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INTRODUCTION-
Heart failure is characterized by the heart’s inability to pump an adequate supply of blood to the body. Without sufficient blood flow, all major body functions are disrupted. Heart failure is a condition or a collection of symptoms that weaken your heart.
In some people with heart failure, the heart has difficulty pumping enough blood to support other organs in the body. Other people may have a hardening and stiffening of the heart muscle itself, which blocks or reduces blood flow to the heart.
Heart failure can affect the right or left side of your heart, or both at the same time. It can be either an acute (short-term) or chronic (ongoing) condition.
In acute heart failure, the symptoms appear suddenly but go away fairly quickly. This condition often occurs after a heart attack. It may also be a result of a problem with the heart valves that control the flow of blood in the heart.
In chronic heart failure, however, symptoms are continuous and don’t improve over time. The vast majority of heart failure cases are chronic.
About 5.7 million Americans have heart failure, according to the Centers for Disease Control and Prevention. Most of these people are men. However, women are more likely to die from heart failure when the condition goes untreated.
Heart failure is a serious medical condition that requires treatment. Early treatment increases your chances of long-term recovery with fewer complications. Call your doctor right away if you’re having any symptoms of heart failure.
Heart failure, sometimes known as congestive heart failure, occurs when your heart muscle doesn’t pump blood as well as it should. Certain conditions, such as narrowed arteries in your heart (coronary artery disease) or high blood pressure, gradually leave your heart too weak or stiff to fill and pump efficiently.
Not all conditions that lead to heart failure can be reversed, but treatments can improve the signs and symptoms of heart failure and help you live longer. Lifestyle changes — such as exercising, reducing sodium in your diet, managing stress and losing weight — can improve your quality of life.
One way to prevent heart failure is to prevent and control conditions that cause heart failure, such as coronary artery disease, high blood pressure, diabetes or obesity.
CAUSES-
Heart failure is most often related to another disease or illness. The most common cause of heart failure is coronary artery disease (CAD), a disorder that causes narrowing of the arteries that supply blood and oxygen to the heart. Other conditions that may increase your risk for developing heart failure include:
- cardiomyopathy, a disorder of the heart muscle that causes the heart to become weak
- a congenital heart defect
- a heart attack
- heart valve disease
- certain types of arrhythmias, or irregular heart rhythms
- high blood pressure
- emphysema, a disease of the lung
- diabetes
- an overactive or underactive thyroid
- HIV
- AIDS
- severe forms of anemia
- certain cancer treatments, such as chemotherapy
- drug or alcohol misuse
Heart failure often develops after other conditions have damaged or weakened your heart. However, the heart doesn’t need to be weakened to cause heart failure. It can also occur if the heart becomes too stiff.
In heart failure, the main pumping chambers of your heart (the ventricles) may become stiff and not fill properly between beats. In some cases of heart failure, your heart muscle may become damaged and weakened, and the ventricles stretch (dilate) to the point that the heart can’t pump blood efficiently throughout your body.
Over time, the heart can no longer keep up with the normal demands placed on it to pump blood to the rest of your body.
An ejection fraction is an important measurement of how well your heart is pumping and is used to help classify heart failure and guide treatment. In a healthy heart, the ejection fraction is 50 percent or higher — meaning that more than half of the blood that fills the ventricle is pumped out with each beat.
But heart failure can occur even with a normal ejection fraction. This happens if the heart muscle becomes stiff from conditions such as high blood pressure.
Heart failure can involve the left side (left ventricle), right side (right ventricle) or both sides of your heart. Generally, heart failure begins with the left side, specifically the left ventricle — your heart’s main pumping chamber.
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TYPES-
| Type of heart failure | Description |
|---|---|
| Left-sided heart failure | Fluid may back up in your lungs, causing shortness of breath. |
| Right-sided heart failure | Fluid may back up into your abdomen, legs and feet, causing swelling. |
| Systolic heart failure | The left ventricle can’t contract vigorously, indicating a pumping problem. |
| Diastolic heart failure (also called heart failure with preserved ejection fraction) | The left ventricle can’t relax or fill fully, indicating a filling problem. |
Any of the following conditions can damage or weaken your heart and can cause heart failure. Some of these can be present without your knowing it:
- Coronary artery disease and heart attack. Coronary artery disease is the most common form of heart disease and the most common cause of heart failure. The disease results from the buildup of fatty deposits (plaque) in your arteries, which reduce blood flow and can lead to heart attack.
