Chronic Systolic Heart Failure

Introduction

Chronic systolic heart failure (HF) is a condition in which the heart's ability to pump blood adequately is reduced due to weakened heart muscle contraction. This condition is often measured by the left ventricular ejection fraction (LVEF), which is typically reduced (≤40%) in systolic heart failure.

Causes and Risk Factors

Several factors can lead to or aggravate chronic systolic heart failure, including: - Coronary artery disease (CAD): The most common cause of heart failure, CAD leads to reduced blood flow and damage to the heart muscle. - Hypertension (high blood pressure): Increased workload of the heart over time can weaken its ability to pump efficiently. - Dilated cardiomyopathy: A condition where the heart chamber enlarges and weakens. - Valvular heart disease: Dysfunction of heart valves can increase strain on the heart. - Arrhythmias: Irregular heart rhythms can impair cardiac function. - Diabetes and metabolic syndrome: These conditions increase cardiovascular disease risk. - Obesity and a sedentary lifestyle: These exacerbate heart failure progression.

Symptoms

Patients with chronic systolic heart failure may experience: - Shortness of breath, especially on exertion or when lying down - Fatigue and weakness - Swelling in legs, ankles, feet, and sometimes the abdomen (edema) - Rapid or irregular heartbeat - Persistent cough or wheezing with white or pink-tinged mucus - Difficulty concentrating

Diagnosis

The diagnosis is based on a combination of medical history, physical examination, and diagnostic tests such as: - Echocardiogram: The most important test to assess ejection fraction and heart structure. - Electrocardiogram (ECG): To detect arrhythmias or ischemic heart disease. - Blood tests: To check for markers like BNP (B-type natriuretic peptide), kidney function, and thyroid function. - Chest X-ray: To look for fluid buildup in the lungs. - Cardiac MRI or CT scan: In select patients for a more detailed heart assessment.

Treatment

The aim of treatment is to relieve symptoms, slow progression, and reduce complications. Treatment options include:

1. Lifestyle Modifications:

• Diet: Limit sodium intake, maintain a heart-healthy diet (low in saturated fats, processed foods, and excess sugar).
• Exercise: Regular, moderate physical activity tailored to the individual’s capacity.
• Weight Management: Maintain a healthy weight to reduce cardiac strain.
• Alcohol and Smoking: Avoid tobacco and limit alcohol intake.

2. Medications:

• ACE inhibitors/ARBs/ARNIs: Drugs like enalapril, losartan, or sacubitril-valsartan to reduce heart strain and protect the heart muscle.
• Beta-blockers: Such as carvedilol or metoprolol, to help the heart beat more efficiently and reduce workload.
• Aldosterone antagonists: Such as spironolactone, which help prevent fluid retention.
• Diuretics: To manage edema and fluid overload.
• SGLT2 inhibitors: Like empagliflozin, which benefit heart failure patients with or without diabetes.
• Ivabradine: In selected patients with a high heart rate despite beta-blocker use.

3. Device Therapy:

• Implantable Cardioverter Defibrillator (ICD): For patients at high risk of life-threatening arrhythmias.
• Cardiac Resynchronization Therapy (CRT): For those with electrical conduction abnormalities in the heart.

4. Advanced Therapies:

• Heart transplantation: In severe cases when other treatments fail.
• Left ventricular assist device (LVAD): For patients with very advanced heart failure awaiting transplant.

Prevention and Prognosis

Preventing heart failure involves managing risk factors such as hypertension, diabetes, and avoiding smoking. While chronic systolic heart failure is a progressive condition, adherence to appropriate treatment can significantly improve quality of life and life expectancy.

Conclusion

Chronic systolic heart failure is a serious condition, but with modern treatments and lifestyle adaptations, patients can lead a fulfilling life. Regular follow-ups with a cardiologist ensure optimal management and early detection of complications.

Source recommendations

1. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure

1. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001063
2. https://pubmed.ncbi.nlm.nih.gov/35363499/
3. https://www.sciencedirect.com/science/article/pii/S0735109721083959
4. https://pubmed.ncbi.nlm.nih.gov/35378257/
5. https://professional.heart.org/en/science-news/2022-guideline-for-the-management-of-heart-failure

2. 2021 ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure

1. https://pubmed.ncbi.nlm.nih.gov/34447992/
2. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Acute-and-Chronic-Heart-Failure
3. https://academic.oup.com/eurheartj/article/42/36/3599/6358045
4. https://onlinelibrary.wiley.com/doi/full/10.1002/ejhf.2333
5. https://academic.oup.com/eurheartj/article/44/37/3627/7246292