Understanding the roots of heart failure

It can sound quite resolute as a term and is not normally curable, but heart failure is manageable with the right treatment, accommodations, and vigilance, people with heart failure can live rich, long lives. Professor Amitava Banerjee, a distinguished cardiologist, shares his expertise about the causes, symptoms, and prognosis for heart failure.

What is heart failure?

Heart failure is a condition where the heart is not strong enough to keep up with the demands of the body. This means that the body and organs do not receive the oxygen needed to function, as the heart is responsible for transporting oxygen throughout the body via the blood it pumps, and if the heart is unable to fulfil that purpose, then the body will eventually shut down.

The heart may try to compensate by stretching and contracting more so that the blood pumps with more force, increasing in muscle mass to improve its stamina, and beating faster so that the blood cycles more rapidly through the body.

Alternatively, the body will also try to compensate by narrowing the blood cells so pressure stays consistent, or the kidneys retain more salt and water, rather than having it pass with urine in order to increase the volume of blood.

Heart failure most often occurs in adults over 65 years old, as time wears down the heart, but children and infants can also have this condition, likely from a heart defect that they were born with, known as congenital heart disease. 

What are the symptoms of heart failure?

The symptoms of heart failure are:

• breathlessness
• chronic fatigue and inability to maintain physical activity
• dizziness and fainting
• swelling of the legs
• palpitating heart
• chest pain

What the causes of heart failure?

Heart failure can come about due to an accumulation of issues with the heart, such as:

• coronary heart disease, where there is an obstruction in the arteries from a build-up of fatty substances
• high blood pressure (hypertension)
• cardiomyopathy
• arrhythmias
• obesity
• anaemia
• hyperthyroidism, which causes palpitations
• diabetes
• abuse of substances like alcohol, tobacco, and recreational drugs

How is heart failure diagnosed and treated?

To be diagnosed with heart failure, a doctor will conduct a physical exam and consider the patient’s lifestyle, substance use, previous medical history, and family history. They may investigate further with blood tests and a cardiopulmonary exercise test (CPET) to assess the performance of the heart and the levels of oxygen in the body. Previous chemotherapy or radiotherapy treatments can be involved in causing heart failure, as well.

There are four stages of heart failure:

1. Stage A (pre-heart failure) means that the patient is at risk of developing heart failure due to their family history of heart failure or for having a pre-existing condition such as diabetes or hypertension. The patient should take care to reduce their risk factors where possible by regularly exercising and eating healthily, for example.
2. Stage B (pre-heart failure) means that the doctor has detected that the left ventricle, which is the side that receives the blood from the lungs and sends it through the rest of the body, may be underperforming or abnormally structured but there are no further symptoms of heart failure. Treatment would be to continue the treatments from Stage A, medications like beta-blockers or angiotensin-converting enzyme inhibitors (ACE-I), and interventional surgery if needed, such as coronary bypass surgery.
3. Stage C (active heart failure) is when there is a diagnosis of heart failure and the patient is exhibiting symptoms but is still treatable. Treatment options include more intensive medications and weight tracking, possibly a pacemaker, in addition to the precautions from Stages A and B.
4. Stage D is when the patient is exhibiting advanced symptoms which cannot be treated, but can be slowed down by continuing with the treatments from Stages A, B, and C.

If you believe you are at risk for heart failure and would like an assessment, Professor Amitava Banerjee is available for consultation via his Top Doctors profile.