- High blood pressure (hypertension). If your blood pressure is high, your heart has to work harder than it should to circulate blood throughout your body. Over time, this extra exertion can make your heart muscle too stiff or too weak to effectively pump blood.
- Faulty heart valves. The valves of your heart keep blood flowing in the proper direction through the heart. A damaged valve — due to a heart defect, coronary artery disease or heart infection — forces your heart to work harder, which can weaken it over time.
- Damage to the heart muscle (cardiomyopathy). Heart muscle damage (cardiomyopathy) can have many causes, including several diseases, infections, alcohol abuse and the toxic effect of drugs, such as cocaine or some drugs used for chemotherapy. Genetic factors also can play a role.
- Myocarditis. Myocarditis is an inflammation of the heart muscle. It’s most commonly caused by a virus, including COVID-19, and can lead to left-sided heart failure.
- Heart defects you’re born with (congenital heart defects). If your heart and its chambers or valves haven’t formed correctly, the healthy parts of your heart have to work harder to pump blood through your heart, which, in turn, may lead to heart failure.
- Abnormal heart rhythms (heart arrhythmias). Abnormal heart rhythms may cause your heart to beat too fast, creating extra work for your heart. A slow heartbeat also may lead to heart failure.
- Other diseases. Chronic diseases — such as diabetes, HIV, hyperthyroidism, hypothyroidism, or a buildup of iron (hemochromatosis) or protein (amyloidosis) — also may contribute to heart failure. Causes of acute heart failure include viruses that attack the heart muscle, severe infections, allergic reactions, blood clots in the lungs, the use of certain medications or any illness that affects the whole body.
SYMPTOM-
If you have heart failure, you may not have any symptoms, or the symptoms may range from mild to severe. Symptoms can be constant or can come and go. Heart failure symptoms are related to the changes that occur to your heart and body, and the severity depends on how weak your heart is. The symptoms can include:
- Congested lungs. A weak heart causes fluid to back up in the lungs. This can cause shortness of breath with exercise or difficulty breathing at rest or when lying flat in bed. Lung congestion can also cause a dry, hacking cough or wheezing.
- Fluid and water retention. A weak heart pumps less blood to your kidneys and causes fluid and water retention, resulting in swollen ankles, legs, and abdomen (called edema) and weight gain. This can also cause an increased need to urinate during the night as your body attempts to get rid of this excess fluid. Bloating in your stomach may cause a loss of appetite or nausea.
- Dizziness , fatigue, and weakness. Less blood to your major organs and muscles makes you feel tired and weak. Less blood to the brain can cause dizziness or confusion.
- Rapid or irregular heartbeats. The heart beats faster to pump enough blood to the body. This can cause a fast or irregular heartbeat. Irregular heartbeats also can become more common as the heart weakens.
Heart failure can be ongoing (chronic), or your condition may start suddenly (acute).
Heart failure signs and symptoms may include:
- Shortness of breath (dyspnea) when you exert yourself or when you lie down
- Fatigue and weakness
- Swelling (edema) in your legs, ankles and feet
- Rapid or irregular heartbeat
- Reduced ability to exercise
- Persistent cough or wheezing with white or pink blood-tinged phlegm
- Increased need to urinate at night
- Swelling of your abdomen (ascites)
- Very rapid weight gain from fluid retention
- Lack of appetite and nausea
- Difficulty concentrating or decreased alertness
- Sudden, severe shortness of breath and coughing up pink, foamy mucus
- Chest pain if your heart failure is caused by a heart attack
When to see a doctor
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See your doctor if you think you might be experiencing signs or symptoms of heart failure. Seek emergency treatment if you experience any of the following:
- Chest pain
- Fainting or severe weakness
- Rapid or irregular heartbeat associated with shortness of breath, chest pain or fainting
- Sudden, severe shortness of breath and coughing up pink, foamy mucus
Although these signs and symptoms may be due to heart failure, there are many other possible causes, including other life-threatening heart and lung conditions. Don’t try to diagnose yourself. Call 911 or your local emergency number for immediate help. Emergency room doctors will try to stabilize your condition and determine if your symptoms are due to heart failure or something else.
