HEART FAILURE

Heart failure is a chronic degenerative disease that affects your heart’s ability to pump enough blood to meet your body’s needs efficiently. This means that the blood cannot carry enough oxygen, as well as the nutrients necessary for your body to work normally.

Heart failure can be caused by current or past diseases such as coronary disease, heart attack or high blood pressure that have damaged and forced your heart into working harder than usual.

One of the main effects of heart failure are fatigue as a result of your heart’s inability to pump enough blood to the rest of your body. Secondly, it causes blood to be withheld, waiting to go into your heart. This blood accumulation can cause fluid to find a way out through your blood vessels and into the surrounding tissue (lungs and abdomen) and your lungs to congest.

Heart failure can appear at any age, but chances it appears increase with age.

Nowadays, it is estimated that more than 26 million people in the world suffer from heart failure; each year 1 million new cases are diagnosed and this disease is considered the cause of death for 50 thousand people during that same period.


Types And Stages Of Heart Failure


There are two main types of heart failure:

  • Chronic heart failure. Symptoms disappear gradually but tend to worsen over time. This is the most common type of heart failure.
  • Acute heart failure. Symptoms appear suddenly and are serious at the beginning, but patients improve rapidly if they follow proper medical treatment.

As to the disease stages, the New York Heart Association has identified four clearly delimited classifications:

  • Class I. The patient has no limitations and can perform normal physical activities without fatigue or shortness of breath (dyspnea).
  • Class II. The patient experiences MILD limitation of physical activity. At rest, the patient feels no discomfort, but normal physical activities result in shortness of breath.
  • Class III. The patient experiences MODERATE limitation of physical activity. At rest, the patient feels no discomfort, but some physical activities such as taking a shower or dressing up result in shortness breath.
  • Class IV. The patient experiences SEVERE limitation of physical activity. The patient feels discomfort even at rest and is unable to carry on any physical activity.

In the end, your doctor is the only person who can determine the type and class of heart failure you present in case you suffer from this disease.


Symptoms


A person who suffers from heart failure can present symptoms that can vary from dyspnea (shortness of breath), weight gain as a result of fluid retention, to fatigue or exhaustion and fast heart rate (tachycardia). Symptoms occur due to two main reasons:

  • Fluid accumulation or retention in the body
  • Lack of blood flow in the body

Other symptoms derived from fluid retention in the body can be weight gain and swollen ankles, thighs and abdomen. In order to counteract these effects, your doctor may prescribe you reduce your intake of fluids or start taking diuretics.

Whenever there is lack of blood flow in the body, the following symptoms appear: exhaustion or fatigue, and dizziness. This happens because the person lacks nutrients in their body and oxygen in their muscles (hence the fatigue) as a result of the heart failure’s reduction of the heart’s ability to pump blood. The patient also presents low blood pressure resulting in dizziness, and their heart rate accelerates as the heart tries to compensate lack of blood flow with a quicker beat.

Actually, symptoms respond greatly to the type of heart failure of the patient (chronic or acute), and they can vary from patient to patient. As a result, it is important that the patient is alert to the appearance of such discomfort and notifies their doctor in case any anomaly or new symptom is detected.

Detection

It is important to highlight that only specialized doctors can diagnose you with heart failure or not, and the type and class you’re in. In order to do this, first your doctor has to assess your clinical history by asking several questions regarding your lifestyle, family history and current or past diseases. The more honest your answers are, the more accurate your diagnosis will be.

Later, you will go through a physical examination to check your blood pressure, lungs and heart in order to verify that no abnormal sounds exist. You will also have your legs and abdomen checked in order to detect any indication of swelling.

Lastly, your doctor may carry out other more specific tests at their office such as a chest X-ray and stress tests:

Electrocardiogram EKG, which consists in attaching several patches on different parts of your body, such as the chest and wrists, and then plugging them to a machine that detects the rhythm and electrical activity of your heart. Thanks to this test, your doctor will be able to identify if your heart has been subjected to extra strain (volume or pressure). Your doctor might also ask you to carry a small device with you for some time (24 hrs.) in order to register your heart’s activity during normal physical activities.


