What is Heart failure, its causes, symptoms, diagnosis and treatment?

There is talk of heart failure when the heart’s function is altered, or the heart muscle is unable to pump enough blood to supply the organs, muscles and tissues of the body.

When the heart begins to fail, the body immediately detects it. Instead, it sets compensatory mechanisms in motion, which is why many patients do not perceive the heart’s abnormal symptoms.

These mechanisms are only effective for a certain time, so there comes a time when the body cannot remedy the failure in pumping the heart.

The first symptom of heart failure manifests itself when the patient is subjected to any situation in which a greater pumping of the heart and a greater amount of blood to the body is necessary. The patient will feel choking and short of breath while exercising or carrying out activities previously well tolerated.

Little by little, the situation worsens, and the insufficiency can affect other vital organs, such as the kidneys. Among the main defence mechanisms is tachycardia in a resting condition (by not pumping enough blood, the heart increases the number of beats in each unit of time) and the progressive increase in the heart size to achieve stronger contractions to compensate for its deficiency.

For this reason, patients with heart failure often have an enlarged heart.

This pathology can affect the patient’s quality of life and limit their daily activities due to fatigue and breathing problems. In addition, the disease does not progress linearly. That is, there are periods in which the patient remains stable and others in which decompensations appear that make hospitalisation necessary.

Causes

The most common causes of heart failure are coronary diseases, such as angina pectoris and myocardial infarction.

Another common cause is high blood pressure, which must be detected and controlled in time to prevent and avoid the development of heart failure. Blood pressure should be below 140/90 mmHg in the consultation and 135/85 if the patient or family measures home.

Excessive alcohol consumption can also lead to heart failure since it damages the heart muscle and causes the so-called dilated cardiomyopathy, progressive heart dilation due to the thinning and weakening of its walls.

Symptoms

According to the Heart Foundation, heart failure is characterised by the fact that, in most cases, no symptoms appear throughout the patient’s life. When they appear, the usual manifestations are:

Dyspnoea

Dyspnea or a feeling of shortness of breath when breathing appears at first when making a physical effort, walking fast or climbing stairs. However, gradually the episodes become more intense and appear when performing any task, such as dressing or washing, and even when the patient is at rest.

This is because the blood does not reach the muscles properly, causing muscle fatigue.

Orthopnea

Patients with heart failure may have orthopnea or shortness of breath when lying down, so the patient is forced to sleep with two or three pillows or in a somewhat upright position.

The main reason for this symptom is the accumulation of fluids in the lungs’ alveoli.

Fatigue

Most heart failure patients have muscle fatigue because the heart does not pump enough blood.

Oedema

Another symptom that may appear is swelling, especially in the legs, caused by water and salt retention. In severe cases, oedema can be very bulky.

Oliguria

Some patients may have reduced ability to pass urine (less than 400 millilitres per day). Dyspnea and oedema are often preceded by oliguria.

In heart failure, the kidneys abnormally retain water and salt, accumulating in the lungs and tissues, producing dyspnea and oedema. It is often accompanied by nocturia, increased diuresis at night when adopting the recumbent position and increasing venous return.

Other symptoms are gastric fullness, intestinal discomfort, abdominal swelling, pain in the right side of the abdomen, congestion of the neck veins, palpitations, dizziness, syncope, lack of appetite or anorexia.

As the disease progresses, the shortness of breath will increase, and the patient will have problems performing activities such as getting dressed.

Prevention

In most cases, heart failure can be prevented by changing your lifestyle and adopting a healthier one, as well as reducing cardiovascular risk factors.

Diagnosis

The first step the specialist must take to diagnose heart failure is to conduct a clinical interview with the patient to collect all the symptoms in the patient’s clinical history.

In that history, you should include if you have any cardiovascular risk factors, if there is a family history of ischemic heart disease, cardiomyopathy or vascular diseases or if you are diabetic or have hypertension.

In addition, you should check if you have had any recent infections or have symptoms related to exercise tolerance, swelling and heart rhythm disturbances.

If, after analysing all these manifestations, the specialist still has doubts, he or she can order additional tests to help establish the diagnosis, such as a chest X-ray, stress tests or an electrocardiogram and blood tests.

Treatments

No therapy completely cures this pathology. However, some treatments can delay the progression of heart failure and improve the patient’s prognosis and quality of life:

  • You can treat the underlying cause of the disease in the first place. For example, if the origin is due to alcohol consumption, the patient must stop consuming alcoholic beverages; if it is due to lack of coronary irrigation, a bypass can be performed, etc.
  • Reduce risk factors such as obesity, eat a proper diet or perform physical activities regularly and constantly.
  • Take diuretic products, as they can improve symptoms such as swelling.
  • The doctor may prescribe the patient a pharmacological treatment to, for example, help reduce the heart rate or improve the contractility of the heart if it is decreased.
  •  Cardiac resynchronisation therapies.

If it does not respond to any treatment and depending on the age and characteristics of the patient, a heart transplant can be considered.

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