Heart failure

• Symptoms: Irregular heart beats, shortness of breath, fatigue, rapid heartbeat, inability to exercise, loss of appetite, excess urination at night, cough with or without phlegm, pain in the chest 
• Causes: Coronary artery disease, high blood pressure, problems in the heart valve, damage to the heart muscle due to heart attack or chemotherapy, congenital heart defect, abnormal heart rhythm, and other chronic diseases that might contribute to heart failure 
• Risk factors: High cholesterol, obesity, severe infections, consumption of certain medications, severe viral infection, spreading of allergic reaction rapidly, blood clots in the lungs or any part of the body 
• Severity: Moderate to high (Depending on how soon the condition is treated) 
• Which doctor to consult: Cardiologist or a cardiothoracic surgeon

Overview

Heart failure, also known as congestive heart failure, occurs when an individual’s heart loses its capacity to pump blood sufficiently. As a result, the blood is retained in the heart chambers, which leads to unwanted fluid buildup in the lungs. Hence, the patient might experience shortness of breath.

While heart failure is a sudden manifestation in the body, the symptoms appear early. This is because congestive heart failure happens due to other problems that might lead to narrowed arteries, high blood pressure, or weak heart muscles. The heart cannot pump blood sufficiently in all of the above mentioned issues.

Due to a lack of proper blood flow, other organ functions are impacted significantly. In simple terms, the heart muscles become stiff, reducing the blood flow to other organs. This phenomenon can occur in the left or right side of the heart, and the condition could be acute or chronic.

Even though the condition can be improved with proper treatment and timely intervention, it is essential to observe the symptoms to live a healthy and longer life. Additionally, there is a need to bring lifestyle change that includes weight loss, a nutritious diet, regular exercise, and reduced sodium content in food.

The primary approach to prevent heart failure is to work on the root cause and eliminate the conditions that lead to congestion in the heart. Ultimately, this approach includes better managing pre-existing conditions like high blood pressure, diabetes, and obesity.

When to Consult a Doctor?

Several symptoms associated with heart failure begin when the problem is at an early stage. However, many people might also suffer from sudden or acute heart failure. Hence, the correct time to consult a doctor is when an individual notices unexplained symptoms related to heart problems.

The common symptoms include shortness of breath, rapid or irregular heartbeat, bloating, sudden weight gain, constant fatigue, difficulty in concentrating, persistent pain or heaviness in the chest, and inability to exercise.

However, below are some significant signs that must motivate a person to consult with a cardiologist

• Chest pain: Chest pain could be minor or severe depending on the hardness and stiffening of the heart muscles. An individual must see a doctor immediately if he/she does not have a congenital heart defect or a history of heart problems. In addition, chest pain could be a warning sign for any individual if he/she has been diagnosed with high blood pressure or cholesterol.
• Severe weakness:The heart's inability to pump blood adequately impacts the blood flow in several organs. This collectively weakens the body system, and an individual can often feel dizzy. Thus, if a person has unexplained weakness or fatigue even after consuming a healthy diet, it might be a sign to see a doctor immediately.
• Irregular heartbeat:Several people experience irregularities in their heartbeat or arrhythmia. However, it is not long-lasting unless he/she has a significant heart problem. Hence, if arrhythmia is persistent without any previous heart condition, an individual must take the necessary tests to diagnose the condition.
• Other abnormalities in the blood test:When a blood test shows high levels of bad cholesterol and triglycerides, it is essential to visit the doctor. Another prominent symptom could include coughing alongside shortness of breath. The sputum during coughing could consist of white or pink foamy mucus.

Diagnosis

The doctor needs to look at the patient’s medical history to find out the early signs of heart failure. Below are some of the diagnostic methods used by an expert to diagnose the condition:

• Physical examination

This is an essential diagnostic procedure that looks after the physical signs of heart failure in other body parts. This involves observation of swelling in the foot and ankle, keeping track of high blood pressure, and looking at the BMI of an individual. In addition, the doctor might also listen to the activity in the lungs, which might indicate fluid buildup and heart murmur. In some cases, the doctor might also look at the veins in the neck, and check for fluid buildup in the abdomen or legs.

• Echocardiogram

An ECG is one of the most effective and standard methods to identify heart problems. The sound waves and rhythm of the heart are captured in this method to look for irregularities. This test helps in evaluating the damage to a heart. An ECG also helps determine the underlying causes based on the squeezing and relaxing function of the heart.