Echocardiography, which helps your doctor see your heart in an image (heart ultrasound) and provides valuable information on the structure and size of your heart, its valves and activity. In order to carry out this test, your doctor might ask you to take a stress test before and/or after the echocardiography to compare the condition of your heart both during rest and any physical activity.



Treatment


Based on the diagnosis, your doctor might choose among the following treatment options:

Medication.

Not all patients suffering from heart failure have to take every medication available to control this disease. Your doctor will prescribe the medication deemed appropriate for you to take based on the symptoms your body presents, your overall medical condition and even your normal habits in general.

Among the most common drugs designed to treat heart failure are the following:

Angiogestin-converting enzyme inhibitors (ACEI). These inhibitors block the effects of the angiogestin II hormone produced in the kidneys. ACEIs relax blood vessels, which causes a decrease in blood pressure and your heart’s pumping to normalize.


Angiogestin II receptor antagonists (ARB). They practically have the same function as ACE inhibitors: they relax blood vessels by controlling angiogestin. However, since ARB’s tend to be the highest in cost, they are only prescribed to patients who can’t tolerate ACEIs.


Aldosterone receptor antagonists. These substances block the effects of aldosterone, a hormone produced in the adrenal glands which worsens the level of heart failure in patients. Among the effects of these drugs, we can find arterial congestion and a decrease in blood pressure, which is why the heart is protected against any type of complication that might arise.


Beta blockers. Beta blockers stabilize your heart’s ability to pump by slowing down your heart rate and decreasing blood pressure.


Digitalis. Digoxin is the most famous digitalis. It decreases fluid retention in the heart, thus preventing any future swelling or edema. Besides, it is useful to decrease an accelerated heart rate in patients.


Statins. These drugs are used to counteract coronary disease as they prevent any plaque or cholesterol accumulation in the arteries.


Medications to treat acute heart failure. These drugs, in particular, increase your heart’s short-term performance by dilating blood vessels and allowing your heart to slow down. Generally, these medications are administered under intensive care.


Since people suffering heart failure are patients who need medication for the rest of their lives, it is important that you always ask and tell your doctor about any concern you might have regarding your treatment. It is likely that you also require more than one medication at a time, which means that monitoring them is of utmost importance to ensure your treatment succeeds. Below, we share a table that can help you accomplish this task


Medication Dosage Time Comments/Special Recommendations

Surgery

There will be times when medication is not enough to treat heart failure and it will be necessary to consider heart surgery. This refers to highly specific situations, in which only the doctor can decide if the patient is a suitable candidate to undergo a surgical procedure. Nowadays, three types of surgical procedures are carried out that, despite entailing certain risks, are performed more regularly thanks to current medical advancements.

Coronary revascularization surgery.
The purpose of this surgery is to facilitate blood flow by manipulating the blocked artery (ies) in order to stabilize your heart’s activity.

Valve replacement surgery.
During this surgery, the doctor removes the heart’s damaged valve and replaces it with an artificial valve—metal or plastic—or with a human or animal tissue valve. The new valve reestablishes blood flow towards the heart.


Cardiac transplant surgery.
Once all option treatments for heart failure have been exhausted but the patient still has a good health condition, the doctor might suggest a heart transplant which improves the quality of life and extends life expectancy of the patient. However, transplant surgery leads to an important decision on behalf of the patient and the patient’s family. They must be well advised at all times by the medical team and the patient must undergo several medical tests to determine if they are a suitable candidate or not; this adds to the amount of time the patient has to wait before receiving and ideal donor’s heart.



Devices

Thanks to medical advancements, nowadays there is a great variety of medical devices that improve heart activity. These devices send out small painless electrical signals that stabilize your heart rate.

Among their benefits, we can find that they not only alleviate heart failure symptoms but also increase the patient’s life expectancy over time. Also, some devices have been designed to send out clinical data directly to the treating physician. This way, the doctor can detect more easily any sign of improvement or worsening in the patient.

