Heart Failure—Types, Symptoms, Causes and Treatments

Posted by Medical Board on April 27, 2017 in Heart Health Men Women Last updated on May 29, 2019 Heart-Failure—Types-Symptoms-Causes-and-Treatments

Congestive Heart Failure Affects Many

Weighing scarcely 11 ounces, the extraordinary human heart, many of us take for granted, pumps roughly 2000 gallons of blood through some 60,000 miles of blood vessels in us every day.

Sadly, 5.7 million people in the United States currently suffer with heart failure,[7]and 1 in 5 will develop some form of it in their lifetime.

What Is Heart Failure?

The heart functions as a simple pump delivering oxygen-rich blood from the lungs to the rest of the body, where it is used to transport oxygen and nutrients to cells and tissue. Carbon dioxide-rich blood then gets pumped through the heart and returned to the lungs for more oxygen.  Unfortunately the mechanisms of this vital organ can sometimes fail.

Heart failure is a serious medical condition whereby the heart is unable to pump a sufficient amount of blood to meet the body’s demands. This is because the heart cannot adequately fill with blood, or because the organ can’t pump blood forcefully enough to the other areas of the body. In either case, heart failure does not mean the heart has “suddenly” stopped working, or will do so anytime soon.

Heart failure may further be defined as the inability of the heart to pump sufficient blood to supply the body’s needs without bringing compensatory mechanisms into play.  If the heart is inefficient, pressure within the muscle itself causes blood to back up.  The lungs then become stiff and fluid filled, causing shortness of breath and interfering with oxygen transfer. Congestion of the limbs and swelling of the legs often ensues.

Types of Heart Failure

Heart failure happens over time, gradually, as the heart’s ability to pump strong enough, diminishes. Heart failure can also affect one or both sides of the heart. Right-sided heart failure happens when the heart is unable to pump an adequate amount of used blood into the lungs to gather oxygen.

Left-sided heart failure occurs when the heart cannot pump enough blood, (rich in oxygen) to the rest of the body.

Two types of left ventricle failure include:

Systolic failure: Left ventricle can’t normally contract. This does not allow heart to pump forcefully enough for blood to circulate.

Diastolic failure (also called diastolic dysfunction): The left ventricle can no longer properly relax, thus the heart does not fill properly with blood between heartbeats.[5]

What is congestive heart failure?

Congestive heart failure occurs when blood flow out of the heart slows down, and blood returning through the veins backs up. This causes congestion in bodily tissues, and swelling in the legs and ankles results. Fluid in the lungs may also collect, especially while lying down. This is known as, “pulmonary edema” and accounts for shortness of breath. The kidneys may also retain fluids due to congestive heart failure.[5]

Heart Failure Symptoms

Heart failure is characterized by a variety of symptoms depending on the side of the heart affected. Right-sided heart failure includes fluid build up in feet, ankles, legs, liver, abdomen, and neck veins. Left-sided heart failure often results in shortness of breath and fatigue.[7]

Other Signs and Symptoms of Heart Failure

  • Pulmonary edema
  • Chronic Coughing or Wheezing
  • Feeling lightheaded
  • Lack of appetite
  • Nausea
  • Confusion
  • Cognitive impairment
  • High heart rate[5]

Heart Failure Guidelines

In order to further promote awareness of heart failure, The American Heart Association, along with other agencies have created, “Get With The Guidelines, Heart Failure”, comprehensive programs for heart healthcare employees and patients. These include a data tracking performance patient management tool, scientific publications, professional education workshops and webinars, educational materials, and a clinical tools library. Many hospitals and medical professionals have utilized updated heart failure guidelines to help advance possible treatment modalities, explore alternative medical options, and further promote healthy lifestyle changes to reduce current symptoms.[1]

Causes of Heart Failure

It is important to note that heart failure is not one single condition, but the end result of many different forms of heart disease.

The most common of these in North America is coronary artery disease. This develops when fatty plaques form inside the coronary arteries, the conduits that carry oxygen and other fuels to the working heart muscle. The resulting obstruction can cause heart attacks, which leave less muscle to drive the circulatory system. 

Hypertension (high blood pressure) increases the workload on the heart causing it to build greater muscle mass in an attempt to compensate for the higher force of blood flow.

The valves in the heart, which prevent blood from flowing backwards during contraction, can become damaged by various inflammatory processes or increased age. When these valves become narrowed, leak or both, the heart has to work harder and faster to maintain adequate blood flow.

