Heart Failure - Symptoms, Causes, Types and Treatment

Heart failure is a serious condition where the heart cannot pump blood effectively. This causes insufficient blood supply and flow throughout the body, leading to blood accumulating in other areas, commonly in the lungs, legs, and feet. It can be chronic or acute: 

1. Chronic heart failure is a long-term disease that develops slowly over time. 

2. Acute heart failure is a sudden, rapid decline in heart functioning. 

Types of Heart Failure

Heart failure can be classified into various forms, each with distinct symptoms and complications. Recognising the type of heart failure, whether it is left-sided, right-sided, systolic, or diastolic, is essential for targeted treatment and management.

Understanding the heart failure stages is crucial for early detection and appropriate management. Each stage represents a progression in the severity of the condition, necessitating different levels of care and treatment strategies.

Heart failure symptoms can start slowly or develop suddenly. These can range from mild to severe and may include the following:

1. Shortness of breath (especially during physical activity or when lying down) 

2. Severe fatigue and weakness (reducing the ability to perform daily activities like walking)

3. Oedema (swelling due to fluid buildup) in the legs, ankles, feet, and abdomen 

4. Heart palpitations (feeling like the heart is racing or fluttering) 

5. Persistent cough (generally with white or pink blood-tinged mucus) 

6. Sudden weight gain (due to fluid retention) 

7. Loss of appetite or nausea 

8. Trouble focusing or experiencing confusion 

Causes of Heart Failure

The primary cause of heart failure is a damaged, weakened, or stiff heart. It may result in the following: 

1. Damage or weakening of the heart can cause the chambers to stretch and enlarge. This reduces the ability of the heart to pump sufficient blood. 

2. When the main pumping chambers (ventricles) become stiff, they cannot fill with enough blood between heartbeats, leading to inefficient blood circulation.

As a cardiologist, I understand the immense toll that heart failure can take on a person's life. It's a condition that robs individuals of their independence and ability to fully engage in the activities they love. But with our treatment approach, I've witnessed remarkable transformations in the lives of my patients. By addressing the underlying factors contributing to heart failure, we're able to improve cardiac function and alleviate distressing symptoms significantly.

- Dr Saurabh Chopra
Cardiologist, Interventional Cardiologist

Several aspects can increase an individual’s risk of developing this condition. Understanding these helps take preventive measures to protect heart health. The heart failure risk factors are as follows: 

Non-modifiable factors that an individual cannot alter are as follows: 

1. Age: The functioning of the heart decreases with age, particularly after 65. 

2. Family History: Genetic predisposition to heart conditions can elevate the risk.

Modifiable risk factors of heart failure include: 

1. High Blood Pressure: Increases the workload of the heart, leading to weakening of the heart muscle.

2. Coronary Artery Disease: Narrowed or blocked arteries reduce blood flow to the heart.

3. Heart Attack: These can damage the heart muscle and affect its ability to pump blood.

4. Smoking or Excessive Alcohol Consumption: It can weaken the blood vessels and heart muscle.

5. Obesity: Excess weight strains the heart and leads to conditions that cause heart failure.

Heart Failure Prevention

Making lifestyle changes for heart failure and managing existing health conditions are important for preventing the condition. Here are some key prevention strategies:

1. Exercising regularly 

2. Maintaining a healthy weight 

3. Eating heart-healthy foods 

4. Quitting smoking and limiting alcohol consumption 

5. Getting enough sleep

Given the complexity of the condition, heart failure diagnosis involves a detailed evaluation involving various tests to pinpoint its severity. The key steps in the process are as follows: 

1. Medical History and Physical Evaluation: The doctor reviews the patient’s symptoms, lifestyle factors, and family history. They also conduct a physical examination to check for signs of heart failure, such as abnormal heart sounds and fluid buildup in the lungs. 

2. Blood Tests: Several evaluations are performed to check for kidney and thyroid function. Other tests detect high cholesterol levels and anaemia.  

3. B-type natriuretic peptide (BNP) Blood Test: BNP is a hormone that the heart releases when it works harder than normal to pump blood. As a result, high levels may indicate inefficiency in blood pumping. 

4. Electrocardiogram (ECG or EKG): This test records the electrical activity of the heart to identify abnormal heart rhythms or other heart conditions. 

5. Echocardiogram: An ultrasound of the heart that offers detailed images of its structure and function. 

6. Chest X-ray: It reveals the size of the heart and detects fluid buildup in the lungs. 

7. Stress Test: This assessment measures how well the heart functions during physical activity. It can help diagnose coronary artery disease. 

8. Cardiac Catheterisation: It is a procedure where a thin, flexible tube is inserted into a blood vessel and guided to the heart to evaluate its functioning. 

How to prepare for a doctor consultation? 

When attending a consultation for heart failure, being well-prepared can significantly enhance the quality of care. It ensures that the heart doctor has all the information needed to provide accurate and effective treatment. Here’s how to prepare:

1. Keep a detailed log of the symptoms, including when they occur, their severity, and any triggers. 

2. Collect medical records, including previous diagnoses, treatments, surgeries, and family history of heart disease.

3. Make a list of all current medications, supplements, and over-the-counter drugs, along with their dosages. 

4. Note daily habits, such as diet, exercise, alcohol consumption, and smoking, as these can significantly impact heart health. 

5. If the doctor has ordered tests, follow any pre-test instructions, such as fasting or avoiding certain medications, to ensure accurate results.

