Heart Failure

Heart failure is a condition where the heart fails to pump blood in order to maintain the metabolic needs of the body. In most cases, heart failure is a chronic, long-standing and on-going condition, but it can develop suddenly.

A person may experience heart failure because of structural changes in the walls of the heart chambers or improper functioning of the valves.

Any factor that increases the workload of the heart muscles is a risk factor for heart failure. Some of these causes include:

• Coronary heart disease: It is a condition of the narrowing of arteries because of plaque build-up on vessel walls which reduce the blood supply to the heart muscle
• History of heart attack
• Uncontrolled high blood pressure
• Uncontrolled diabetes

Other causes of heart failure include valvular heart disease, such as aortic stenosis, congenital heart defects, cardiomyopathy – disease of the heart muscle, lung diseases, arrhythmias (irregular heartbeat) and chronic alcoholism.

The "failing" heart continues to work, but not as efficiently as it should. People with heart failure cannot exert themselves because they experience shortness of breath and get tired easily.

Common symptoms of heart failure are:

• Fatigue
• Breathlessness and difficulty in breathing
• Weight gain because of retention of fluids
• Inability to lie down flat on bed because of fluid retention in the lungs
• Swelling in the legs (edema)

Your doctor will diagnose heart failure based on your medical history alone, but may also ask you to undergo a series of diagnostic tests.

• Medical history: Medical history includes physical examination, questions regarding your symptoms, personal history and family history of any heart disease.
• Chest X-ray: A chest X-ray can show if your heart is enlarged and if you have fluid accumulation in and around your lungs.
• Electrocardiogram: Electrocardiogram is done to measure the electrical activity of your heart. It provides your doctor with information about your heart rate, rhythm, size of the heart chambers and previous damage to the heart.
• Echocardiogram: Echocardiogram is a test that uses sound waves to create a moving picture of the heart. These ultrasound images help to identify abnormalities in the heart muscle, valves and fluid that may surround the heart.
• Nuclear heart scans: This test shows blood flow to the heart and any damage to the heart muscle. A radioactive dye is injected into your bloodstream and a special camera is used to see the dye and find out areas of reduced blood flow.
• Angiography (Cardiac Catheterisation): Angiography is a test that enables your doctor to take X-ray images of the inside of your blood vessels. This procedure is performed by a cardiologist and involves threading a tiny catheter through a small incision into a large artery, usually in your groin. Once the catheter reaches the site of the blood vessel to be viewed, a dye is injected and X-ray images are taken.

The management of heart failure includes general management, medications and surgery.

General Management

• Reduction of physical activity reduces the demand on the heart
• Dietary modifications – low salt and low fat diet
• Losing weight if you are overweight
• Quitting smoking
• Alcohol restriction

Medications

The medications that may be prescribed include:

• Diuretics: These agents promote salt and water excretion by the kidneys. This reduces the workload of the heart and symptoms of fluid retention. They help relieve shortness of breath and leg swelling.
• Vasodilating agents: They dilate the blood vessels and decrease the work load on the heart.
• Digoxin: Increases the ability of the heart muscle to contract properly and prevent heart arrhythmias.
• Cardioselective beta blockers: These agents slow down the heart rate, reduce the heart’s need for oxygen and improve the supply of blood to the heart muscle.

Surgery

Left ventricular assist device: A mechanical heart pump called a left ventricular assist device (LVAD) which helps to pump blood from the heart to the rest of the body can be implanted until you have surgery or also as a long-term treatment.

Cardiac transplantation: Cardiac transplantation is the process of replacing the failing heart with a healthy donor heart. The donor heart is usually collected from a person who has been declared clinically brain dead. It is recommended in younger patients with severe heart failure and life expectancy less than 6 months.