If you have a diagnosis of heart failure and if any of the symptoms suddenly become worse or you develop a new sign or symptom, it may mean that existing heart failure is getting worse or not responding to treatment. This may be also the case if you gain 5 pounds (2.3 kg) or more within a few days.
DIAGNOSIS-
An echocardiogram is the most effective way to diagnose heart failure. It uses sound waves to create detailed pictures of your heart, which help your doctor evaluate the damage to your heart and determine the underlying causes of your condition. Your doctor may use an echocardiogram along with other tests, including the following:
Your doctor may also perform a physical exam to check for physical signs of heart failure. For instance, leg swelling, an irregular heartbeat, and bulging neck veins may make your doctor suspect heart failure almost immediately.
Risk factors
A single risk factor may be enough to cause heart failure, but a combination of factors also increases your risk.
Risk factors include:
- High blood pressure. Your heart works harder than it has to if your blood pressure is high.
- Coronary artery disease. Narrowed arteries may limit your heart’s supply of oxygen-rich blood, resulting in weakened heart muscle.
- Heart attack. A heart attack is a form of coronary disease that occurs suddenly. Damage to your heart muscle from a heart attack may mean your heart can no longer pump as well as it should.
- Diabetes. Having diabetes increases your risk of high blood pressure and coronary artery disease.
- Some diabetes medications. The diabetes drugs rosiglitazone (Avandia) and pioglitazone (Actos) have been found to increase the risk of heart failure in some people. Don’t stop taking these medications on your own, though. If you’re taking them, discuss with your doctor whether you need to make any changes.
- Certain medications. Some medications may lead to heart failure or heart problems. Medications that may increase the risk of heart problems include nonsteroidal anti-inflammatory drugs (NSAIDs); certain anesthesia medications; some anti-arrhythmic medications; certain medications used to treat high blood pressure, cancer, blood conditions, neurological conditions, psychiatric conditions, lung conditions, urological conditions, inflammatory conditions and infections; and other prescription and over-the-counter medications. Don’t stop taking any medications on your own. If you have questions about medications you’re taking, discuss with your doctor whether he or she recommends any changes.
- Sleep apnea. The inability to breathe properly while you sleep at night results in low blood oxygen levels and increased risk of abnormal heart rhythms. Both of these problems can weaken the heart.
- Congenital heart defects. Some people who develop heart failure were born with structural heart defects.
- Valvular heart disease. People with valvular heart disease have a higher risk of heart failure.
- Viruses. A viral infection may have damaged your heart muscle.
- Alcohol use. Drinking too much alcohol can weaken heart muscle and lead to heart failure.
- Tobacco use. Using tobacco can increase your risk of heart failure.
- Obesity. People who are obese have a higher risk of developing heart failure.
- Irregular heartbeats. These abnormal rhythms, especially if they are very frequent and fast, can weaken the heart muscle and cause heart failure.
Complications
If you have heart failure, your outlook depends on the cause and the severity, your overall health, and other factors such as your age. Complications can include:
- Kidney damage or failure. Heart failure can reduce the blood flow to your kidneys, which can eventually cause kidney failure if left untreated. Kidney damage from heart failure can require dialysis for treatment.
- Heart valve problems. The valves of your heart, which keep blood flowing in the proper direction through your heart, may not function properly if your heart is enlarged or if the pressure in your heart is very high due to heart failure.
- Heart rhythm problems. Heart rhythm problems (arrhythmias) can be a potential complication of heart failure.
- Liver damage. Heart failure can lead to a buildup of fluid that puts too much pressure on the liver. This fluid backup can lead to scarring, which makes it more difficult for your liver to function properly.
Some people’s symptoms and heart function will improve with proper treatment. However, heart failure can be life-threatening. People with heart failure may have severe symptoms, and some may require heart transplantation or support with a ventricular assist device.
Prevention
The key to preventing heart failure is to reduce your risk factors. You can control or eliminate many of the risk factors for heart disease — high blood pressure and coronary artery disease, for example — by making lifestyle changes along with the help of any needed medications.
Lifestyle changes you can make to help prevent heart failure include:
- Not smoking
- Controlling certain conditions, such as high blood pressure and diabetes
- Staying physically active
- Eating healthy foods
- Maintaining a healthy weight
- Reducing and managing stress
TREATMENT
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Treating heart failure depends on the severity of your condition. Early treatment can improve symptoms fairly quickly, but you should still get regular testing every three to six months. The main goal of treatment is to increase your lifespan.
