What is Heart Failure?

When the heart fails as a pump for blood, this condition is known as heart failure. In this condition, the heart fails as a pump for the blood flow needed to the body organs. The supply for oxygen and nutrients and the clearing up of toxic substances from the organs is reduced, leading to organ damage.

Types of Heart Failure

Depending on the type of failure

1. Systolic failure: in which the heart can’t maintain the systolic blood pressure due to the decreased power of the heart muscle to contract.
2. Diastolic failure: in which the heart fails to dilate properly. The heart needs to do so for the efficient filling of the heart with blood so that it can later generate enough pressures to pump it forward.

Depending on the side of failure

1. Right-sided heart-failure: when the right side of the heart fails to pump the deoxygenated blood collected from the body tissues to the lungs for the purpose of oxygenation.
2. Left-sided heart failure: the left side of the heart fails to pump the oxygenated blood to the body tissues.

What causes Heart Failure?

Numerous factors lead to congestive heart failure and other types of heart failure

1. Myocardial infarction, which is an injury to the cardiac muscle. When the oxygen and nutrient supply to the heart itself is not adequate as in coronary artery disease¹, the heart muscle tissue can’t generate enough energy to work as an efficient pump leading to lethargic heart muscle activity.
2. Heart valve disease; in this condition, the heart valves are either hardened, prolapsed, regurgitating, etc. causing more input then the output gradually leading to failure.
3. Congenital heart diseases like Atrial septal defects, ventricular septal defects, causing mixing of the blood leading to decreased efficiency of the heart as a pump.
4. Cardiac muscle disease/inflammation (myocarditis) this condition is caused by any kind of injury to the heart muscle causing inflamed tissue leading to inefficient pumping.
5. High blood pressure (hypertension): hypertension is known as a silent killer. This condition damages the vessels leading to thickening of the vessels so the heart can’t pump the blood in the forward direction due to increased resistance, this causes pressure and stress on the heart muscle plus overload on the heart gradually leading to failure.
6. Alcohol and other drugs: these chemicals cause direct and indirect injury to the heart muscle leading to heart failure.
7. Lung diseases: Conditions like this lead to less oxygen of blood, due to which the oxygen supply to the heart itself and other organs causes direct damage to the tissue.

Heart-failure Symptoms

The congestive heart failure symptoms are based on where and when the heart-failure has occurred:

The left-sided heart-failure symptoms include:

• Increased respiratory rate
• Shortness of breath which is in early stages more on lying down on the bed and then in the late stages even in standing. It is aggravated with any kind of exercise.
• Bluish discoloration of the skin
• Pale skin
• Cough
• Wheezing
• Fatigue
• Difficulty concentrating
• Increased heart rate

The right-sided heart-failure symptoms include:

• Puffy and swollen face and eyes
• Visibly pulsatile veins in the neck
• Pulsatile liver²
• Distended abdomen
• Generalized body swelling

Treatment

Once the patient develops cardiac failure, he needs to be on the treatment lifelong. It starts with changing the daily lifestyle of the patient like completely ignoring drugs/smoking, restraining from strenuous exercise, no excessive fluid intake, restraining added salt, eating low cholesterol diet, sleeping with the head propped up at 25 to 35 degrees.

The medications include:

• ACE (Angiotensin converting enzyme) inhibitors

These drugs are nowadays used as first-line agents for the treatment of cardiac failure. These drugs decrease the overload of fluid on the heart; they also decrease the resistance in the vessels leading to easier pumping of blood by the heart. The most common side effect perhaps is a cough due to which poor compliance can occur. Some of the examples include Enalapril, lisinopril, and captopril.

• Angiotensin 2 receptor blockers

These drugs may be used as an alternative to ACE inhibitors for those who can’t tolerate the side effects of ACE inhibitors (i.e., cough). Some of the examples include losartan, Arbisartan, Valsartan.

• Beta-blockers

These drugs are mainly used for the treatment of tachycardia and as an adjunctive drug in the treatment of hypertension. These drugs are known for their good effects on lowering the pathologic remodeling of the heart due to hypertension and other diseases. They are classified further as selective (having their effects only on the heart) and nonselective beta blockers (having their effects on the heart and respiratory system). Some of the examples include propranolol (nonselective), misprolol atenolol esmolol (selective).

• Diuretics

These drugs increase the flow of fluids from the body into urine decreased the fluid overload thus decreasing the swelling and improving the symptoms and signs of the patient. They are commonly known as water pills. These, along with water, also excrete potassium and magnesium thus leading to sometimes dangerously provoked cardiac arrhythmias occurring due to hyperkalemia (decreased levels of potassium in the blood). So, they are prescribed along with potassium and magnesium supplements. Some of the commonly used drugs like Lasix (furosemide) belong to this category.

• Digoxin

This drug is commonly used for the treatment of arrhythmias. This drug increases the power of the muscle of heart to pump and also slows down the heart rate. The known side effect of digoxin is hyperkalemia which can also provoke arrhythmias which can even kill the patient.

• Inotropic agents

These drugs also increase the power of the heart muscle to pump more blood to the tissues, and they also have their effects on blood pressure.

• Aldosterone antagonists

These drugs decrease the fluid in the body which is causing overload on the heart. They work by increasing the urine production thus eliminating excess water and salts. Some of the examples include spironolactone also known as Aldactone.

References:

1. NIH - Coronary Heart Disease
2. BMJ Best Practice - Tricuspid Regurgitation