Overview
Heart failure is a medical condition where the heart is unable to pump sufficient blood to meet the body's needs. This can result from weakened heart muscles or structural defects.
Specialties Involved
Heart failure is commonly managed by specialists in cardiology, pediatric cardiology, and thoracic surgery.
Causes of Heart Failure
Heart failure can be caused by several conditions that impair heart function. The most common include:
- Coronary artery disease, which accounts for two-thirds of cases, often leading to heart attacks.
- Cardiomyopathies, including genetic or idiopathic heart muscle diseases and myocarditis caused by viral infections.
- Hypertension (high blood pressure).
- Valvular heart diseases, where the heart valves don't function properly.
Other factors such as chronic alcohol abuse, persistent stress, and tachycardia (rapid heartbeat) can lead to reversible heart failure if treated. Rarely, pregnancy-related heart failure (peripartum cardiomyopathy) can develop.
Symptoms
The hallmark symptom of heart failure is shortness of breath (dyspnea), which worsens with activity or when lying down. In severe cases, it can cause sudden nighttime episodes of breathlessness. Other symptoms include:
- Fatigue and reduced ability to exercise.
- Swelling (edema), typically in the legs and abdomen.
- Coughing, caused by fluid buildup in the lungs.
- Arrhythmias (irregular heartbeats) and sometimes confusion or depression in older patients.
Diagnosis
Diagnosis of heart failure is based on a combination of medical history, physical examination, and several diagnostic tests, such as:
Blood tests: These include tests for anemia, kidney and liver function, and thyroid issues, all of which can contribute to heart failure.
Electrocardiogram (ECG): Detects previous heart attacks, heart enlargement, or arrhythmias.
Chest X-rays: Can reveal heart enlargement or fluid buildup in the lungs.
Echocardiography: This is the most crucial test to evaluate heart structure and function.
Nuclear imaging (SPECT or PET): Used to assess heart muscle damage, particularly after a heart attack.
Treatment
Treatment depends on the severity of the heart failure and its underlying cause. It typically involves a combination of lifestyle changes, medication, and sometimes surgery.
Lifestyle Changes
Patients are advised to adopt a low-sodium diet, quit smoking, limit alcohol, and engage in regular, moderate exercise like walking or cycling.
Medications
Key medications for heart failure include:
- ACE inhibitors or ARBs to reduce blood pressure and heart strain.
- Beta-blockers to slow the heart rate and improve its efficiency.
- Aldosterone antagonists to prevent harmful hormonal effects.
- Diuretics to reduce fluid buildup.
Other medications like digoxin and vasodilators can help relieve symptoms.
Advanced Therapies
In severe cases, patients may require:
- Implantable devices, such as defibrillators to prevent life-threatening arrhythmias.
- Cardiac resynchronization therapy (CRT), where a pacemaker helps the heart's chambers pump in sync.
- In some cases, ventricular assist devices (VADs) or heart transplants are considered for end-stage heart failure.
Complications
Complications of heart failure include arrhythmias, stroke, and organ failure, such as kidney or liver failure, especially in advanced stages. Without intervention, end-stage heart failure often leads to death.
Prognosis
Despite medical advances, heart failure remains a serious condition with a high mortality rate. About half of the patients die within five years of diagnosis.
Prevention
Preventing heart failure involves managing risk factors like high blood pressure, diabetes, and coronary artery disease. Regular checkups, a healthy lifestyle, and early intervention in cardiovascular diseases can reduce the risk of developing heart failure.
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