Heart failure may be caused from a number of medical conditions, lifestyle factors, and diseases including:

  • Coronary heart disease
  • Diabetes
  • High blood pressure
  • Arrhythmia—This occurs when the heart beats outside of its regular
    rhythm.
  • Cardiomyopathy—This condition affects the heart muscle, making it enlarged, thick, or rigid.
  • Congenital heart defects—Children are born with a heart that has a structural defect. Heart failure may be caused by primary disorders of the muscle and thickening of its linings, which restricts filling.
  • Heart valve disease—One or more heart valves does not correctly work. This can be congenital, or present after an infection or alcohol or drug abuse, including cocaine or other illegal drugs. Infants and children can develop heart failure if they are born with abnormal valves or signaling disturbances between the heart chambers.
  • HIV/AIDS
  • Thyroid disorders
  • Excessive amounts of vitamin E
  • Radiation and chemotherapy for cancer treatment[6]
  • Environment—In some parts of the world industrial pollution is an important cause of lung disease causing heart failure.
  • Smoking—In North America cigarette smoking is a major risk factor for both chronic obstructive lung disease and coronary artery disease.

Treatment Approach to Heart Failure

The treatment of heart failure is generally determined by the underlying causes for the condition. 

Surgical Procedures

Bypass surgery may be effective for patients with partial or total artery blockage due to coronary artery disease.  The procedure routes another artery in the body to the heart muscle to increase blood flow.  While it does not cure coronary artery disease in other arteries, it may prevent serious consequences such as heart attack in the future.

Surgical correction for congenital abnormalities involving heart valves or other tissue structure may be effective if heart damage is caught in its early stages.

Drug Therapies

A whole host of pharmaceuticals are available for the treatment of heart failure.

Medication may be prescribed to:

  • Manage chronically elevated blood pressure levels
  • Prevent clotting
  • Open narrowed artery passages
  • Slow heart rate
  • Minimize cholesterol build up
  • Increase force of heart contractions
  • Relax blood vessels
  • Release fluid in the tissues

Each medication performs a different task in its ability to help treat or prevent heart failure. 

Diuretics work to release water through the kidneys. This reduces the congestion and excess fluid in the lungs improving shortness of breath, the most prominent and limiting manifestation of heart failure.

Drugs that dilate blood vessels lower resistance to blood flow and decrease the heart’s workload.

The mainstay of drug treatment for heart failure is “Digoxin”, which has been available for over 200 years. This medication increases the force of heart contractions and helps control a rapid or irregular heart rhythm. Digoxin may be prescribed by itself or in conjunction with other medications to treat heart failure.

Congestive Heart Failure Treatment

Heart failure treatment is based on the severity and type of heart failure at the time of diagnosis. The goal of treatment is to identify and treat the underlying cause, reduce symptoms, stop the heart failure from getting worse and improve quality of life.

Heart Treatment may include any or all of the following:

  • Lifestyle changes
  • Medication
  • Surgical procedures
  • Monitoring[4]

Chronic Heart Failure

Chronic heart failure occurs slowly over time, as the heart becomes weak and permanently damaged. While there is no cure for chronic heart failure in general, many individuals can improve their medical condition through lifestyle changes such as, weight loss, cutting salt consumption, reducing alcohol intake, and quitting smoking.

Heart Failure Treatment

The treatment approach used for heart failure patients varies greatly and is dependent on the age of the individual, the stage of heart failure, and the area of the heart that is specifically affected.

Pharmacology for the Heart

Common treatments include medications such as, Angiotensin-converting enzyme (ACE) inhibitors. These work to widen blood vessels, thus allowing the heart to pump blood more easily. Angiotension II receptor blockers (ARBs) also dilate blood vessels and can be used for patients who cannot tolerate ACE inhibitors. A combination of the two medications may be prescribed and have been successful in reducing the number of cardiac events in some individuals as well. Diuretics may be used in patients to facilitate urination and relieve fluid build up in the tissues. Isosorbide dinitrate and hydralazine hydrochloride (BiDil) are combined to dilate blood vessels also. Beta-blockers may be used, under certain circumstances. If there is evidence of systolic heart failure, beta- blockers may limit or reverse some of the damage incurred.[2]

Coronary bypass surgery—If blocked arteries are the primary cause of heart failure blood vessels from the leg, arm, or chest may be surgically implanted to bypass coronary arteries. This allows blood to flow through the heart more freely.

Heart valve repair or replacement—The original heart valve can be modified to eliminate backward blood flow. Heart valve replacement can also be done when repair is not an option.

Implantable cardioverter-defibrillators (ICDs)—This device can act as a pacemaker and also shock the heart back to a normal rhythm if necessary.

Cardiac resynchronization therapy (CRT), or biventricular pacing-This pacemaker sends electrical signals to both the upper and lower chambers of the heart.

