Heart failure

Overview of heart failure – Heart failure is a syndrome that has resulted from structural or functional heart disorder.

The ability of the heart to fill or eject blood is impaired.

There are two types of heart failure –

  • Heart failure with reduced left ventricular ejection fraction also called systolic heart failure
  • Heart failure with preserved ejection fraction also called diastolic heart failure.

 

Classification of heart failure –  ACC/AHA stages of heart failure are

Stage A – Patients at risk of developing heart failure. Includes patients with diabetes mellitus, hypertension, atherosclerotic disease, metabolic syndrome, obesity, or patients with a family history of cardiomyopathy.

Stage B – Patients with structural heart disease but without signs or symptoms of heart failure.

Stage C – Patients with structural heart disease, with previous or current symptoms of heart failure

Stage D – Patients with advanced structural heart failure requiring specialized interventions.

 

Symptoms of heart failure – Shortness of breath at rest or on exertion, reduced exercise tolerance, shortness of breath while lying flat, shortness of breath that occurs at night and awakens you from sleep, swelling

 

Causes and risk factors of heart failure –  Coronary artery disease, hypertension, diabetes mellitus, obesity, valvular heart disease, cardiomyopathy (disease where the heart muscle is enlarged, thick or rigid)

 

Complications of heart failure –  Kidney damage or kidney failure, heart rhythm problems, heart valve problems, liver damage.

 

Diagnosis of heart failure – Diagnosis of heart failure is based on clinical features, physical examination may include tests such as blood test, echocardiography, echocardiogram, chest x-ray, stress test, computerized tomography scan, magnetic resonance imaging, coronary angiogram

 

Management of heart failure –

Lifestyle management of heart failure –

Diet – Follow the diet recommended by your doctor and diet for the underlying diseases. Consume the number of calories recommended by your doctor or dietician.

-Trans fat (hydrogenated fats) are atherogenic, while mono- and polyunsaturated fats (particularly omega-3 fatty acids) – eg, those found in fish, olive oil, nuts are protective and prevent and treat cardiovascular disease.

–Fiber intake should be at least 14 grams per 1000 calories daily.

Sodium(salt) restrictionPatients with symptomatic heart failure should restrict their sodium(salt) intake to less than 3 grams a day.

 

All patients with heart failure should monitor for signs and symptoms of heart failure daily.

Weight – Weight needs to be checked every day. A reasonable plan might be that for a two- to five-pound weight gain in one week.

Weight gain more than 5 pounds in one week requires an immediate call to your doctor or nurse.

Swelling – Check your legs each day for swelling. Progressive and severe swelling requires an immediate call to your doctor or nurse.

Exercise tolerance – Use a scale ranging from no shortness of breath, shortness of breath after moderate exertion, shortness of breath after mild exertion, shortness of breath at rest. Severe shortness of breath requires an immediate call to your doctor or nurse.

Breathing at night – Use a scale ranging from no shortness of breath lying flat, needing two pillows or more, sleeping upright or awakening with sudden shortness of breath. Severe shortness of breath requires an immediate call to your doctor or nurse.

Dizziness and lightheadedness – Use a scale ranging from not dizzy, dizzy for a while after standing, near syncope/syncope or fall. Severe dizziness and syncope require an immediate call to your doctor or nurse.

Fluid restriction – Fluid should be restricted to 1.5 – 2 liters a day in patients with refractory heart failure.

Pharmacologic management –  The medications used for heart failure are Angiotensin-converting enzyme inhibitors – lisinopril, enalapril, captopril.

Angiotensin II receptor blockers – losartan, valsartan, candesartan

Beta-blockers – Carvedilol, bisoprolol, metoprolol

Hydralazine and nitrates

Diuretics – Furosemide, bumetanide, torsemide, metolazone

Spironolactone

Digoxin and warfarin/dabigatran

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