Heart failure occurs as a result of which the heart does not pump enough blood to supply the entire body. Depending on the type of heart failure and its origin, symptoms of the disease will be different. Hence the importance of correctly diagnose what type it is to administer proper treatment.
Heart failure: what is
Heart failure is the result of imbalance between the ability to pump blood by the heart and the body 's needs to stock up on it.
Accordingly, heart failure is mainly produced in two situations:
- When the heart muscle has insufficient pumping, following a disease of the heart valve disease, arrhythmia, cardiomyopathy, (which can be of various origins) and coronary heart disease, mainly.
- The second situation is due to circumstances in which the demand for blood in the body is high even for a healthy heart. These circumstances include: infections, anemia and thyroid diseases, mainly.
Today heart failure is a syndrome that plagues much of the population, especially the elderly segment. This is due, on the one hand, the aging population in the developed which, in turn, is most at risk world and, moreover, the high prevalence of risk factors in today's society, such as: hypertension, diabetes, physical inactivity, obesity, alcohol or smoking, among others.
Types of heart failure
This inadequate heart pumping can proceed right ventricle (right heart failure), the left ventricle (left ventricular failure) or both (biventricular heart failure), as the cause of heart failure. This will cause different symptoms in each case.
There is also a second type of heart failure, when the heart muscle becomes stiff, with difficulty relaxing and properly filled, is called cardiac diastolic function (filling) unlike the aforesaid, systolic heart failure (pumping or expulsion ).
Moreover, heart failure can occur, depending on the cause that triggers two ways, acute and chronic.
Symptoms of heart failure
Symptoms of heart failure depend on whether it is a right heart failure or a left heart failure but eventually patients with left heart failure may also develop right heart failure, then being in a situation of heart failure biventricular.
The main symptom of left heart failure is dyspnea or difficulty breathing. This is due to waterlogging of fluid in the lungs. In an initial phase this difficulty breathing will be presented to make significant efforts and if the disease progresses, it will increasingly appearing before less effort or even at rest. It can also cause the need for sleep built over a pillow or waking up suddenly with feeling of breathlessness or a cough. Other symptoms of heart failure are due to insufficient pumping and consequently to lower blood supply to other organs and systems of the body, causing fatigue, asthenia, renal impairment, with less urine, liver, digestive, cerebral , etc.
Right heart failure in the main symptoms are due to an accumulation of fluid in the venous system, being difficult emptying in the right heart, which involves:
- Swelling (edema) in the feet and ankle
- Swelling in the neck veins (jugular venous distention)
- Enlarged liver (hepatomegaly)
- Retention of fluid in the peritoneal cavity (ascites), in advanced cases
- abdominal swelling
Other symptoms are more urine output overnight, rapid and irregular pulse and often unjustified weight gain, which corresponds to the retained liquid.
How is heart failure diagnosed
The diagnosis of heart failure is based primarily on a thorough interrogation of the patient, inquiring if the symptoms described above as well as discovering the risk factors referred to above. A physical exam also is also required in search of clinical signs aforementioned. With this would be sufficient, in principle, to have a diagnosis of heart failure. However, in Cardiology we have additional tests that will help us confirm the diagnosis, determine the cause and assess the severity of it.
These additional examinations, we have some simple tests initially conducted, such as an electrocardiogram, a chest radiograph and an analytical. Today it is essential to have a Doppler echocardiography, a bloodless and simple technique that will give us information on the state of the heart valves, the size of the cavities, the thickness of its walls or pump function of the heart.
Other possible diagnostic techniques are:
- the stress test, to have information about the deterioration of functional capacity
- Holter monitoring, to determine the presence of heart rhythm disorders
- cardiac catheterization, which allow us to know the state of the coronary arteries, the valve operation and make measurements of pressure within the heart
- cardiac magnetic resonance, with an increasingly important role today.
Prognosis of heart failure
The prognosis of heart failure depends primarily on the cause that originates, whether it is an appropriate and optimal treatment and the time it is diagnosed. If excessive time elapses between the onset of symptoms, establishing cause and initiation of treatment, the prognosis worsens considerably.
Prognosis also directly related to the overall health of the patient, especially by the existence of other concomitant diseases. A very important prognostic factor is the scrupulous monitoring of medication and lifestyle changes that medical advice and control of risk factors that may aggravate the patient's condition. In this sense it is vital to support the patient receives from its environment, especially the family.
Treatments for heart failure
There are many treatments that will come given depending on the cause that caused heart failure.
However, reference must be made, first, to measures of general hygienic-dietary type that every patient must be present, such as weight control, perform a low salt diet, adjust fluid intake to the need patient, physical exercise (as recommended by the cardiologist), getting enough rest, control alcohol consumption or delete it (if so advised), smoking cessation, reduced levels of cholesterol and other fats, control of other concomitant diseases such as diabetes and hypertension, among other measures.
The therapeutic arsenal currently available is multiple, as each case must be identified. Thus we digoxin, diuretics, vasodilators, beta-blockers, aldosterone inhibitors, inotropic agents, etc.
Moreover, depending on the cause responsible for heart failure, the patient may require some type of surgery as a replacement or valve repair, coronary bypass, correction of congenital defects ... or even, in some cases, a heart transplant.
Today more and more patients may benefit from percutaneous treatments that can solve the cause of heart failure, such as coronary angioplasty and stenting , or valvuloplasty. There are also other procedures such as pacemaker implantation devices for ventricular resynchronization and implantable defibrillators.
In conclusion, to underline two aspects:
- the importance of educating and involving the patient and their environment in the knowledge of heart failure signs and symptoms of alarm, need for cardio-healthy habits of life and perform well the prescribed treatment.
- insist on the need to combat cardiovascular risk factors that may increase in the population the incidence of heart failure.