Definition and Overview

Heart failure is a medical condition in which the heart is not pumping enough blood to the rest of the body. Because of this, different organs, such as the brain and lungs, do not receive enough oxygen and nutrients. The condition can be life-threatening. But medications and making healthy lifestyle changes can enable patients to live full and even active lives.

Heart failure can either be left or right sided. Left-sided heart failure is caused by problems with the heart’s left ventricle (LV). LV supplies most of the heart’s pumping power. It can lose its ability to contract (systolic failure) or relax normally (diastolic failure).

In a systolic heart failure (SHF), the heart is unable to pump enough blood into circulation. In a diastolic heart failure (DHF), on the other hand, the heart muscle becomes stiff. It also does not take enough time to rest in between heartbeats. Thus, it does not fill with enough blood. This causes blood to flow back to other parts of the body. This increases the pressure in the ventricles as blood from the next heartbeat tries to enter the heart.

Causes of Condition

DHF can be caused by:

  • Chronic high blood pressure - This refers to the condition in which the blood pressure in the arteries is high. In adults, the normal blood pressure is 120/80. The first number (120) is the pressure in the blood vessels when the blood is pushed out of the heart (systolic blood pressure). The second number (80), on the other hand, is the pressure when the heart relaxes to fill with blood (diastolic blood pressure). High blood pressure makes the heart work harder. This can make the heart muscle thicker or larger.

  • Coronary heart disease (CHD) - CHD occurs when arteries that supply blood to the heart muscle are blocked. The blockage is often caused by plaque buildup.

  • Ageing - DHF is commonly diagnosed in patients aged 50 and up. As a person gets older, his or her blood vessels become less elastic.

  • Aortic stenosis - This refers to the narrowing of the aortic artery. The aorta is the main artery of the body. It is responsible for distributing blood to different body parts and organs.

  • Hypertrophic cardiomyopathy - This occurs when the heart muscle is enlarged.

  • Restrictive cardiomyopathy - A heart muscle disease in which the lower chambers of the heart are unable to expand as they fill with blood.

Key Symptoms

DHF prevents the heart from pumping enough blood to the rest of the body. This reduces the amount of oxygen and nutrients that go to the vital organs, such as the lungs and the brain. Because of this, patients present with the following symptoms:

  • Shortness of breath - Patients often find themselves gasping for breath especially when they are lying down. This can interrupt their sleep. This symptom also leads to weakness and fatigue.

  • Swollen lower limbs

  • Lack of appetite and nausea

  • A fast heart rate

  • Fluid buildup in the chest area

  • An enlarged heart

  • Prominent or enlarged neck veins

  • A chronic cough or wheezing

Who to See and Types of Treatments Available

Diagnosing DHF can sometimes be a challenge. This is because its symptoms can also be caused by other diseases. These include obesity and lung conditions. It is also sometimes challenging to distinguish SHF from DHF.

The most commonly used test to diagnose DHF is cardiac catheterisation. For this test, the doctor inserts a thin and flexible catheter into a blood vessel to reach the heart. The test can confirm any problem with the heart’s ability to relax and fill with blood. Doppler echocardiography is also often used. It is an ultrasound test that creates pictures of the heart. It helps doctors determine the speed and direction of blood flow. Other tests used include chest x-rays, electrocardiogram, and exercise test.

Treatment of DHF focuses on preventing it from progressing. It also involves treating underlying diseases. These may include diabetes and high blood pressure.

Doctors treat the condition with medications. Patients are prescribed with drugs to achieve normal blood pressure as well as prevent abnormal heart rate. Medications that remove plaque build up and widen blood vessels are also often used. Patients are also advised to make healthy lifestyle changes. They must maintain a healthy weight, eat a healthy diet, and exercise on a regular basis. Getting enough sleep and drinking eight glasses of water everyday also help. They must also stop smoking and avoid drinking alcohol as much as possible.

With prompt and adequate treatment, the prognosis for patients with DHF is generally good. Many are able to live normal and even active lives with the help of medications.

References:

  • Heart failure (HF). The Merck Manual Professional Edition. http://www.merckmanuals.com/professional/cardiovascular_disorders/heart_failure/heart_failure_hf.html?qt=heart%20failure&alt=sh.

  • Yancy CW, et al. 2013 ACCF/AHA guideline for the management of heart failure. Journal of the American College of Cardiology. 2013;62:e147.

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