What is Heart Failure?

Causes of Heart Failure

When your heart fails to pump enough blood to meet the body’s needs, a person may experience heart failure. This heart condition can be caused by several underlying health issues, which include:

1. Heart attack

A heart attack occurs when blood flow to the heart muscle is blocked, causing damage. This weakens the heart, making it less effective at pumping blood, which can lead to heart failure. The more severe the heart attack, the greater the risk of developing heart failure.

2. Coronary Artery Disease (CAD)

Coronary artery disease is a common cause of heart failure. It happens when the arteries supplying blood to the heart become narrowed or blocked due to cholesterol buildup. As a result, less oxygen reaches the heart muscle, leading to weakened heart function and potential heart failure.

3. Congenital Heart Disease (CHD)

Some people are born with structural heart problems, known as congenital heart disease. These issues can put extra strain on the heart over time, causing it to work harder and potentially leading to heart failure if left untreated.

4. Cardiomyopathy (Heart muscle disease)

Cardiomyopathy affects the heart muscle, causing it to thicken, stiffen, or enlarge. This makes it harder for the heart to pump blood effectively, increasing the risk of heart failure. Cardiomyopathy can be genetic or develop later in life due to other conditions like high blood pressure or diabetes.

5. Valvular heart disease (Disease of heart valves)

The valves of the heart control blood flow within the heart. When these valves don’t open or close properly, blood can leak backward or flow inefficiently. This forces the heart to work harder, eventually leading to heart failure if not addressed.

6. Hypertension (High blood pressure)

High blood pressure is a major risk factor for heart failure. When blood pressure is consistently elevated, the heart has to work harder to pump blood, which can weaken the heart over time. If untreated, this increased workload can lead to heart failure.

7. Untreated congenital heart defects

If congenital heart defects are not treated early, they can worsen over time. These structural issues in the heart can lead to improper blood flow, increasing the workload of the heart and raising the likelihood of heart failure later in life.

8. Atrial fibrillation

Atrial fibrillation is an irregular heart rhythm that affects the ability of the heart to pump blood efficiently. This condition can lead to blood clots, strokes, and heart failure if not managed properly.

9. Myocarditis (Heart inflammation)

Myocarditis is inflammation of the heart muscle, often caused by infections. The inflammation can weaken the heart, reducing its ability to pump blood and increasing the risk of heart failure.

10. Pulmonary hypertension

Pulmonary hypertension refers to high blood pressure in the arteries of the lungs. This condition forces the right side of the heart to work harder to push blood through the lungs, which can lead to heart failure if not treated.

11. Hyperthyroidism

When the thyroid gland produces too much thyroid hormone, it can cause the heart to beat faster and work harder than normal. This increased workload can lead to heart failure, especially in people with other heart conditions.

12. Anemia

Anemia occurs when there are not enough red blood cells to carry oxygen to the tissues of your body. To compensate, the heart has to pump more blood, which can strain the heart and eventually lead to heart failure if the anemia is severe and untreated.

13. Infections

Certain infections, like those affecting the heart valves or heart muscle, can cause inflammation and damage to the heart. If the heart is weakened by infection, it may struggle to pump blood, increasing the risk of heart failure.

Note that heart failure is often a result of multiple factors working together.

Risk factors

Heart failure is a serious condition where the heart struggles to pump enough blood to meet the body’s needs. Several risk factors can increase your chances of developing heart failure.

• Age: As we grow older, the heart weakens naturally, which can increase your risk of heart failure.
• Gender: Gender also plays a role—men tend to develop heart failure earlier, while women are at higher risk after menopause.
• Race: Race can be a factor too, with dark-skinned people more likely to experience heart failure at younger ages.
• Genetics: Genetic predisposition can also influence your chances—a family history of heart disease puts you at higher risk.
• Diabetes mellitus: Beyond these, diabetes mellitus is also a major contributor.
• High blood sugar: High blood sugar damages blood vessels and the heart itself. So, it can also raise your risk of heart failure and other heart-related problems.
• Sleep apnea: It is a condition that interrupts breathing during sleep and can strain the heart over time.
• Overweight or obese: If you are overweight or obese, you add extra pressure on the heart, forcing it to work harder.
• Poor lifestyle: Apart from these factors, lifestyle choices like smoking and excessive alcohol consumption also increase the risk of heart failure by damaging blood vessels and raising blood pressure.
• Unhealthy diet: Eating foods high in fat or cholesterol contributes to plaque buildup in the arteries, which can restrict blood flow and weaken the heart.

By managing these risk factors—especially through a balanced diet, regular exercise, and avoiding harmful habits—you can reduce your risk of heart failure significantly. Also, make sure you go for regular checkups because it can help in early diagnosis.

Key Facts About Heart Failure

Major Symptoms	Breathlessness Persistent cough Fatigue Swelling Feeling faint or lightheaded Increased need to urinate Loss of appetite Sudden weight gain Increased heart rate Chest pain and discomfort Dizziness and lightheadedness Confusion or memory loss Bloated feeling Protruding neck
Necessary Health Tests	Blood tests: Electrolytes (sodium, potassium) Blood glucose Serum creatinine Albumin Blood urea nitrogen (BUN) Estimated glomerular filtration rate (eGFR) Thyroid-stimulating hormone (TSH) NT-pro BNP (B-type natriuretic peptide) Imaging tests: Chest X-ray Heart MRI CT scan of the heart Heart function tests: Electrocardiography (ECG or EKG) Echocardiography (Echo) Ejection fraction (EF) MUGA scan Coronary angiogram Treadmill test/exercise stress test
Treatment	Medications: Diuretics Angiotensin-converting enzyme (ACE) inhibitors Beta-blockers Aldosterone antagonists Angiotensin II receptor blockers (ARBs) Surgical options: Angioplasty Bypass surgery Coronary artery bypass Percutaneous coronary intervention Transplant surgery Valve replacement Medical devices Pacemakers Left ventricular assist device (LVAD) Implantable cardioverter defibrillator (ICD) Cardiac resynchronization therapy

Symptoms of Heart Failure

Heart failure occurs when the heart cannot pump enough blood to meet the needs of the body. It can affect the right side, the left side, or both sides of the heart. Usually, the left side is affected first.

