Heart Failure

Most people who develop heart failure have a prior heart condition. Common conditions that lead to heart failure include:

1. Heart Conditions

• Coronary Artery Disease: A build-up of plaque in the arteries, narrowing blood vessels and restricting blood flow to the heart.
• Heart Attack: Reduces blood flow to the heart, impairing its ability to pump.
• Cardiomyopathy: Diseases that damage the heart muscle, affecting its function and structure.
• Valvular Heart Disease: Often caused by rheumatic fever, permanently damaging heart valves.
• Hypertension: High blood pressure causes the heart to work harder, increasing the risk of heart failure.
• Atrial Fibrillation (AF): Irregular heart rhythms that strain the heart.
• Congenital Heart Defects: Rare conditions present at birth that can affect heart function.

2. Non-Modifiable Factors

• Age: The risk increases with age as heart muscles weaken and blood vessels become stiffer.
• Gender: Women are more likely to develop heart failure due to hypertension, while men are more affected by coronary artery disease.
• Race/Ethnicity: Heart failure is more prevalent among younger black individuals, particularly men, and people of Hispanic origin.
• Genetic Factors: A family history of heart disease can increase the risk of heart failure.

3. Modifiable Factors

• Diabetes
• Sleep Apnea
• Obesity
• Anemia
• Infections
• Lifestyle factors like smoking.

Blood Tests

• Serum Electrolytes: These tests identify imbalances that can indicate the severity of heart failure or the impact of medications.
• Random Blood Sugar: Helps identify diabetes, which is a key risk factor for heart failure.
• Serum Creatinine: Assesses kidney function, which may be compromised in individuals with heart failure.
• Serum Albumin: Low levels may suggest poor nutrition or fluid retention due to heart failure.
• BUN (Blood Urea Nitrogen): Measures kidney function, which can decline with heart failure.
• Estimated Glomerular Filtration Rate (eGFR): Evaluates kidney efficiency, often impaired in heart failure.
• Thyroid-Stimulating Hormone (TSH) Test: Detects thyroid problems that may contribute to heart failure.
• NT-pro BNP (B-Type Natriuretic Peptide) Test: Confirms heart failure by measuring heart strain and fluid overload.

Imaging Tests

• Chest X-ray: Identifies fluid build-up in the lungs and heart enlargement in heart failure patients.
• Electrocardiography (ECG or EKG): Records the heart’s electrical activity to detect heart failure and other related conditions.
• Echocardiography (Echo): An ultrasound used to measure blood volume in the heart, assess mass, and evaluate valve function.
• Multigated Acquisition Scan (MUGA): A non-invasive test that evaluates how well the heart's ventricles are pumping blood.
• Ejection Fraction (EF): Measures the heart’s pumping efficiency to diagnose heart failure and assess its severity.
• Treadmill Test (TMT) or Exercise Stress Test: Assesses heart function during physical activity to detect reduced blood flow.

Preventing conditions that damage the heart is the best strategy to avoid heart failure. The following steps can help reduce the risk or delay the onset of heart failure:

Stay Active

Regular exercise improves overall health, supporting a healthy weight, blood pressure, cholesterol, and blood sugar levels, all of which benefit heart function.

Maintain a Healthy Weight

Aim for a body mass index (BMI) between 18.5 and 24.9. Focus on losing belly fat, as it is more strongly linked to heart disease risk than fat in other body areas.

Quit Smoking

Smoking damages arteries and increases the risk of heart failure. Avoid secondhand smoke as well.

Limit Alcohol Consumption

Excessive alcohol intake can raise blood pressure. Men should limit their intake to no more than two drinks per day, and women to one.

Manage Stress

High stress levels can increase blood pressure. Practices like Tai Chi, yoga, Qi Gong, and meditation can help manage stress, preventing heart disease that may lead to heart failure.

Prioritize Quality Sleep

Establish consistent sleep habits, such as going to bed and waking up at the same time each day and keeping electronic devices out of the bedroom. Sleep disorders, including sleep apnea, can heighten the risk of heart failure, so seek treatment if necessary.

Get Annual Flu Vaccination

The flu shot helps prevent respiratory infections that can worsen heart failure symptoms.

Note: For individuals at high risk of heart failure, early screening for natriuretic peptide biomarkers and timely intervention can help prevent the condition.

Specialists to Consult

If you experience symptoms of heart failure, don’t ignore them. It is essential to consult a healthcare provider who can evaluate the underlying cause and assess heart function. Specialists who can assist with diagnosing and treating heart failure include:

• Cardiologist: A cardiologist diagnoses and manages heart failure through medications, lifestyle changes, and non-surgical treatments.
• Cardiac Surgeon: For more severe cases of heart failure, a cardiac surgeon may perform surgical procedures such as bypass surgery, valve repair, or heart transplants.

The risk of heart failure can be reduced by making lifestyle adjustments at home, such as modifying your diet and exercising regularly. In addition to these, the treatment for heart failure includes the following:

Medications

Diuretics:

Also called water pills, these medications help remove excess fluid and certain electrolytes from the body. This increases urine production, helping manage hypertension and heart failure. Common examples include:

• Furosemide
• Hydrochlorothiazide

Angiotensin-Converting Enzyme (ACE) Inhibitors:

These drugs work by dilating blood vessels, which allows blood to flow more easily and helps the heart pump blood more effectively. Examples include:

• Captopril
• Ramipril
• Enalapril
• Lisinopril

Beta-Blockers:

These medications slow the heart rate, making it easier for the heart to pump blood. They also lower blood pressure and help prevent heart attacks, while promoting better blood flow by relaxing the blood vessels. Some common options are:

