In case of heart failure (HF), the pumping function of the heart has been reduced. The heart compensates for the reduced pumping function by working harder or creating additional muscles. At a given moment, this doesn’t work anymore and symptoms occur, such as fatigue and shortness of breath. Heart failure is usually a chronic condition that gradually worsens. Sometimes, heart failure can occur suddenly.
Cause
Heart failure has several causes. Known causes are, for example:
- Previous heart attack. Since a part of the heart has died, the heart works less well in future.
- High blood pressure for years. In case of high blood pressure, the heart must work harder than normal. This can make the cardiac muscle getting stiffer, so blood is pumped around less well.
- Heart valve problems.
- Infection to the cardiac muscle or the heart.
- Congenital heart defect.
- Enlarged heart.
- A history of cardiovascular diseases or diabetes.
- Smokers are at higher risk.
Symptoms
The symptoms of heart failure are caused by lack of oxygen on the one hand and high blood pressure in the lungs on the other hand. Because the heart doesn’t pump the blood fast enough into the body and the supply of blood continues coming from the veins and the lungs, the blood pressure in the veins and in the lungs becomes too high. As a result, moisture ends up outside the bloodstream. And this may cause swelling in legs and feet. Moisture can also get behind the lungs, causing shortness of breath.
Examples of signs and symptoms that may indicate heart failure include:
- Fatigue.
- Shortness of breath.
- Confusion.
- Memory problems.
- Swollen feet or legs.
- Decreased appetite.
- Sleeping problems.
- Coughing.
- Peeing a lot at night.
Diagnosis
The diagnosis of heart failure can often be made on the basis of the symptoms and the patient’s history. The doctor listens with a stethoscope for indications of valve defects or moisture in the lungs. The doctor watches further whether the patient retains fluid in the legs and if the liver is swollen.
To confirm the diagnosis, further examination must take place, such as electrocardiography, thorax X-ray, ultrasound, stress test, angiography, MRI scan, nuclear examination and CT scan of the coronary arteries.
Treatment
In case of heart failure, two types of medications are usually prescribed: diuretic drugs and drugs that increase the pumping force and relieve the heart as much as possible. The patient must take them throughout life. These are the following medications:
- ACE inhibitors: lower blood pressure.
- Beta blockers: ensure the heart beating slower and more powerful.
- Blood thinners: prevent the development of clots in blood vessels and the heart.
- Diuretic tablets: help to get rid of excess moisture.
When medication and adjustment of lifestyle don’t help to get heart failure under control, surgery may be necessary. The following methods of operation are possible:
- Implanting a pacemaker or ICD. These devices are placed under the pectoral muscle by means of a small intervention. A pacemaker sends electrical impulses to the heart and causes the heart to contract regularly. An internal defibrillator (ICD) sends an electrical shock to the heart at the moment a serious cardiac rhythm disorder occurs.
- The heart defect, causing the heart failure, can sometimes be corrected by heart surgery. Possible operations are: the repair or replacement of heart valves, the application of a mechanical pump that supports the function of the ventricles (support heart), interventions on narrowed coronary arteries, such as angioplasty, placement of a stent or bypass surgery or the repair of congenital heart defects, such as a hole in the wall between both heart halves. In very rare cases, a heart transplant may be a final option.
Prognosis
The long-term prospects are usually pretty bad. If the cause cannot be treated, life expectancy is statistically only a few years. Treatment with medications leads to a reduction of symptoms and a delay of the progression of the disease, but can never completely cure the patient.
Considerations
- Get sufficient exercise.
- Overweight is an extra burden on the heart. Eat healthy.
- Check whether no moisture is retained.
- Be very careful with salt, because salt causes the body to retain extra moisture.
- Don’t drink more than 2.5 liters of fluid a day (in case of severe heart failure up to 1.5 to 2 liters a day).
- Limit alcohol consumption to one or two glasses a day.
- Quit smoking. Smoking reduces blood flow through the cardiac muscle.
- Polyunsaturated fatty acids seem to reduce the risk of severe heart failure. Eat preferably fatty fish, such as mackerel, salmon or herring twice a week.
- Sex is allowed, but do it easily when it takes a lot of effort.
- Air travelling is allowed, but watch out when mild symptoms remain, even with medications.
- If the patient is already short of breath while sitting in a chair, driving a car is not allowed.