Medication
Early stages of heart failure may be treated with medications to help relieve your symptoms and prevent your condition from getting worse. Certain medications are prescribed to:
- improve your heart’s ability to pump blood
- reduce blood clots
- reduce your heart rate, when necessary
- remove excess sodium and replenish potassium levels
- reduce cholesterol levels
Always speak with your doctor before taking new medications. Some medications are completely off-limits to people with heart failure, including naproxen (Aleve, Naprosyn) and ibuprofen (Advil, Midol).
Surgery
Some people with heart failure will need surgery, such as coronary bypass surgery. During this surgery, your surgeon will take a healthy piece of artery and attach it to the blocked coronary artery. This allows the blood to bypass the blocked, damaged artery and flow through the new one.
Your doctor may also suggest an angioplasty. In this procedure, a catheter with a small balloon attached is inserted into the blocked or narrowed artery. Once the catheter reaches the damaged artery, your surgeon inflates a balloon to open the artery. Your surgeon may need to place a permanent stent, or wire mesh tube, into the blocked or narrowed artery. A stent permanently holds your artery open and can help prevent further narrowing of the artery.
Other people with heart failure will need pacemakers to help control heart rhythms. These small devices are placed into the chest. They can slow your heart rate down when the heart is beating too quickly or increase heart rate if the heart is beating too slowly. Pacemakers are often used along with bypass surgery as well as medications.
Heart transplants are used in the final stages of heart failure, when all other treatments have failed. During a transplant, your surgeon removes all or part of your heart and replaces it with a healthy heart from a donor.
PHYSICAL THERAPY FOR HEART FAILURE –
Physiotherapy is important in the management of heart failure. The cornerstone of physiotherapy management is cardiac rehabilitation. In patients undergoing heart surgery, physiotherapy can also help with recovery after surgery.
Up until the late 1980s, exercise was considered unsafe for the patient with HF. It was unclear whether any benefit could be gained from rehabilitation, and concern also existed regarding patient safety, with the belief that additional myocardial stress would cause further harm. Since this time, considerable research has been completed and the evidence resoundingly suggests that exercise for this patient group is not only safe but also provides substantial physiological and psychological benefits. As such, exercise is now considered an integral component of the non pharmacological management of these patients
Effective treatment for heart failure should aim to:
- Strengthen the heart
- Improve symptoms
- Reduce the risk of a flare-up or worsening of symptoms
- Improve Quality of Life
- Offer longevity
Recent Research findings
- Systematic review and meta-analysis show a significant effect of aerobic and resistance training on peak oxygen consumption, muscle strength, and health-related quality of life in patients with heart failure with a reduced left ventricular ejection fraction.
- A study published in the Journal of Cardiopulmonary Rehabilitation and Prevention 2020, comparing the effects of β-blockers and non-β-blockers on Heart Rate (HR) and Oxygen Uptake (VO2) during exercise and recovery in older patients with heart failure with a preserved ejection fraction (HFpEF) demonstrated no significant differences in values (HRpeak, HRresv, HRrecov, or VO2) between both the groups, along with significant correlation between HRresv and VO2peak, suggesting the efficacy of these measures in prognostic and functional assessment and clinical applications, including the prescription of exercise, in elderly HFpEF patients.
- Studies show a contrasting effect of aerobic training and resistance training on some echocardiographic parameters in patients with heart failure with reduced ejection fraction. While aerobic training was associated with evidence of worsening myocardial diastolic function, this was not apparent after resistance training. Further studies are indicated to investigate the long-term clinical significance of these adaptations.
- А single-blind, prospective randomized controlled trial suggests: modified group-based High-intensity aerobic interval training (HIAIT) intervention showed more considerable improvement as compared to moderate-intensity continuous training (MICT) in the rehabilitation of patients with chronic heart failure (CHF). Physical and rehabilitation medicine (PRM) physicians should apply Group based Cardiac intervention in routine cardiac rehabilitation (CR) practice.
- An article published online (March 2020) suggests positive outcomes with the High-intensity interval training (HIIT) for patients with heart failure along with preserved ejection fraction.
- A study assessing patients carrying out 5-months cardiac rehabilitation CR showed a lower rate of clinical events with higher maximal inspiratory pressure, suggesting that the changes in respiratory muscle strength independently predicted the occurrence of clinical manifestations in patients with Heart Failure HF.
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