Heart pumps—These devices assist the weakened heart by helping to pump blood throughout the body. Heart transplant-For some heart failure patients, a heart transplant is the only option for a healthy, disease-free life. Many individuals are sustained through device or drug therapy while waiting for a donor heart.[3]

Heart Failure Prevention—The Key To A Healthy Heart

Maintaining a smoke-free lifestyle, eating a balanced diet, getting plenty of rest and exercise, and keeping stress to a minimum all contribute to a healthy heart muscle. While certain risk factors for heart disease may be hereditary, or caused from a congenital defect, lifestyle choices contribute to many heart conditions and diseases.

At the center of each of us, is a beating heart, circulating blood throughout the body, driving oxygen to the brain, moving blood borne precious nutrients to every cell in the body, as it maintains a perfect rhythm. When that rhythm is disturbed through disease, disorder, or defect, heart failure can occur. Finding proper individualized treatment is critical for the health of your heart, and the overall quality of your life.

References

1″Get With The Guidelines-Heart Failure”. Heart.Org, 2017, https://www.heart.org/HEARTORG/Professional/GetWithTheGuidelines/GetWithTheGuidelines-HF/Get-With-The-Guidelines-Heart-Failure-Home-Page_UCM_306087_SubHomePage.jsp.

2″Heart Failure”. University Of Maryland Medical Center, 2017, http://www.umm.edu/health/medical/altmed/condition/heart-failure.

3″Heart Failure Treatments And Drugs – Mayo Clinic”. Mayo Clinic, 2017, http://www.mayoclinic.org/diseases-conditions/heart-failure/basics/treatment/con-20029801.

4″How Is Heart Failure Treated? – NHLBI, NIH”. Nhlbi.Nih.Gov, 2017, https://www.nhlbi.nih.gov/health/health-topics/topics/hf/treatment.

5″Types Of Heart Failure”. Heart.Org, 2017, http://www.heart.org/HEARTORG/Conditions/HeartFailure/AboutHeartFailure/Types-of-Heart-Failure_UCM_306323_Article.jsp#.WP-fJ2U4mb8.

6″What Causes Heart Failure? – NHLBI, NIH”. Nhlbi.Nih.Gov, 2017, https://www.nhlbi.nih.gov/health/health-topics/topics/hf/causes.

7″What Is Heart Failure? – NHLBI, NIH”. Nhlbi.Nih.Gov, 2017, https://www.nhlbi.nih.gov/health/health-topics/topics/hf.

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2 Comments

  • I would like to enquire regarding the heart condition of my 74 years old mother. She suffered a massive heart attack (according to the hospital doctors) about 2 weeks ago. Initial complaint was giddiness and some signs of cough and cold. A visit to a GP found her blood pressure to be normal and heart OK. The GP even declared her to be healthly except for some flu and prescribed her some medication.

    Over the next two days, her condition appeared the same. On the third morning (and even the night before), her giddiness was bad and was subsequently admitted to hospital that morning on the advice of another visiting GP. The hospital doctors’ diagnosis of her condition was that she had suffered a massive heart attack with at least one of her 3 arteries blocked and the other 2 probably in no good shape. After about a week of intensive monitoring and medication, her condition has stablised. The doctors said that this attack has resulted in a weak heart with about 1/4 to 1/3 of it damaged beyond repair. Coupled with this, she also has pockets of water in her lungs, an enlarged liver, anemia and low blood count (haemoglobin). About 3 days ago, she was transferred out of the MICU to the generic wards but placed under observation. Now, her condition is considered stable. Over the last 2 days, she appeared much better and has since been taken off the monitoring equipment of her heart.

    The cardiologist at the hospital felt that it is not advisable for her to go for any treatment such as ballooning or bypass. She is of the opinion that it is too risky especially due to the not-fully functional heart as well as her age but instead should go on long term medication to strengthen the remaining functioning part of the heart. She has been on thyroid medication for many years too and had no history of heart problem. She visits the government polyclinics every 2 to 3 months.

    I would really appreciate any kind of professional opinion & recommendations for my mother’s condition based on what I have described.

    Medical Board ratings for this post: Medical Board gives a rating of 5Medical Board gives a rating of 5Medical Board gives a rating of 5Medical Board gives a rating of 5Medical Board gives a rating of 5
    • Answer:

      Your mother had heart failure following her heart attack due to the damage causing poor pump function. She is not a candidate for balloon angioplasty or bypass surgery unless she develops intractable angina (chest pain due to lack of blood supply to the heart muscle)

      She should be on long term aspirin and probably an angiotensin converting enzyme inhibitor (enalapril) plus a diuretic. If she is a smoker she must stop. Other considerations are a bet-blocker (metoprolol) if her heart failure resolves, a lipid lowering agent (lovostain) if her LDL cholesterol is greater than 3.5 mmol/l (125mg%) and post-menopausal hormone replacement.

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