1. Left-sided heart failure: It occurs when the left ventricle cannot pump blood effectively to the rest of the body. Blood backs up into the lungs, causing shortness of breath, persistent coughing, and fatigue.
2. Right-sided heart failure: It often develops after left-sided failure. It leads to fluid buildup in the body, particularly in the legs, ankles, and abdomen (edema). The right side of the heart struggles to pump blood to the lungs, causing swelling and fluid retention.

Common symptoms of heart failure include:

• Breathlessness: Difficulty breathing, especially during physical activity or while lying down, due to fluid buildup in the lungs.
• Persistent cough or wheezing: Often accompanied by pink, frothy mucus, this happens due to fluid in the lungs.
• Fatigue or constant tiredness: The heart struggles to pump blood efficiently, leaving you feeling exhausted.
• Swelling (edema): Fluid retention causes noticeable swelling in the feet, ankles, or legs.
• Feeling faint or lightheaded: Poor blood flow can cause dizziness, especially when standing up.

In addition to these above-mentioned symptoms, a person with heart failure also experiences symptoms such as:

• Increased need to urinate, especially at night
• Loss of appetite due to lack of blood flow to the digestive system
• Sudden weight gain within a few days from fluid retention
• Increased heart rate
• Chest pain and discomfort if heart failure is caused by a heart attack
• Dizziness and lightheadedness due to reduced blood flow to the brain
• Confusion or memory loss caused by lack of oxygen in the blood
• Bloated feeling caused by fluid buildup
• Protruding neck veins (when neck veins are more visible) due to increased pressure in the blood vessels

Since these symptoms can often develop gradually, it is important to seek medical advice if they persist or worsen, especially if there is a history of any heart-related conditions. Early detection of the symptoms is key to managing heart failure effectively and improving quality of life.

Types

Based on the severity of symptoms, heart failure can be classified into these 4 different types:

1. Asymptomatic (symptom-free) heart failure: The heart is weakening, but there are no noticeable symptoms. It is often detected through tests during routine checkups. Although no symptoms are present, damage to the heart is progressing.

2. Mild heart failure: Symptoms such as shortness of breath during physical activity, mild fatigue, or swelling in the feet begin to appear. While the heart struggles, daily life is not heavily impacted.

3. Moderate heart failure: Symptoms become more pronounced, including breathlessness, even with minimal activity. Fatigue, swelling, and difficulty sleeping due to shortness of breath are common, affecting daily life more significantly.

4. Severe heart failure: Simple tasks cause breathlessness and extreme fatigue, and the body retains excess fluid, leading to significant swelling. Daily life is heavily restricted, and medical interventions are necessary to manage symptoms.

Diagnosis of Heart Failure

Diagnosis of heart failure involves several tests to evaluate heart function and overall health. Here are common tests that may be done to diagnose heart failure:

Blood tests

1. Electrolytes (sodium, potassium): An imbalance can indicate fluid retention or kidney issues, both common in heart failure.
2. Blood glucose: The high levels may indicate diabetes, a risk factor for heart failure.
3. Serum creatinine: It assesses kidney function, as heart failure can reduce kidney efficiency.
4. Albumin: The low levels may suggest poor nutrition or kidney and liver function issues, which can worsen heart failure.
5. Blood urea nitrogen (BUN): It measures how well your kidneys are working, as kidney function can decline with heart failure.
6. Estimated glomerular filtration rate (eGFR): It evaluates kidney filtration efficiency, important because heart failure affects kidney function.
7. Thyroid-stimulating hormone (TSH): It checks for thyroid issues, as both overactive and underactive thyroids can impact heart health.
8. NT-pro BNP (B-type natriuretic peptide): The elevated levels indicate heart stress or failure as this peptide is released when the heart struggles to pump.

Imaging tests

1. Chest X-ray: It detects an enlarged heart or fluid buildup in the lungs, which are signs of heart failure.
2. Heart MRI: It provides detailed images of the structure of the heart, helping to identify damage or abnormalities.
3. CT scan of the heart: It helps visualise heart structure and potential issues with the coronary arteries.

Heart function tests

1. Electrocardiography (ECG or EKG): It identifies abnormal heart rhythms or damage.
2. Echocardiography (Echo): It offers detailed imaging of the heart’s chambers and valves, assessing how well the heart pumps blood.
3. Ejection fraction (EF): It measures how much blood the heart ejects with each beat; a lower EF suggests heart failure.
4. MUGA scan: It evaluates the heart’s pumping ability using a radioactive tracer.
5. Coronary angiogram: It examines blood flow in coronary arteries to identify blockages or narrowing.
6. Treadmill test/exercise stress test: It assesses how the heart performs under physical exertion, detecting blood flow or rhythm issues.

Treatment of Heart Failure

Medications:

• Diuretics
• Angiotensin-converting enzyme (ACE) inhibitors
• Beta-blockers
• Aldosterone antagonists
• Angiotensin II receptor blockers (ARBs)

Surgical options:

• Angioplasty
• Bypass surgery
• Coronary artery bypass
• Percutaneous coronary intervention
• Transplant surgery
• Valve replacement

Medical devices

• Pacemakers
• Left ventricular assist device (LVAD)
• Implantable cardioverter defibrillator (ICD)
• Cardiac resynchronization therapy