Understanding Cardiac Heart Failure

Introduction

Cardiac heart failure, often referred to as heart failure (HF), is a chronic condition where the heart is unable to pump blood efficiently to meet the body's needs. This leads to a reduced supply of oxygen and nutrients to organs and tissues, causing symptoms such as fatigue, shortness of breath, and fluid retention.

Causes and Risk Factors

Heart failure can result from various conditions that damage or weaken the heart, including:

• Coronary artery disease (CAD) – Blockages in the heart's arteries can reduce blood supply to the heart muscle.
• Hypertension (high blood pressure) – Increased pressure forces the heart to work harder, leading to enlargement and weakening.
• Diabetes – High blood sugar levels can damage blood vessels and the heart.
• Myocardial infarction (heart attack) – A heart attack damages the heart muscle, reducing its pumping ability.
• Valvular heart disease – Dysfunctional heart valves can overload the heart.
• Obesity and sedentary lifestyle – Excess weight puts additional strain on the heart.
• Smoking and alcohol consumption – Both can contribute to heart muscle weakening.

Types of Heart Failure

Heart failure is classified based on the efficiency of the heart’s pumping function:

1. Heart failure with reduced ejection fraction (HFrEF) – The heart's left ventricle has a weak contraction and cannot pump out enough blood.
2. Heart failure with preserved ejection fraction (HFpEF) – The heart contracts normally but has impaired relaxation, leading to ineffective blood refill.

Symptoms of Heart Failure

Patients with heart failure commonly experience:

• Shortness of breath (dyspnea), especially during exertion or while lying down.
• Persistent coughing or wheezing, sometimes with white or pink mucus.
• Fatigue and weakness.
• Swelling in the legs, ankles, and feet (edema).
• Rapid or irregular heartbeat.
• Sudden weight gain due to fluid retention.

Diagnosis

Heart failure is diagnosed using a combination of:

• Physical examination – Physicians check for swelling, heart sounds, and lung congestion.
• Echocardiogram – This test assesses the heart’s structure and ejection fraction.
• Electrocardiogram (ECG) – Monitors electrical heart activity.
• Blood tests – Tests like NT-proBNP help detect heart strain.
• Chest X-ray – Helps evaluate heart enlargement and fluid accumulation.
• Cardiac MRI or CT scan – Provides detailed imaging of heart function.

Treatment Approaches

While heart failure is a chronic condition, modern treatments help manage symptoms effectively:

1. Medications

• ACE inhibitors or ARBs – Help relax blood vessels and reduce heart workload.
• Beta-blockers – Slow the heart rate and improve function.
• Diuretics – Reduce fluid buildup and decrease swelling.
• Aldosterone antagonists – Improve survival in some HF patients.
• SGLT2 inhibitors – Initially for diabetes, but now beneficial in HF treatment.

2. Lifestyle Changes

• Diet – Low salt intake, avoiding alcohol, and increasing fruits and vegetables.
• Exercise – Moderate physical activity can improve heart strength.
• Weight management – Essential to reduce strain on the heart.
• Smoking cessation – Essential for heart health.

3. Medical Devices and Surgery

• Pacemakers or implantable defibrillators (ICDs) – Help regulate heartbeat.
• Cardiac resynchronization therapy (CRT) – Useful in certain heart failure patients.
• Heart transplant or ventricular assist device (VADs) – For severe cases.

Conclusion

Heart failure is a serious but manageable condition with proper medical treatment and lifestyle adjustments. Early diagnosis and adherence to treatment are crucial for improving quality of life and longevity. If you experience symptoms, consult a healthcare provider as soon as possible to receive appropriate care.

Source recommendations

1. American College of Cardiology (ACC) and American Heart Association (AHA) Guidelines for Heart Failure Management

1. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001063
2. https://www.jacc.org/doi/10.1016/j.jacc.2023.12.024
3. https://www.acc.org/education-and-meetings/products-and-resources/features/global-cv-institute/heart-failure-guidelines
4. https://pubmed.ncbi.nlm.nih.gov/35363499/
5. https://www.acc.org/Guidelines

2. European Society of Cardiology (ESC) Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure

1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Acute-and-Chronic-Heart-Failure
2. https://pubmed.ncbi.nlm.nih.gov/34447992/
3. https://academic.oup.com/eurheartj/article/42/36/3599/6358045
4. https://pubmed.ncbi.nlm.nih.gov/22611136/
5. https://academic.oup.com/eurheartj/article/44/37/3627/7246292