Heart failure is a chronic and progressive disease that affects the heart’s ability to pump blood efficiently. Contrary to what its name suggests, heart failure does not mean that the heart stops beating. It refers to the inability of the heart muscle to pump enough blood to meet the body’s needs. This condition can lead to fluid buildup in the lungs (pulmonary edema) and in the extremities (peripheral edema).
Symptoms of heart failure
The symptoms of heart failure can vary in intensity and manifest gradually or suddenly. It is important to note that the intensity of symptoms does not always correlate with the severity of the disease. Some patients may experience mild symptoms even with significantly compromised cardiac function, while others may present with severe symptoms despite relatively preserved cardiac function. Some of the most common are:
Shortness of breath (dyspnea):
it can occur during exertion, when lying down, or even at rest.
Fatigue and weakness:
constant feeling of tiredness and lack of energy.
Swelling in ankles, feet and legs (edema):
caused by the accumulation of fluids.
Persistent cough or wheezing:
especially when lying down.
Rapid weight gain:
due to fluid retention.
Loss of appetite and nausea:
associated with congestion of the digestive system.
Confusion or difficulty concentrating:
due to lack of oxygen in the brain.
Increased heart rate (palpitations):
the heart beats faster to compensate for its insufficiency.
Classification of heart failure
Heart failure is classified based on the ejection fraction, which measures the percentage of blood pumped by the left ventricle with each heartbeat. This classification is essential for determining the prognosis and guiding treatment. Knowing the ejection fraction allows the doctor to determine the type of heart failure and tailor the treatment to the patient’s specific needs. Depending on the percentage of blood the heart is able to pump, there are mainly two types of heart failure:
Heart failure with reduced ejection fraction (HFrEF): the heart does not pump enough blood with each beat (less than 40%). This form of heart failure is associated with a higher risk of complications and mortality.
Heart failure with preserved ejection fraction (HFpEF): the heart pumps a normal amount of blood, but the left ventricle does not relax properly during diastole, making filling difficult. Although the ejection fraction is normal, the stiffness of the left ventricle impairs filling and reduces the amount of blood the heart can pump.
Causes of heart failure
Heart failure is usually the result of other conditions that damage or weaken the heart. Identifying the underlying cause of heart failure is crucial for effective treatment.
Various factors can increase the risk of developing heart failure. It is important to know them in order to take preventive measures and reduce the likelihood of developing the disease. Some risk factors are modifiable, such as smoking, obesity, and hypertension, while others, such as age and family history, cannot be modified. The most frequent ones include:
Old age: the natural aging of the heart can weaken it over time, reducing its ability to pump blood efficiently.
Family history: a family history of heart failure increases the risk, suggesting a genetic predisposition.
Smoking: it damages blood vessels, increases blood pressure, and reduces the amount of oxygen available to the heart, significantly increasing the risk of heart failure.
Obesity: excess weight forces the heart to work harder to supply blood to the body, increasing the workload of the heart muscle.
Diabetes: it damages the blood vessels and nerves that control the heart, increasing the risk of coronary heart disease and heart failure. Proper blood glucose control is essential to reduce the risk.
Sleep apnea: it interrupts breathing during sleep, reducing blood oxygen levels and stressing the heart. Treating sleep apnea can improve heart function.
Excessive alcohol consumption: it can weaken the heart muscle over time and depending on the level of consumption, leading to a form of cardiomyopathy known as alcoholic cardiomyopathy.
Chronic kidney disease: it can affect fluid and electrolyte balance, overloading the heart and increasing the risk of heart failure. Proper management of chronic kidney disease is important to prevent heart failure.
Complications of heart failure
Heart failure can lead to various complications that affect a patient’s health and quality of life. These may require hospitalization and additional treatments. Regular medical follow-up is essential to detect and treat these complications early. Some of the most frequent ones are:
Pulmonary edema: accumulation of fluid in the lungs, making breathing difficult and potentially causing respiratory failure. Acute pulmonary edema is a medical emergency that requires immediate treatment.
Kidney damage: reduced blood flow to the kidneys can impair their function, leading to kidney failure. Kidney failure may require dialysis.
Cardiac arrhythmias: irregular heartbeats can compromise heart function and increase the risk of thromboembolic events. Some types of arrhythmias can be life-threatening.
Liver damage: fluid accumulation can impair liver function, leading to liver failure. Liver failure can have serious health consequences.