Pacemaker.
A pacemaker consists of a small metallic device implanted under the skin that causes no discomfort to the patient and that monitors the patient’s heart rate. Also, when necessary, the pacemaker helps the heartbeat, through small electrical impulses received on the heart’s right side.


Automatic Implantable Cardioverter Defibrillator (AICD).
An AICD is similar to a pacemaker in size and function; however, this device is programmed to raise its electrical shocks when it detects a life-threatening change in the heart’s rhythm: serious (cardioversion) or very serious (defibrillation).


Cardiac Resynchronization Therapy (CRT).
Just like the previous devices, this treatment also stabilizes heart rate using electrical impulses, but this one specifically also acts on the left side of the heart—unlike pacemakers that only serve one side—thus holistically improving its ability and function.


Some Questions To Ask Your Doctor


Below you will find a series of suggested questions you might want to ask your doctor

  • What are the side effects of the medication I’m taking?
  • Whom should I contact in case I experience some side effects?
  • Will I need a new prescription? How often?
  • How can I know if I’m a suitable candidate for a heart transplant?
  • What are the risks of transplant surgery?
  • What would my lifestyle be after surgery?
  • How can I know if I’m a suitable candidate for a medical device and what’s the ideal one for me?
  • Are there any harmful effects to using any of these devices?
  • Once the device is implanted, how often should I make an appointment to verify its condition?
  • Should I take any other medication apart from the device treatment?

Living With Heart Failure


Since heart failure is a chronic disease that depends on a long-term treatment, patients suffering heart failure must be willing to change their habits in order to enable this medical treatment be successful. Below, we share some tips that will help you cope with the treatment:


  • Restrict salt, fat and excess alcohol intake.
  • Some patients consider exercising to be harmful for patients with heart failure; however, if you practice moderate exercise—such as walking—your body fills with oxygen and energy, which improves your heart’s ability to pump. It is highly advisable that any type of exercise is suggested/overseen by your doctor.
  • Closely monitor the medication prescribed by your doctor. You can rely on the table we previously showed you in the Medication section.
  • Learn to check your blood pressure and to manually check your heart rate in order to closely monitor your treatment’s progress.
  • Implement energy-saving techniques, which will allow you to perform more daily activities such as working or even have sexual relations with your partner. You may implement the following techniques, although it is always advisable to ask directly to your doctor about what you can or cannot do:
    • During the day, when you are working, take small breaks.
    • It is advisable to not make sudden moves. Move slowly and smoothly to avoid fatigue.
    • Avoid performing any type of activity right after you’ve had a meal or when you feel too cold or too hot.
    • Do not perform activities that demand excessive effort from you.

Tips For Carers

In all medical treatments, patients find valuable support in their family and friends. They must be understanding and provide enough care to help the patient cope with the many changes the treatment makes to their lives—difficulty to carry out daily activities due to fatigue or shortness of breath and even getting used to taking several medications a day and making changes to their diet.

If you are a relative or a friend of a patient with heart failure, these tips might be useful to you:

  • Support the patient by planning how and when they must take their medication.
  • When you attend medical appointments with the patient, you can also write down any of the doctor’s recommendations in a special notebook and make questions about the treatment.
  • Regarding any change in the patient’s diet plan, you can implement some of the doctor’s recommendations—like cooking using less salt or less oil—with the rest of the family. You can also cook without any salt and then let each family member season to taste.
  • Encourage the patient to be active without exceeding their limits as it is proven that moderate exercise decreases discomfort and increases energy levels in the body.
  • If the patient becomes tired of carrying out daily activities—like taking a shower or dressing up—make sure they get some rest before resuming activities.

Patient Groups


In many countries, there are support groups attended by people who suffer from heart failure, and patients find in these groups a place to share their concerns and experiences regarding their treatment. In these groups, for example, a transplant patient can share their experience with another patient who is considering getting a transplant or patients can share their opinion or experience regarding a medical device or medication.

The dynamic created in these patient groups is very rich and some people claim it is a great tool to cope with the emotional burden that any medical treatment for a chronic disease entails.




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