Overview
Heart failure is a chronic condition in which the heart is unable to pump blood efficiently enough to meet the body’s needs. This can lead to various symptoms, including fatigue, shortness of breath, decreased exercise tolerance, and swelling in the limbs.
Types
- Systolic Heart Failure: Occurs when the left ventricle of the heart cannot contract forcefully enough, leading to reduced blood ejection. Causes include coronary artery disease, myocardial damage from infections or toxins, valve diseases, and uncontrolled hypertension.
- Diastolic Heart Failure: Results from the left ventricle’s inability to relax properly, affecting its capacity to fill with blood. This type often correlates with aging, hypertension, diabetes, and obesity.
There are two types of heart failure in terms of symptoms that can coexist:
- Right sided heart failure: This affects the lower right heart chamber called the right ventricle. Fluid may back up into the belly, legs, and feet causing swelling.
- Left sided heart failure: This affects the lower left heart chamber called the left ventricle. Fluid may back up in the lungs, causing shortness of breath.
Common Causes
- Coronary Artery Disease (CAD): The leading cause, characterized by blocked arteries.
- High Blood Pressure: Chronic hypertension strains the heart.
- Heart Valve Diseases: Dysfunctional valves disrupt blood flow.
- Myocarditis: Inflammation of the heart muscle.
- Other Conditions: Diabetes, hormonal disorders, infections, excessive alcohol consumption, and certain chemotherapy agents.
Risks
- Age: Increased risk with advancing age.
- Lifestyle: Smoking, unhealthy diets, obesity, and sedentary habits.
- Existing Medical Conditions: Hypertension, diabetes, CAD, among others.
Symptoms
- Fatigue: General tiredness with minimal physical activity.
- Dyspnea: Shortness of breath, particularly when lying flat or during exertion.
- Edema: Swelling in the legs, ankles, and sometimes the abdomen due to fluid retention.
- Palpitations: Noticeable, irregular heartbeats.
- Persistent Cough: Especially during the night.
- Cognitive Impairment: Confusion or trouble concentrating.
- Rapid Weight Gain: A result of fluid accumulation.
Treatments
The goal of treating heart failure is to enhance its function and to alleviate the symptoms and avoid further complications. The treatment needed will be decided based on the severity of the problem. However, some of the treatments considered are:
- Lifestyle Modifications: Such as a healthy diet, reduction of salt intake, moderate physical activity, maintaining a healthy weight, and smoking cessation can help improve the symptoms.
- Pharmacological Therapy: This is considered the mainstay of treatments. At least four classes of medications have been shown to improve the symptoms of heart failure and to prolong its survival. These include angiotensin receptoe neprolysin inhibitors (ARNI), beta blockers (BB), mineralocorticoid receptor antagonists (MRA), and sodiumglucose transport protein 2 inhibitors (SGLT2I). These are medications that primarily help symptoms, such as diuretics, digoxin, and intravenous iron supplementation.
Interventional Procedures
- Cardioversion: Electrical shocks to normalize heart rhythm.
- Implantable Cardioverter Defibrillator (ICD): Corrects life-threatening arrhythmias.
- Heart Surgery: Includes valve repair/replacement and bypass surgery.
- Ventricular Assist Devices (VADs): Mechanical pumps supporting heart function, often as a bridge to transplantation.
Heart Transplantation:
Considered for severe cases where other treatments are ineffective. Due to limited availability, this option is reserved for the most critical patients.
Heart failure treatment is continuous and requires regular monitoring and adjustments. Frequent follow-ups with a cardiologist ensure that the treatment plan remains effective and adapts to the patient’s evolving condition.
With over 25 years of experience, Dr. Fady Turquieh offers comprehensive management for heart failure, guiding patients through diagnosis, treatment, and ongoing care with expertise and compassion.