Heart Failure

Causes and Risks

Structural or functional causes of heart failure include high blood pressure (hypertension), heart valve disease, congenital heart diseases, cardiomyopathy, heart tumor, and other heart diseases. Precipitating factors include infections with high fever or complicated infections, use of negative inotropic drugs (such as beta-blockers and calcium channel blocker), anemia, irregular heartbeats (arrhythmias), hyperthyroidism , and kidney disease .

Structural or functional causes of heart failure include high blood pressure (hypertension), heart valve disease, congenital heart diseases, cardiomyopathy, heart tumor, and other heart diseases. Precipitating factors include infections with high fever or complicated infections, use of negative inotropic drugs (such as beta-blockers and calcium channel blocker), anemia, irregular heartbeats (arrhythmias), hyperthyroidism , and kidney disease .

Other risk factors include smoking, obesity, excess alcohol consumption, and diet high in fat and salt.

Heart failure occurs in approximately 10 out of 100 people, and becomes more prevalent with advancing age.

Prevention

Follow the health care provider’s advice for treatment of conditions that may cause congestive heart failure. Follow dietary guidelines. Minimize or eliminate smoking and alcohol consumption.

Symptoms

• Sensation of feeling the heart beat (palpitations)
• Pulse may feel irregular or rapid
• Weight gain (unintentional)
• Swelling of feet and ankles
• Swelling of the abdomen
• Pronounced neck veins
• Loss of appetite, indigestion
• Nausea and vomiting
• Shortness of breath, especially with activity
• Difficulty sleeping
• Shortness of breath which occurs after lying down for a while
• Fatigue, weakness, faintness
• Decreased alertness or concentration
• Cough
• Skin discoloration, bluish (cyanosis) or yellow (jaundice)
• Decreased urine production (oliguria)
• Need to urinate at night (nycturia)
• Infants may sweat during feeds (or other exertion)

Signs and Tests

A physical examination may reveal irregular or rapid heartbeat. There may be distended neck veins, enlarged liver, dependent edema, and signs of pleural effusion (fluid around the lungs).
Listening to the chest with a stethoscope ( auscultation ) may reveal lung crackles or abnormal heart sounds . Blood pressure may be low or may drop upon rising (orthostatic hypotension).

Enlargement of the heart or decreased heart functioning may be seen on:

• A echocardiogram
• A coronary angiography
• A chest X-ray
• A chest CT scan
• A nuclear heart scans (MUGA, RNV)
• An ECG may show arrhythmias.
• A urinalysis may indicate kidney failure as a cause of the disorder, or because of left heart failure.
• Multiple blood studies may be performed, including CBC, blood chemistry , and other studies to determine the exact cause of heart failure.

This disease may also alter the following test results:

• Urine specific gravity
• Urine concentration test
• Urinary casts
• Thoracentesis
• Swan-Ganz (right heart catheterization)
• Sodium, urine
• Serum sodium
• Protein, urine
• Pleural fluid analysis
• Peri cardiocentesis
• Osmolality, urine
• Lactic acid
• Gamma-glutamyl trans peptidase
• ESR
• Creatinine clearance
• Creatinine – urine
• Creatinine
• Chloride; urine
• Serum Chloride
• BUN
• Ammonium ion
• Aldosterone

Treatment

The goals of treatment include reduction of cardiac work load, control of excess salt and water retention (swelling), and improvement of heart functioning.

Heart failure requires monitoring of the condition by the health care provider. Hospitalization may be required if symptoms are severe or unstable; difficulty breathing occurs at rest or with minimal activity; or there is failure to respond to initial treatment.

Underlying disorders and precipitating factors should be treated. This may require medications, surgery, or other treatments. In advanced cases, bedrest or reduced physical activity may be recommended to minimize the heart’s work load.

Vasodilator medications are used to reduce the work load, particularly if symptoms include difficulty breathing, excessive tiredness, and reduce tolerance of activity. Examples of vasodilator medications include captopril, enalapril, and hydralazine.

If swelling is severe, or there are signs of congestion in systemic (body) or pulmonary (lung) vessels, salt and water accumulation may need to be modified A low sodium diet is recommended and fluid may be restricted in some cases.

Diuretic medications may be used. This includes: loop diuretics (e.g., furosemide, bumetanide) for moderate symptoms; thiazide diuretics (e.g., hydrochlorothiazide, chlorthalidone, chlorothiazide) for mild symptoms; and combination diuretics. Digoxin may be given if vasodilators and diuretics do not completely relieve symptoms.

Weight loss may be recommended. Eliminate smoking and alcohol consumption (both decrease the pumping efficiency of the heart).

Aggressive treatment of hospitalized patients is frequently guided by a cardiac specialist. Intravenous medications may be used to give a faster response, including inotropic drugs, vasodilator drugs, and diuretics. Mechanical fluid removal ( thoracentesis or paracentesis ) may be necessary in some cases. In severe cases, dialysis may be performed to remove excess fluid. Circulatory-assist devices such as the intra-aortic balloon pump or left-ventricular assist device may be recommended to stabilize condition. A heart transplant may be considered.

Prognosis

Heart failure is a serious disorder that carries a possibility of reduced life expectancy. Many forms of heart failure are well controlled with medication and correction of underlying disorders. It may become a chronic illness. Heart failure worsens with infection or other physical stressors.

Complications

• Pulmonary oedema
• Total failure of the heart to function (circulatory collapse)
• Arrhythmias including lethal arrhythmias
• Side effects of medications
  • Low blood pressure (hypotension)
  • Light headedness, fainting
  • Lupus reaction
  • Headache
  • Gastrointestinal upset (such as nausea, heartburn , diarrhoea)
  • Digitalis toxicity

Call Your Healthcare Provider?

Call your health care provider if symptoms indicate congestive heart failure may be present.

Call your health care provider if weakness, increased cough or sputum production, sudden weight gain or swelling , or other new or unexplained symptoms develop.

Go to the emergency room or call the local emergency number (such as 911) if severe crushing chest pain, fainting , or rapid and irregular heartbeat occur (particularly if other symptoms accompany a rapid and irregular heartbeat).

For even more information on how to reduce your risk of heart failure. Consult this link here.

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