• Propranolol
• Metoprolol
• Atenolol

Aldosterone Antagonists:

These block the effects of aldosterone, a hormone that leads to sodium and water retention, which increases blood volume and blood pressure. These medications reduce blood pressure and fluid buildup around the heart without causing potassium loss. Examples include:

• Spironolactone
• Eplerenone

Angiotensin II Receptor Blockers (ARBs):

These medications relax the blood vessels, improving blood flow and lowering blood pressure, which helps reduce strain on the heart. Common examples are:

• Telmisartan
• Losartan
• Olmesartan

Other Combination Drugs

• Sacubitril + Valsartan: This combination drug relaxes blood vessels, making it easier for the heart to pump blood while also reducing water retention in the body.
• Ivabradine: This drug reduces the heart rate and decreases the heart's workload, which helps maintain its pumping efficiency.
• Isosorbide Dinitrate + Hydralazine: Isosorbide dinitrate relaxes blood vessels to decrease the heart's oxygen demand, while hydralazine helps maintain this effect.
• Dapagliflozin: Originally developed for diabetes, this drug is also beneficial for heart failure by lowering blood sugar, reducing heart risks, and improving survival.

Surgical Procedures

• Angioplasty: This procedure opens blocked blood vessels that restrict blood flow to the heart muscle, which is a major cause of heart failure.
• Coronary Artery Bypass Surgery: This surgery creates an alternative route for blood to flow around a blocked artery.
• Valve Replacement: If a damaged or diseased heart valve contributes to heart failure, it may be replaced with an artificial valve.
• Heart Transplantation: For individuals whose heart function continues to decline despite treatment, a heart transplant may be necessary. This is common for patients with end-stage heart failure or congenital heart disease.

Devices for Heart Failure

• Implantable Cardiac Defibrillator (ICD): A small, battery-powered device implanted in the chest, it detects and stops abnormal heart rhythms by delivering electrical signals to restore a normal rhythm.
• Cardiac Resynchronization Therapy (Biventricular Pacing): This treatment helps coordinate the contractions of the heart's ventricles for more efficient pumping.
• Ventricular Assist Devices (VADs): These are implantable pumps that support blood flow in patients with heart failure or those waiting for a heart transplant.

Heart failure can lead to various health complications, including:

• Arrhythmia (Abnormal Heart Rhythms): Conditions like atrial fibrillation and ventricular arrhythmias are commonly associated with heart failure, affecting about one-third of individuals with the condition.
• Heart Valve Damage: As the heart enlarges and works harder to pump blood, it can result in damage to the heart valves.
• Thromboembolism: Abnormal heart rhythms can cause blood to pool, leading to blood clot formation. These clots can result in conditions like stroke, peripheral embolism, deep vein thrombosis, or pulmonary embolism.
• Respiratory Issues: Heart failure can cause pulmonary congestion, weakness in respiratory muscles, and, in rare cases, pulmonary hypertension.
• Kidney Dysfunction: Reduced kidney function due to heart failure can result in waste buildup, high blood pressure, and worsening heart failure symptoms.
• Anemia: Kidney damage from heart failure can impair the production of erythropoietin, a hormone necessary for red blood cell production, leading to anemia.
• Liver Damage: Insufficient blood flow to the liver due to heart failure, along with fluid buildup, can lead to increased pressure on the portal vein, which may cause liver scarring and damage.
• Weight and Muscle Loss: Heart failure can result in significant weight loss and a decrease in muscle mass.

Simple changes to your lifestyle can help manage the symptoms of heart failure. Stay active, manage stress, monitor weight and fluid retention, avoid excessive alcohol, and quit smoking for a healthier heart. In addition, focus on your diet.

• Follow a Heart-Healthy Diet: Eat plenty of fruits, vegetables, low-fat dairy, lean proteins like skinless chicken, and healthy fats such as olive oil, walnuts, avocados, and fish like tuna and salmon.
• Limit intake of saturated fats, trans fats, and cholesterol, as well as excess sodium, which can cause fluid retention and strain the heart, and sugars, which can contribute to diabetes.
• Stay Physically Active: Engaging in moderate exercise is crucial for heart health and weight management, as obesity is a risk factor for worsening heart failure. Consult your doctor to determine appropriate exercises if you are at risk of heart failure.
• Manage Stress: High stress can raise blood pressure. Manage it by practicing relaxation techniques such as yoga, meditation, or deep breathing exercises.
• Monitor Fluid Retention Symptoms: Watch for signs such as increased shortness of breath or swelling in the ankles, as they may indicate fluid retention.

People with heart failure can improve their quality of life by following these strategies:

Monitor Fluid Intake and Weight

• Limit your fluid intake to around 1.5 liters (6 cups) daily. Keeping a record of your fluid consumption can help. Also, weigh yourself regularly to track signs of fluid retention.

Track and Manage Symptoms

• Heart failure symptoms can vary. It's important to report any new or worsening symptoms to your doctor and monitor them regularly to gauge the progression of the condition.

Collaborate with Your Doctor

• Heart failure progresses differently for each person. While some individuals can manage symptoms for years, others may experience a rapid decline in heart function. Maintain regular communication with your healthcare provider.

Adhere to Your Medication Plan

• Work with your doctor to develop a medication routine that minimizes drug interactions. Ensure that over-the-counter medications, such as painkillers, are safe for you. For example, drugs like diclofenac and ibuprofen can stress the kidneys and should be avoided in heart failure patients.

Get Vaccinated

• Influenza and pneumonia are more dangerous for individuals with heart failure than for those with healthy hearts. Ask your doctor about receiving the annual flu vaccine and a one-time pneumococcal vaccine.