Heart Failure: All you need to know

In her latest online article, Dr Anne Griguer gives us her insights into heart failure. She talks about what it is defined as, the symptoms, the causes, treatment and cure.

What is heart failure defined as?

Heart failure is a medical condition characterised by the heart muscle's inability to deliver an adequate supply of blood and oxygen to meet the body's requirements. For the heart to operate properly, it must expel blood into the body's arteries and subsequently refill with blood.

Heart failure can originate from issues with either pumping or filling functions, resulting in two distinct types of heart failure.

1. When the heart muscle becomes weaker, its pumping capability diminishes, leading to reduced ejection fraction and termed as heart failure with reduced ejection fraction. This diminished output of blood and oxygen from the heart negatively impacts overall bodily functions, including muscles, kidneys, gastrointestinal tract, and even the brain.
2. Alternatively, if the heart muscle becomes overly rigid, the pumping function may remain relatively intact, yet the heart struggles to fill with blood, known as heart failure with preserved ejection fraction. Consequently, this situation elevates pressures within the heart, giving rise to the symptoms detailed below.

What are the symptoms of heart failure?

The main symptoms are fatigue and breathlessness upon physical activity. It starts with a reduced capacity to engage in exercise without experiencing breathlessness, followed by a restriction in routine tasks like climbing stairs or bathing. As the condition progresses, individuals might even encounter breathlessness while lying down, leading to nighttime awakenings marked by respiratory distress, necessitating an upright position for relief. This phenomenon arises due to decreased oxygen delivery and the accumulation of fluid within the lungs.

Moreover, fluid retention can manifest in the form of swelling in the ankles and legs, resulting in oedema. This is evidenced by the expansion of the ankles and legs and an unexplained escalation in body weight.

What causes heart failure?

Various components of the heart can give rise to complications leading to heart failure:

The heart arteries: In instances where these arteries become obstructed, triggering a heart attack, the heart muscle might sustain damage and experience a decline in strength.

The heart valves: Impairments can arise if these valves become constricted (valve stenosis) or exhibit leakage (valve regurgitation).

The heart rhythm: Irregular or excessively rapid heart rhythms (heart arrhythmia) can contribute to the onset of heart failure.

The heart muscle itself: The muscle may weaken due to a diverse array of external factors such as viral-induced inflammation (myocarditis), excessive alcohol consumption, medical treatments like chemotherapy or cancer medications, deficiencies in essential vitamins, thyroid malfunctions, or the accumulation of anomalous substances within the heart (amyloid deposits).

In scenarios where no specific cause is identified or when heart issues tend to have a familial pattern, genetic tests can be conducted to detect genetic abnormalities that underlie cardiomyopathy.

Does heart failure come on suddenly?

It depends on the underlying cause. When a heart attack or heart inflammation triggers the condition, symptoms tend to manifest rapidly.

Alternatively, in certain instances, the heart issue may exhibit a gradual progression, with symptoms accumulating over the course of several weeks or months. Younger patients often manage to endure a longer period before receiving a diagnosis, as their active lifestyle and reduced suspicion towards heart problems can delay recognition.

How is heart failure treated?

There are three distinct categories of treatments.

The initial category, referred to as a diuretic or water tablet, serves the purpose of relieving symptoms. Upon ingestion of a diuretic, patients experience increased urine output, which aids in clearing accumulated fluid from both the lungs and legs. Its effect becomes noticeable within a few hours.

However, addressing solely the symptoms without attending to the underlying muscle and causative factors will result in symptom recurrence.

Moving to the second category, there are medications designed to enhance the heart's functionality over the medium to long term. These drugs take effect within a span of 3 months and display notable efficacy. They target and counteract the malfunctioning hormonal systems associated with heart failure (such as adrenaline, angiotensin, aldosterone, etc.). Noteworthy examples of these medications include beta-blockers, ACE inhibitors, and anti-aldosterone agents. Over the past decade, substantial advancements have occurred, introducing two new medications—neurolysin inhibitors and SGLT2 inhibitors—that have proven effective in aiding heart failure patients.

The third treatment category involves addressing the underlying cause itself, when feasible. This may involve actions like replacing a damaged heart valve or curbing excessive alcohol consumption.

Can heart failure be cured?

It depends on the underlying factor. If the root cause of heart failure can be addressed promptly (such as through heart valve replacement, halting irregular heart rhythms, or curbing excessive alcohol intake), there is a possibility that heart failure could be entirely resolved.

However, when a permanent cure for the cause is not attainable, the typical recommendation involves continuous use of heart function medication throughout one's life. Even if heart function experiences improvement due to medication, discontinuing the treatment might lead to a recurrence of symptoms.

Dr Anne Griguer is a highly regarded general and imaging cardiologist with over a decade of experience. You can book and appointment with Dr Griguer on her Top Doctors profile today.