Diseases & Conditions

 

Heart Failure

Diseases & Conditions

 

What is heart failure?

Heart failure is a condition in which the heart muscle is weakened and fails to pump enough blood to support the body’s needs for oxygen. Heart failure can be caused by coronary artery disease, heart attack, and high blood pressure that leave the heart muscle too weak to work properly.

Heart failure is a major public health problem, with a prevalence of more than 23 million worldwide.1

The prevalence of heart failure and associated mortality are not thoroughly studied in the Middle East. However, a 2011 Saudi study reported that the overall 30-day mortality rate for 1090 acute heart failure patients is 7.5%.2,3

 

What causes heart failure?

Most people who develop heart failure have had another heart condition first. The most common conditions that can lead to heart failure are the following:4

  • Coronary artery disease
  • Hypertension
  • Heart attack

These conditions damage the heart muscle and eventually the heart weakens leading to heart failure. It becomes unable to pump blood to the body’s organs. As the heart weakens, certain proteins and substances could be secreted into the blood. These substances will have a toxic effect on the heart and blood flow worsening heart failure.

 

What are the risk factors for heart failure?

Risk factors for heart failure include:5

  • Hypertension
  • Coronary artery disease: When the arteries are blocked or narrowed, the heart is weakened as it is not getting enough oxygen-rich blood.
  • Heart attack
  • Type 2 diabetes mellitus: Diabetes increases the risk of hypertension and coronary heart disease
  • Sleep apnea: Sudden drops in blood oxygen levels that occur during sleep apnea increase blood pressure and this could damage the heart.
  • Congenital heart disease
  • Valvular heart disease: Valvular heart disease is characterized by damage to or a defect in one of the four heart valves. This disease will increase the risk of heart failure.
  • Some viruses: A Virus infection could damage the heart.
  • Smoking
  • Overweight or obesity
  • Irregular heartbeats

 

What are the symptoms of heart failure?

Common symptoms of heart failure are:6

  • Cough
  • Fatigue and weakness
  • Loss of appetite
  • Excessive urination at night
  • Irregular heartbeats
  • Shortness of breath when exercising or when lying down
  • Swollen liver or abdomen
  • Swollen feet and ankles
  • Weight gain

 

How is heart failure diagnosed?

The doctor will diagnose heart failure based on physical examination and test results.7

  • Physical examination: The doctor will listen to the heart and lungs and look for signs and symptoms of heart failure.
  • Electrocardiogram (ECG or EKG): An ECG records the heart’s electrical activity to show irregularities or damage in its rhythm.
  • Chest X-ray: A chest X-ray shows signs of heart failure by taking pictures of the structures inside the chest.
  • Blood test: The level of the protein B-type Natriuretic Peptide (BNP) in the blood increases when heart failure symptoms worsen and hence can be used to detect the disease.
  • Echocardiography: This test shows the size and shape of the heart and how well the heart chambers and valves function.
  • Doppler Ultrasound: This test shows how blood flows through the heart and blood vessels.
  • Holter Monitor: This test records the heart's electrical activity for a day or two while the patient carries out normal daily routine.
  • Nuclear Heart Scan: This test shows how well blood is flowing through the heart.
  • Cardiac Catheterization: This test helps to measure how well the heart is functioning and provides pictures of the coronary arteries to look for blockages.
  • Coronary Angiography: This test helps to identify narrowed arteries in the heart that can be a cause of heart failure.
  • Stress Test: This test involves exercising like walking on a treadmill to increase the heart rate while an electrocardiogram, heart rate and blood pressure are monitored.
  • Cardiac magnetic resonance imaging (MRI): This test can show whether parts of your heart are damaged.

 

How is heart failure treated?

Heart failure is a chronic disease needing lifelong management. Treatment for heart failure depends on the type and severity of the heart failure.8

  • Medications:
    • Angiotensin-converting enzyme (ACE) inhibitors: ACE inhibitors relax blood vessels and lower blood pressure to decrease the work of the heart.
    • Angiotensin II receptor blockers: These drugs have the same effect as ACE inhibitors.
    • β-blockers: These drugs help relax the heart muscle, slow the heart rate and decrease blood pressure.
    • Diuretics: These drugs help reduce fluid build-up in the lungs and swelling in the feet and ankles.
    • Aldosterone antagonists: These drugs work in a similar way to diuretics and may also help reduce scarring of the heart muscle.
    • Digoxin: Digoxin can increase the strength of the heart muscle contractions and slow down the heart rate.

 

  • Surgery and medical devices
    • Coronary bypass surgery: This procedure can help the blood flow to the heart muscle and improve angina. It consists of removing a blood vessel from the leg, arm or chest bypass a blocked artery in the heart.
    • Heart valve repair or replacement: If a damaged heart valve causes heart failure, the doctor may recommend repairing or replacing the valve.
    • Implantable cardioverter-defibrillators (ICDs): An ICD is a device planted near the heart which can check the heart rate and use electrical pulses to correct irregular heart rhythms.
    • Cardiac resynchronization therapy (CRT), or biventricular pacing: This device helps both sides of your heart contract at the same time, which can decrease heart failure symptoms.
    • Heart pumps: A mechanical heart pump helps pump blood from the heart to the rest of the body.
    • Heart transplant: A heart transplant is an operation in which a patient’s heart is replaced with a healthy heart from a deceased donor.

 

References

  1. Roger, Véronique L. "Epidemiology of heart failure." Circulation research 113.6 (2013): 646-659.
  2. AlHabib, Khalid F., et al. "Design and preliminary results of the Heart Function Assessment Registry Trial in Saudi Arabia (HEARTS) in patients with acute and chronic heart failure†." European journal of heart failure 13.11 (2011): 1178-1184.
  3. Al-Shamiri, Mostafa Q. "Heart failure in the Middle East." Current cardiology reviews 9.2 (2013): 174.
  4. Causes and Risks for Heart Failure (Causes and Risks for Heart Failure) http://www.heart.org/HEARTORG/Conditions/HeartFailure/CausesAndRisksForHeartFailure/Causes-and-Risks-for-Heart-Failure_UCM_002046_Article.jsp#.VpNBicZ97IU (Accessed January 11, 2016)
  5. Heart failure (Risk factors) http://www.mayoclinic.org/diseases-conditions/heart-failure/basics/risk-factors/con-20029801 (Accessed January 11, 2016)
  6. Heart failure - overview: MedlinePlus Medical Encyclopedia (U.S National Library of Medicine) https://www.nlm.nih.gov/medlineplus/ency/article/000158.htm (Accessed January 11, 2016)
  7. How Is Heart Failure Diagnosed? (- NHLBI, NIH) http://www.nhlbi.nih.gov/health/health-topics/topics/hf/diagnosis (Accessed January 11, 2016)
  8. Heart failure (Treatments and drugs) http://www.mayoclinic.org/diseases-conditions/heart-failure/basics/treatment/con-20029801 (Accessed January 11, 2016)