Questions to ask the Doctor 

When consulting a cardiologist about heart failure, it is important to have a clear understanding of the condition and treatment options. Asking the right questions can help patients manage their health more effectively. Consider the following: 

1. What specific type of heart failure do I have, and what does it mean for my health?

2. What are the main treatment options available for my condition?

3. What lifestyle changes should I make to manage my heart failure better?

4. Are there any specific dietary recommendations I should follow?

5. What signs and symptoms should prompt me to seek immediate medical attention?

Heart failure treatment depends on the cause of the condition. Effective management aims to improve symptoms, enhance quality of life, and reduce complications. Options include: 

Medications 

The medical expert may prescribe a combination of drugs to treat heart failure. These are as follows: 

1. Angiotensin-converting Enzyme (ACE) Inhibitors: Relaxes blood vessels and reduces the workload on the heart. Examples include enalapril, lisinopril, and capropril. 

2. Beta Blockers: Slows the heart rate and lowers blood pressure, improving heart function. Examples include carvedilol, metoprolol, and bisoprolol. 

3. Diuretics: Removes excess fluid from the body, reducing breathing difficulties. Furosemide is an example of these water pills. 

4. Potassium-sparing Diuretics: This drug, also called aldosterone antagonists, increases the life expectancy of individuals with severe heart failure with reduced ejection fraction (HFrEF). 

5. Digoxin: Also known as digitalis, it helps the heart pump blood more effectively and slows the heartbeat. It reduces heart failure symptoms in people with HFrEF.  

Surgery 

When heart failure medications do not offer relief, doctors may recommend surgical procedures to treat its cause. Mentioned below are these methods: 

1. Coronary Bypass Surgery: This procedure improves blood flow to the heart muscle by creating a new pathway around blocked or narrowed coronary arteries. It uses a graft, often from a blood vessel in the leg or chest.

2. Heart Valve Replacement or Repair: Repair involves fixing the damaged heart valve. Replacement uses artificial or biological valves to restore normal blood flow.

3. Implantable Cardioverter-Defibrillators (ICDs): The surgeon implants these devices in the chest to monitor heart rhythms. They deliver electric shocks when life-threatening arrhythmias are detected to restore a normal heartbeat.

4. Cardiac Resynchronisation Therapy (CRT): A pacemaker is implanted to coordinate the timing of the contractions of the heart. It improves heart rhythm and the efficiency of each heartbeat.

5. Ventricular Assist Devices (VADs): Mechanical pumps are implanted to assist the heart in pumping blood. They are generally used in patients with severe heart failure before transplant or as long-term therapy.

6. Heart Transplant: This is considered for patients with severe heart failure whose condition does not improve with other treatments. It involves replacing the diseased heart with a healthy donor heart.

Note: The best approach to heart failure management depends on the patient’s condition, the cause of the disease, and the doctor’s opinion.

The prices mentioned in the table above are approximates. These can vary widely depending on the surgeon’s expertise, type of hospital, and geographical location. Patients are advised to consult HexaHealth experts for accurate expenses. 

Postponing treatment for heart failure can lead to a range of serious complications, impacting various aspects of health. Some common issues associated with heart failure include:

1. Fluid Buildup (Oedema): Excessive fluid retention in the limbs, lungs, or liver can lead to severe swelling and discomfort.

2. Stroke: Heart failure increases the risk of blood clots forming, which can travel to the brain and cause a stroke.

3. Kidney Damage: Reduced blood flow can impair kidney function, causing kidney failure and the need for dialysis.

4. Liver Damage: Fluid buildup and congestion can result in liver dysfunction and scarring (cirrhosis).

5. Arrhythmias: Abnormal heart rhythms can develop, increasing the chances of stroke and sudden cardiac arrest.

6. Heart Attack: The risk increases due to the elevated strain on the heart and compromised blood flow.

When to call a doctor?

Knowing when to seek medical attention for heart failure is crucial to managing the condition effectively. The signs that indicate a need to call the heart specialist are as follows:

1. Severe or sudden shortness of breath and coughing up pink or white frothy mucus.

2. Chest pain or discomfort.

3. Fatigue or weakness.

4. A fast or irregular heartbeat, especially when accompanied by fainting, shortness of breath, and chest pain.

5. Rapid weight gain (2.3 kilograms or more in a week).

Maintaining a heart-healthy diet is vital for managing heart failure. Some dietary recommendations include the following:

1. Limit Sodium Intake: Reduce salt in the diet to help manage fluid retention and blood pressure. Consume fewer than 2,000 mg of sodium per day.

2. Monitor Fluid Intake: Drinking too much fluid can strain the heart and lead to swelling, shortness of breath, and weight gain. Patients should drink 2 litres of water throughout the day. 

3. Eat More Fruits and Vegetables: Incorporate various colourful fruits and vegetables rich in antioxidants, minerals, and vitamins.

4. Choose Whole Grains: Opt for brown rice, whole wheat bread, oats, and quinoa to get essential nutrients and fibre.

5. Select Lean Proteins: Include sources such as chicken, turkey, fish, beans, and legumes. Limit red meat and avoid processed meats.

6. Consume Healthy Fats: Consider olive oil, avocados, nuts, and seeds to improve heart health.

Heart failure is a life-threatening condition that requires ongoing management and lifestyle adjustments. Persistent fatigue, shortness of breath, and other heart failure symptoms signal the need for medical intervention and specialised care.  

HexaHealth provides comprehensive support, improving heart failure prognosis through expert consultations and personalised treatment plans. Our platform connects you with top specialists to ensure you have access to the best care for your heart health.

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• ICD vs Pacemaker
• Heart Block