• MRI

Magnetic resonance imaging is an appropriate technique to produce images of the heart without radiation. Similarly, a nuclear scan uses radioactive material to make a clear image of the heart chambers during the scan.

• Blood test

The blood test detects the rise in B-type natriuretic peptide. An increase in this hormone indicates heart failure and requires an immediate action plan from experts.

• Coronary angiogram

This type of test in which the doctor inserts a catheter into the blood vessels through the arms or groin. The catheter is guided toward the heart and assesses the amount of blood flowing through the heart. This determines the blood volume and detects inefficiencies in the heart.

Treatment

Heart conditions that lead to heart failure are chronic and require lifelong treatment to prevent congestion in the heart. However, timely treatment can improve the quality of life significantly.

Below are some treatment options to prevent heart failure:

Medications

• Angiotensin-converting enzyme (ACE) inhibitors

These medicines are known to relax the constricted blood vessels and improve the blood flow. As a result, it removes the excess strain the heart faces due to the stiffening or hardening of heart muscles.

• Beta-blockers

This medication slows the heart's pace to reduce blood pressure in patients suffering from hypertension. Metoprolol and bisoprolol are two common beta blockers that can reduce heart failure symptoms.

• Diuretics

These are commonly known as water pills because it is known to release the retained fluid through frequent urination. This reduces the fluid buildup in the body and prevents shortness of breath, a common symptom of heart failure.

• Positive inotropes

It is an intravenous drug administered to patients suffering from heart failure admitted to the hospital. It helps in pumping blood and maintaining a healthy blood pressure in people with heart problems.

• Digoxin

This drug is also known as digitalis and increases heart muscle strength. Additionally, the drug maintains the regularity of heartbeat and prevents systolic heart failure. This drug is also administered during atrial fibrillation.

Surgical Procedure

• Coronary bypass surgery

This procedure is used for people suffering from severe blockage in arteries. In this surgery, a healthy blood vessel is taken from the leg, arm, or chest and grafted below or above the blocked arteries. This improves the blood flow of the heart.

• Heart valve repair or replacement

If the heart muscles are damaged, causing irregularities in the contraction and relaxation, there is a requirement for heart valve repair or replacement. This involves repairing the valve flaps for better movement and tightening the supporting muscles.

• Cardiac resynchronisation therapy

As the name suggests, it involves biventricular pacing so that both chambers function in sync with each other. A biventricular pacemaker sends electrical signals regularly to ensure the contractions are coordinated.

• Heart transplant

This is performed in severe cases when surgical procedures and medications are no more effective. It requires a large team of highly experienced doctors to complete the procedure successfully.

Palliative Care

Palliative care is a specialised medical care that alleviates the symptoms and enhances the quality of life in terminally ill patients. The sole aim of this therapy is to reduce the pain and side effects of the condition.

Risks and Complications if Left Untreated

Below are some of the risk factors of heart failure that might aggravate the condition:

• Chronic hypertension or diabetes in patients 
• Sleep apnea that might increase the risk of arrhythmias
• Pre-existing valve disease, which might further weaken the heart valves and surrounding muscles 
• Hyperthyroidism or hypothyroidism directly affects the heart rate and leads to shortness of breath in patients 
• Anaemia is another significant risk factor that might intensify heart failure symptoms 
• Coronary artery disease is a significant risk factor contributing to heart failures 
• Certain behavioural traits or lifestyle habits like smoking, alcohol consumption, overeating, and lethargy can also increase the risk of heart failure

In addition to worsening the symptoms, untreated heart failure can further lead to congestion and death of the patient. It might lead to severe fluid buildup in the liver and lungs, potentially life-threatening.
Furthermore, the complications also include kidney dysfunction, thromboembolism, stroke, and atrial fibrillation.

Additional Information

Heart failure is divided into multiple classes and stages. Below is a brief explanation of the classification of heart failure. 
Different classes of heart failure are mentioned below:

• Class I: No visible symptoms of heart failure
• Class II: The individual can complete day-to-day activities typically, but exertion causes shortness of breath
• Class III: Difficulty in completing regular tasks and activities 
• Class IV: Shortness of breath even when the individual is at rest or makes a minor movement. This is one of the most severe forms of heart failure.

Below are the different stages of heart failure in an individual:

• Stage A: Individual has multiple risk factors, but there are no early signs of heart failure
• Stage B: No signs of heart failure despite having heart disease 
• Stage C: A major or minor heart disease accompanied by heart failure symptoms 
• Stage D: Advanced symptoms of heart failure which demand immediate treatment