Definition and Overview

Heart failure (HF) refers to a chronic and progressive medical condition characterized by the poor function of the heart, which is to pump blood. It is sometimes used interchangeably with congestive heart failure, although this term is also a type of HF.

The heart is a strong hollow muscled organ, which main function is to pump blood to various parts of the body. This blood contains both nutrients and oxygen that are necessary for the body’s cells to function properly.

The heart works on autopilot, which means the pumping action is instantaneous, continuous, regular, and involuntary. Because the heart is designed to do this for the patient’s lifetime, the organ has its own type of muscle called the cardiac muscle.

At certain times, however, the heart cannot pump blood the way it should. Usually, something prevents it from keeping up with its workload. During the initial stages, the heart may aim to compensate for the insufficiency by building more muscle mass or enlarging itself. It may also be forced to pump faster. These changes, however, can have negative effects on the body. If it remains unmanaged and untreated, the heart’s function may further weaken and the organ becomes more damaged.

Heart failure can be diagnosed as either left or right-sided, which refers to the heart’s ventricles and atriums. Left-sided HF may be systolic or diastolic. The right-sided HF, on the other hand, often occurs due to left-sided failure. This is because during each pump, blood travels from the left to the right side. If the blood flow causes congestion, then the HF is considered congestive.

HF doesn’t always lead to death and irreparable damage. It can be reversed, and many people are able to live productive lives despite having the condition.

Causes of Condition

A heart failure may be caused by:

  • Atherosclerosis – this is a medical condition that involves the narrowing of arteries (stenosis) due to the buildup of plaque. The actual cause of atherosclerosis is unknown, although experts believe that it is due to weakened artery. As it gets weaker, deposits can accumulate while the body tries to resolve the problem through clotting. The blood clot, however, can block the blood’s passageway that can further worsen the condition.

  • Coronary artery disease – This occurs when the arteries connected to the heart that supply the organ the oxygen and nutrients it needs become blocked or narrow. Because the cardiac muscles do not receive the much-needed nutrients and oxygen, the cells eventually die, leading to heart damage.

  • Heart attack – Also referred to as myocardial infarction (MI), a heart attack is a medical emergency caused by the sudden blockage of blood flow to the heart, causing infarction or death of the heart tissues.

  • Underlying conditions – Certain conditions can increase the risk of heart failure. These include diabetes, hypertension (high blood pressure), kidney issues, anemia, and thyroid disease.

  • Congenital – Certain congenital defects affecting the heart can prevent the organ from functioning normally over time. These include problems with the valve, which can speed up the heartbeat.

  • Cardiomyopathy – this is a broad term that describes changes to the cardiac muscles, such as if they have become rigid, thick, or enlarged. The actual cause of these conditions remains unclear.

Certain risk factors that are also associated with HF include:

  • Obesity
  • Poor diet
  • Sedentary lifestyle or lack of physical activity
  • Smoking and alcohol
  • Drug abuse
  • Certain medications

Key Symptoms

  • Ascites (the build-up of fluid in the abdominal cavity, causing the abdomen to swell)
  • Persistent coughing, sometimes accompanied by pink- or white-colored phlegm
  • Difficulty in breathing
  • Shortness of breath
  • Unexplained fatigue
  • Quick exhaustion
  • Weakness
  • Edema (buildup of fluid in the legs and arms)
  • Chest pain (angina)
  • Fainting spell
  • Irregular heartbeat
  • Difficulty in concentration

As mentioned earlier, as the heart and body try to compensate for the changes in the pumping action and blood flow, HF may not be detected quickly and easily. People who are considered high risk should consider regular checkup or condition monitoring.

It may be considered an emergency if the patient suffers from chest pain, irregular heartbeat, difficulty in breathing, fainting, confusion, swelling, or shortness of breath.

Who to See and Treatments Available

Patients who are suffering from HF work closely with a cardiologist who specializes in conditions affecting the heart.

Heart failure may be diagnosed through:

  • Stress tests
  • Blood tests
  • Electrocardiography (ECG)
  • Arteriogram or angiography
  • Chest X-ray
  • Doppler ultrasound
  • Heart scan
  • Cardiac catheterization

A cardiologist may also monitor the overall activity of the heart over a certain period through a Holter monitor, a device that records the organ’s electrical activity while the patient proceeds with his normal daily routine. The device is portable and has electrodes that are attached to the chest. After 24 to 48 hours, the records stored by the monitor are analyzed.

If a person is diagnosed with HF, the following treatment options may be suggested:

  • Treatment of the underlying condition – If heart failure is caused by other conditions not directly affecting the heart, the condition will be treated first to prevent the HF from worsening. This may require coordination with other specialists.

  • Medications – Drugs such as beta blockers, aldosterone inhibitors, and diuretics may be provided to control the effects of HF, as well as to reduce, eliminate, or manage the symptoms.

  • Bypass surgery – this may be recommended if the artery leading to the heart is already damaged. In this process, the blood flow is rerouted to another artery, bypassing the damaged one.

  • Attachment of a left ventricular assistive device (LAVD) – LAVD works like a substitute pump to allow the blood to flow between the chambers.

  • Heart transplant – This is recommended for severe cases or when other procedures, including surgery, didn’t work.

Other preventive or management measures include:

  • Eating a healthy diet – The American Heart Association recommends the DASH (dietary approaches to stop hypertension) diet, which emphasizes low consumption of sodium, fat, and cholesterol, and the intake of whole foods such as vegetables, fruits, lean meats, and complex grains.
  • Ensuring adequate liquid intake
  • Maintaining healthy weight
  • Monitoring physical activity or exercise

  • Goodlin SJ, Bonow RO. Care of patients with end-stage heart disease. In: Mann DL, Zipes DP, Libby P, et al. eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 31.

  • Mann DL. Management of heart failure patients with reduced ejection fraction. In: Mann DL, Zipes DP, Libby P, et al. eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 25.

  • Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJV, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WHW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;128:e240-e327. PMID: 23741058

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