Heart Failure: What is it?

Heart failure is defined as a failure of the heart to pump enough blood to meet body requirements. It is a Syndrome that is common in elderly but can occur in young people and children. Heart failure in children occur soon after birth, mostly due to congenital Heart Diseases.

There are many causes and risk factors that predispose one to Heart failure which will be mentioned here, many of them can be prevented or treated before they cause the heart to fail. Treatment of heart failure depends mainly on the causes, once the cause is identified and treated, the symptoms resolve, but if the problem/cause is in the heart itself ( like in the case of Myocardial infarction) ,then treatment options include Heart Transplant.

How Human Heart Works

Before understanding how the human Heart fails to perform its duties, it is important to first understand how it works under normal circumstances. The Human Heart basically has four main chambers which pump the blood, there are one way valves that divide chambers which ensure that blood flows in one direction only.

The cambers are: the Right Atrium which receives blood from the body and pumps it into the Right Ventricle (2nd chamber), the two chambers are divided by a one way valve (Tricuspid Valve). From there the blood is pushed into the lungs to receive Oxygen, then it returns into the heart to the Left Atrium (3rd chamber) which pumps blood to the Left Ventricle (4th chamber). The left ventricle pumps blood into the rest of the Body. Look at the diagram below which shows what is explained here.

Anatomy of the Human Heart
Heart anatomy. Source:wikimedia.

When a person has Heart Failure it is either because the right side of the heart is failing to pump blood efficiently to the lungs or the left side is failing to push blood to the rest of the body. This is why some people have a diagnosis of Right Heart Failure (RHF) or Left Heart Failure (LHF).

Causes of Heart Failure

There are many causes of Heart failure, some are in the heart itself and some are due to an illness elsewhere in the body. Below is a list of Heart failure causes:

  • Hypertension
  • Myocardial infarction (Heart attack)
  • Cardiac Arrhythmias
  • Heart Valve Disease such as Regurgitation or stenosis
  • Cardiomyopapthy

Other important causes of Heart Failure are:

  • Anaemia
  • Pregnancy
  • Vitamin B1 (Thiamine) deficiency
  • Pulmonary Embolism
  • Obesity
  • Alcohol abuse
  • pregnancy
  • Thyroid disorders e.g. Hypothyroidism

Classification of Heart failure

Heart Failure can be classified in three ways:

It is based on one of the above classifications in which a treatment plan is made for each individual.

  1. By Side affected: as mentioned above, there is Right Heart failure and Left Heart failure
  2. Duration of symptoms: here we have Acute Heart Failure in which symptoms develop over few days or weeks and Chronic Heart Failure where symptoms take longer to develop.
  3. Echocardiogram findings: after an echo a person may be diagnosed with Heart failure with Reduced Ejection Fraction (HFrEF), Heart Failure with Preserved Ejection fraction (HFpEF) or Heart Failure with Midrange Ejection Fraction (HFmrEF). For more information on Echocardiograph, Read Here.

Signs and Symptoms of Heart failure

Depending on the type of Heart failure and the cause of it, symptoms and signs can develop very quickly over few days or slowly over weeks. The most common signs that the heart is not working efficiently are:

  1. Shortness of breath: this can happen either when lying flat or walking up stairs. Some people may need more than one pillow to sleep comfortable
  2. Leg swelling: painless swelling of the lower limbs (legs) is very common due to the heart failing to move blood in the veins effectively, the swelling is present during the day after walking or standing for some time, it disappears when waking up in the morning.
  3. Abdominal Swelling: some people when Heart failure is severe have stomach bloating and Ascites (accumulation of fluid in the abdominal cavity)
  4. Cough : a cough with clear or frothy, sometimes pinkish phlegm is common due to fluid accumulation in the lungs
  5. Fatigue: because the Heart cannot pump enough blood to the vital body organs, the person might get tired without doing any work
  6. Dizziness
  7. Chest pains
  8. Headaches

Most people have more than one of the above mentioned symptoms, they may also have other signs which point to the cause of Heart failure, for presence of High Blood Pressure on top of the signs may mean that Hypertension is the likely culprit.

New York Heart Association Classification

New York Heart Association (NYHA) classification of heart failure severity by symptoms is helpful in detecting how bad the situation is:

INo shortness of breath when doing ordinary activities
IIComfortable at rest, cannot do small activities
IIICannot walk do small activities like wearing clothes
VShortness of breath even at rest

A full examination by a Medical Doctor or Qualified clinician is always necessary to Diagnose Heart Failure. This is because additional tests are also needed before a diagnosis is made. Further tests to Diagnose Heart failure include: Chest X-ray, ECG, Echo and Blood tests like BNP.

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