28 September 2020 When the heart weakens or becomes thick and stiff, the heart muscle cannot handle the workload that is required and heart failure arises. Causes of heart failure Heart failure is caused by a weakening or thickening of the heart muscle (myocardium). Thus, any condition that impairs the function of the heart can cause heart failure. Examples of these conditions are: Coronary artery disease; Heart attack; Inflammation of the heart muscle (myocarditis); High blood pressure (hypertension); Diseases of the heart valves; Some types of cardiac arrhythmias; Prolonged alcohol abuse. In some cases, the exact cause of heart failure may not be known. Types of heart failure There are several classifications for heart failure, including: Systolic and / or diastolic Systolic: The heart loses strength on the left side (left ventricle) and cannot pump blood into the systemic circulation, there is systolic heart failure or heart failure on the left side. When this occurs, the heart is enlarged and weak. Diastolic: The heart becomes thicker and more rigid and the left ventricle cannot fill up enough and blood is not pumped into the circulation even though the pumping action is strong. Congestive or non-congestive Congestive heart failure is the inability of the heart muscle to maintain circulation, leading to an accumulation of blood in the veins and fluid in the tissues. These can accumulate in the legs causing swelling (edema), in the lungs causing pulmonary edema, or in the abdomen, called ascites. Acute and/or chronic Acute decompensated heart failure is a medical emergency. Phases of the heart failure There are four stages (classes) of heart failure, used to classify the severity of symptoms, which represent a progression of cardiac muscle weakness. The New York Heart Association (NYHA) puts the phases of heart failure into four classes: Phase (or class) I: no activity limitations, normal activities can be performed; Phase (or class) II: mild limitations and mild symptoms with activity; no symptoms at rest; Phase (or class) III: visible limitations in the activity; just comfortable at rest; Phase (or class) IV: symptoms occur at any level of activity and are uncomfortable even at rest. Possible complications of heart failure: these include marked fatigue and weakness, inability to complete activities of daily living, kidney damage, and progressive heart failure that may ultimately require a heart transplant. Symptoms of heart failure The first signs and symptoms of heart failure may not be apparent and develop only after the disease has progressed over time. Symptoms include: Falta de ar; Shortness of breath; Fatigue; Dizziness; Exercise intolerance; Loss of appetite; Nausea; Cough (or chronic cough); Fast beats or racing heart; Excessive tiredness; Confusion; Difficulties in thinking or concentration; Swelling in the ankles; Swelling in the abdomen; Chest pain. Symptoms are usually worse at night when lying down. The symptoms of systolic and diastolic heart failure are very similar, so your doctor may need more tests to be sure what type of heart failure is present. Risk factors for heart failure The most common risk factors for heart failure include: Coronary artery disease; Previous history of myocardial infarction (heart attack), Problems with one or more heart valves; Cardiomyopathy (heart muscle disease). Other risk factors are: Arterial hypertension; Genetic factors (congenital heart defects); Infections (especially viral infections); Obesity. Less recognized risk factors include: Sleep apnea; Nutritional deficiencies; Unhealthy diet (low in antioxidant vegetables and high in animal fats); Stress; Lack of exercise. All of these factors also contribute to coronary artery disease, which is, in turn, an important risk factor for heart failure. When risk factors for heart failure are present, there is usually inflammatory stress, which further damages the heart muscle, whose cells are deprived of energy and antioxidants. Diagnosis and treatment of heart failure Heart failure can be diagnosed by the symptoms reported by the patient, by physical examination or by a chest X-ray. The echocardiogram can identify problems with a thick, rigid heart muscle and if used to distinguish between the systolic and diastolic types of heart failure. Changes in certain blood test values may suggest heart failure. Heart failure treatment options include adopting a healthy lifestyle, medication and, in some cases, implanting devices similar to ‘pacemakers’. In acute or decompensated heart failure, hospitalization or intravenous medication may be required to help recovery. In some more serious cases, the need for a heart transplant can be considered. What medical specialties treat heart failure? Patients can initially consult their general practitioner of General and Family Medicine or Internal Medicine doctor. In a sudden or more serious situation, they must be observed by a specialist in emergency medicine in a hospital emergency service. Usually, patients are referred to a Cardiology consultation. What medication is used to treat heart failure? The medication helps to reduce the symptoms of congestive heart failure and can actually improve the function of the heart muscle. There are several main classes of drugs used to treat weak heart muscle. It will be up to your doctor to choose the appropriate therapy based on the symptoms and whether your heart needs to be strengthened or relaxed. What procedures or surgeries treat heart failure? In severe heart failure, there are devices (such as a pacemaker) that help the heart to pump blood better. In fact, some patients may benefit from the implantation of a special 'pacemaker' system that promotes resynchronization of the contraction, which improves the effectiveness of the contraction of the heart muscle. In some cases, surgical procedures such as myocardial revascularization surgery, percutaneous coronary intervention (or angioplasty) may be performed to treat risk factors and other causes of heart disease. Heart failure prognosis The prognosis for heart failure is highly variable and will depend on adopting a healthy lifestyle, following the indicated therapy and correcting the causes of the disease. Heart failure can become a progressive and eventually fatal condition. This means that the heart muscle will weaken and you will have a harder time keeping up with the workload. The evolution of the disease may, in some situations, justify periods of hospitalization to compensate for the symptoms. Prevention of heart failure Heart failure can be prevented and even reversed. For this it is necessary to follow a healthy lifestyle, maintain physical activity, follow a balanced diet. The Mediterranean diet, rich in vegetables, has been shown to prevent heart failure among people who have suffered a heart attack. Not smoking, not abusing alcoholic beverages and being physically active daily helps to prevent heart failure. It is also important to combat stress through resilience techniques such as yoga or meditation, which can contribute to significantly reduce the risk of many cardiovascular diseases. The treatment of early signs of heart failure and risk factors, such as hypertension (high blood pressure), excess weight or obesity and hardening of the arteries (atherosclerosis) are preventive strategies for heart failure. Regular follow-up in specialized consultations, compliance with recommendations and medication and periodic performance of prescribed tests can also prevent, in many cases, complications from heart failure. More information on heart failure at Heart Failure Matters Meet the cardiology team and book your consultation. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