Sudden cardiac death: in severe cases, heart failure can lead to sudden cardiac arrest. Sudden cardiac death is one of the leading causes of death in patients with heart failure.
Diagnosis of heart failure
Diagnosing heart failure requires a thorough medical evaluation that includes a variety of tests and procedures. An accurate diagnosis is essential to determine the best course of treatment and improve the patient’s prognosis. The diagnostic process may involve different specialists, such as cardiologists, radiologists, and laboratory technicians. Diagnostic tests include:
Medical history and physical examination: the doctor will review the symptoms and medical history and perform a physical examination, looking for signs such as swelling, irregular heartbeat, and abnormal lung sounds.
Blood tests: they allow the evaluation of kidney, liver, and thyroid function, as well as the detection of anemia or infections. B-type natriuretic peptide (BNP) is a biomarker that is elevated in heart failure and is useful for confirming the diagnosis. Other biomarkers, such as troponin, may be useful in ruling out other heart conditions.
Electrocardiogram (ECG): it records the electrical activity of the heart, detecting arrhythmias, previous heart attacks, and other heart problems.
Chest X-ray: it shows the size and shape of the heart and lungs, and can reveal pulmonary congestion.
Echocardiogram: echocardiography of the heart provides detailed images of its structure and function, including chamber size, wall thickness, and ejection fraction. It is crucial for the diagnosis and classification of heart failure.
Stress test: it evaluates the heart’s response to exercise, potentially revealing limitations in its pumping capacity and diagnosing coronary artery disease. The stress test can be performed on a treadmill or a stationary bike.
Cardiac scintigraphy: it uses small amounts of radioactive material to assess blood flow to the heart, detecting areas of ischemia or myocardial damage. Cardiac scintigraphy can be performed at rest or during exercise.
Cardiac magnetic resonance imaging (MRI): it provides detailed images of the heart and blood vessels, helping to identify the cause of heart failure and assess the viability of the myocardium. Cardiac MRI is a non-invasive test that provides high-resolution images of the heart.
Cardiac catheterization and coronary angiography: an invasive procedure that allows visualization of the coronary arteries and measurement of pressures in the heart, diagnosing coronary artery disease and evaluating the function of the heart valves. Cardiac catheterization is performed by inserting a catheter through an artery in the groin or forearm.
Treatment of heart failure
Heart failure treatment is tailored to each patient and aims to relieve symptoms, improve quality of life, and slow the progression of the disease. The treatment plan is individualized based on the severity of heart failure, the underlying cause, the presence of other diseases, and the patient’s preferences. Treatment may involve a combination of lifestyle changes, medications, devices, and surgery.
Lifestyle changes: a low-sodium diet, fluid restriction, regular exercise, weight control, and quitting smoking are essential to control symptoms and improve heart function. These lifestyle changes can help reduce the workload on the heart and improve overall health.
Cardiac rehabilitation: supervised exercise and education programs to improve physical capacity, exercise tolerance, and emotional well-being. Cardiac rehabilitation can help patients regain their self-confidence and resume their daily activities.
Pharmacological treatment: heart failure medications work through different mechanisms to improve heart function, reduce symptoms, and prevent complications. Some of the most commonly used medications are angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor antagonists (ARBs), beta-blockers, mineralocorticoid receptor antagonists (MRAs), sodium-glucose cotransporter type 2 (SGLT2) inhibitors, diuretics, hyperpolarization-activated, cyclic nucleotide–modulated channel blockers and guanylate cyclase stimulators.
Surgical treatment: surgical options for heart failure are reserved for specific cases where medical treatment is insufficient or when there is an underlying cause that can be treated surgically. Surgical procedures may include:
Coronary revascularization surgery: it improves blood flow to the heart by using grafts that bypass blocked arteries.
Valve repair or replacement: it repairs damaged heart valves.
Ventricular assist devices (VADs): mechanical pumps that help the heart pump blood.
Heart transplant: replacement of the damaged heart with a healthy one from a donor.
The treatment of heart failure often requires a multidisciplinary approach involving cardiologists, specialist heart failure nurses, nutritionists, physical therapists, and social workers. HM Hospitales has a heart failure unit, where different aspects are addressed, such as education for the patient and primary caregiver, structured follow-up by a cardiology specialist, and the management of other common problems in these patients. It also involves including these patients in the cardiac rehabilitation program.
Remember that this article is for informational purposes only and does not replace professional medical advice. If you suspect you have heart failure, consult a specialist to obtain an accurate diagnosis and an appropriate treatment plan tailored to your needs.
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