Definition

The heart is a vital organ in the human circulatory system. It is made up of four chambers: the right atrium, left atrium, right ventricle, and left ventricle. The ventricles act as the heart's main pumping chambers and have thicker muscular walls compared to the atria. These chambers are divided by heart valves that prevent the blood from flowing backward.

Heart failure occurs when the heart muscle fails to pump blood efficiently. This results in blood accumulation, potentially causing it to flow back into the lungs, a condition known as congestive heart failure. "Congestion" signifies accumulation or buildup.

Heart failure does not imply a total failure of the heart's pumping ability. Instead, the heart continues circulating blood throughout the body, albeit less effectively than in a healthy individual. This condition predominantly affects the elderly and those with a history of heart disease.

Causes

Several conditions can damage or weaken the heart, leading to heart failure:

• Coronary artery disease and heart attack: The most common causes of heart failure, coronary artery disease results from fat accumulation in coronary arteries, obstructing blood flow and potentially leading to a heart attack.
• High blood pressure: Chronic high blood pressure forces the heart to work harder, eventually leading to stiff or weak heart muscles.
• Heart muscle damage: This can result from infections, inflammation, excessive alcohol consumption, and certain toxic medications.
• Congenital heart defects: These defects in the heart's chambers or valves cause the heart to work harder to pump blood.
• Other diseases: Long-term conditions such as diabetes, HIV, and thyroid disorders can lead to heart failure.

Risk factor

Several factors increase the risk of developing heart failure, often combining to amplify the risk:

• Coronary artery disease: This condition blocks blood supply to the heart, weakening the heart muscle.
• Heart attack: A sudden coronary artery disease event that damages heart muscle tissue.
• High blood pressure: Causes the heart to overwork, leading to heart failure.
• Congenital heart defects: Structural heart imperfections present at birth.
• Diabetes: Raises the risk of high blood pressure and coronary artery disease, both of which can lead to heart failure.
• Obesity: Significantly heightens the risk of heart failure.
• Smoking: Increases the risk of heart disease and heart failure.
• Alcohol consumption: Excessive intake weakens the heart muscle, potentially causing heart failure.
• Certain medications: These include anti-inflammatory drugs, anesthetics, hypertension drugs, medications for pulmonary and urinary disorders, and infection treatments.

Symptoms

Three primary symptoms characterize heart failure:

• Shortness of breath during activity or rest
• Persistent fatigue and feeling excessively tired during physical exertion
• Swelling in the abdomen, legs, and ankles

Additional symptoms include:

• Rapid and irregular heartbeat
• Dry cough
• Bloating, loss of appetite, and nausea
• Increased nighttime urination
• Weight gain

Symptoms may appear suddenly or gradually over weeks to months, worsening as heart failure progresses.

Diagnosis

Medical History To diagnose heart failure, your doctor will inquire about your symptoms, medical history, medication usage, lifestyle, and any factors related to heart failure. They will also check for risk factors such as high blood pressure, coronary artery disease, and diabetes.

Physical Examination During a physical exam, the doctor will listen to your lungs for fluid buildup and check your heart with a stethoscope for abnormal sounds indicative of heart failure. They will also examine the neck veins for fluid accumulation in the abdomen and legs.

Diagnostic Tests Following a physical exam, additional tests may include:

• Blood tests to detect conditions affecting the heart.
• Chest X-rays to assess lung and heart conditions.
• CT scans or MRI for detailed heart imaging, with MRI providing superior, albeit costlier, results.
• Electrocardiogram (EKG) to record heart signals and evaluate heart function.
• Stress tests to measure heart health during activity.
• Coronary angiogram using a flexible tube to examine coronary blood vessels.

Management

Heart failure is a chronic condition requiring lifelong treatment. However, proper treatment can alleviate symptoms and strengthen the heart. The doctor will address the underlying causes, such as congenital heart defects, potentially requiring surgery. Most heart failure patients need medication management, sometimes combined with devices to aid heart function.

Complications

Heart failure complications vary based on severity and age, including:

• Kidney damage or failure: Reduced blood flow to the kidneys can cause kidney failure if untreated.
• Liver damage: Fluid buildup from heart failure increases liver pressure, impairing its function.
• Heart valve issues: Heart enlargement from increased workload can damage valves, disrupting blood flow direction and mixing between heart chambers.

Prevention

Preventing heart failure hinges on adopting a healthier lifestyle and adhering to prescribed medications. Quitting smoking, managing high blood pressure and diabetes, eating a healthy diet, maintaining normal weight, staying physically active, and learning stress management techniques can significantly reduce heart failure risk.

When to see a doctor?

Consult your doctor if you experience persistent or worsening heart failure symptoms.

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