Heart failure

Heart failure means that heart is not able adequately pump blood around body. Heart failure is a serious condition but it does not mean cardiac arrest or that heart completely ‘failed’; it is rather that the heart does not work well enough to meet the demands of the body organ. Heart failure is caused by either weakness or abnormal stiffness of the heart muscle. Heart failure is more common in elderly people and its prevalence is increasing due to aging population.

Causes of heart failure

Coronary artery disease (CAD) and heart attack leading to damage to the heart muscle is one of the important and most common causes of heart failure. Other causes include dilated cardiomyopathy (enlarged and weakened heart with normal coronary arteries), hypertension (high blood pressure), heart valve disease, myocarditis (infection of the heart muscle) and arrhythmias (heart rhythm disturbances).

Acute heart failure appears suddenly as a result of new onset problem, chronic heart failure develops gradually over period of time. Heart failure can be effectively controlled and the right treatment enables many affected patients to lead normal life.

Symptoms of heart failure

Symptoms of heart failure may appear slowly with gradually increasing tiredness, breathlessness and reduced exercise tolerance. Later symptoms and signs include necessity to sleep on incline, waking from sleep at night due to breathlessness and swollen legs. The symptoms may progress from onset at strenuous exertion up to problems on even mild exercise or ultimately at rest.

Heart failure can be classified depending on contactility (pumping function) of the left ventricle:

  • Heart failure with reduced ejection fraction (HFREF) - left ventricular systolic dysfunction; left ventricle (LV, the main cardiac pumping chamber) is enlarged and weak so that it cannot pump properly. Ejection fraction (EF) is a parameter summarizing the contractility of LV.
  • Heart failure with preserved ejection fraction (HFPEF) where heart chambers do not fill adequately due to increased stiffness of the heart muscle.

The diagnosis of heart faire and its subtype is based on clinical examination, history, ECG, BNP (brain natriuretic peptide, a special blood test) and echo (heart ultrasound).

Treatment of heart failure

Heart failure can be treated with lifestyle measures, combination of medicines, including beta blockers, ACE inhibitors, diuretics (furosemide, bumetanide), eplerenone, digoxin; devices (biventricular pacemaker, CRT = cardiac resynchronization therapy and implantable cardioverter defibrillator, ICD) and ultimately in some cases with heart transplantation.