failure. These tests include a chest Xray which looks at the shape and size of the heart, an ECG which measure the electrical activity of the heart and picks up abnormal heart rhythms.
Blood tests can also be done to exclude metabolic causes of heart failure and to detect certain hormones that get released where there is heart failure. Other tests that can be done include stress testing which looks at how well the heart performs during exercise and cardiac catheterisation which looks at whether the heart vessels are blocked or not.
The management of heart failure can be complicated and requires a multidisciplinary approach. The goals of management are relieving symptoms and prolonging survival.
Non-medical management of heart failure includes lifestyle modification such as; fluid restriction.
Heart failure patients should not consume more than 1-1.5L of fluid per day. A low salt diet is also important as salt tends to cause water retention. If symptoms allow then regular exercise should be done to improve cardiovascular fitness and strengthen muscles. Other important lifestyle adjustments include weight loss in those that are overweight, stopping smoking and limiting alcohol intake.
Diuretics or “water pills” are primarily used to reduce shortness of breath and leg swelling. Other different forms of antihypertensive medication are used to increase survival and delay progression of heart failure.