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10 September, 2018 00:00 00 AM

Heart failure

Bamrungrad International Hospital
Heart failure

Heart failure refers to a wide range of symptoms caused by abnormalities in the functioning of the heart. It may develop due to abnormalities in either the structure or functioning of a patient's heart, which, as a result, causes the heart to become inefficient in pumping blood to the rest of the body or in retrieving blood from the rest of the body.

 

Types of heart failure

Heart failure is divided into many different types, but when classified according to the duration of symptoms, heart failure falls into one of two categories:

Acute heart failure – Acute heart failure refers to cases in which new heart failure symptoms develop rapidly and in a short period of time. Acute heart failure may also refer to cases in which symptoms of previous heart failure have stabilized, but have later returned and become more severe in a short period of time.

Chronic heart failure – When the doctor physical examination for chronic heart failure, they are looking to find out whether the patient's symptoms and/or abnormalities in heart function have been present for an extended period of time.

 

Symptoms of heart failure

Heart failure produces symptoms and other complications when the amount of blood being pumped from the heart is insufficient in meeting the demands of the rest

of the body. Symptoms may also arise due to excess salt and

fluid retention.

Common symptoms of heart failure include:

Shortness of breath (which is a key symptom of heart failure). Patients may also experience exhaustion during physical activity, fatigue, difficulty breathing or coughing when lying down, and may wake during the night due to shortness of breath.

Patients may develop fatigue and muscle cramps when there is a reduced amount of blood reaching the muscles, making it difficult to carry out daily routines.

Swelling may develop due to fluid and salt retention, which usually occurs around the legs and ankles. Additionally, heart failure patients may also develop fluid retention in the lungs, liver, or large intestine. Fluid retention can also occur in the abdominal cavity, causing discomfort, pain, and bloating of the abdomen.

 

Factors which may exacerbate heart failure symptoms

Heart conditions, such as rapid heart rate (tachycardia), slow heart rate (bradycardia), the heart muscle not receiving sufficient blood (myocardial ischemia), cardiomyopathy, or heart valve disease, etc.

Excessive salt, fluid, or medication intake

Use of medications that cause fluid or salt retention, impair heart muscle function, or are toxic on the heart.

Not taking medications

regularly.

Excessive alcohol consumption

Various conditions, such as kidney damage or failure, blood clots in the lungs, high blood pressure, thyroid disorders, anemia, and infections, etc.

 

Diagnosing heart failure

The patient’s history should be examined in detail in order to identify risk factors and other conditions which may result in heart failure – this also includes reviewing the history of previous heart failures in both the patient and their relatives.

Comprehensive physical examination.

Assessment of fluid and electrolyte balance.

Laboratory tests to assist in diagnosis and treatment:

Blood test, red blood cell count, kidney function test, liver function test, thyroid gland function test, or cardiac enzyme test.

Chest X-ray.

 Electrocardiogram.

Heart test using an echocardiogram or ultrasound scan.

Guidelines for treating heart failure

Many factors must be considered before a patient may begin heart failure treatment. The cause of the patient's heart failure, for example, must first be established, as well as the severity and duration of symptoms, and other co-existing conditions. After assessing such factors, the doctor will decide on the best treatment option for the patient. Heart failure treatment aims to reduce the severity of the patient's symptoms and increase life expectancy by focusing on suppressing or decelerating the development of changes in the structure or functioning of the heart, and also by protecting against other complications which may arise as the condition progresses.

Treatment options include:

Medication, such as diuretic drugs, drugs to reduce blood pressure, drugs to increase heart function, hormone therapy, drugs to treat coronary artery disease, antiplatelet drugs, drugs to treat irregular heart rate, etc.

Use of an automated implantable cardioverter-defibrillator (AICD) or a permanent pacemaker implantation to help the lower left and right heart chambers contract together. These two treatments may also be combined simultaneously.

Coronary bypass surgery (CABG) or angioplasty to help improve blood flow to the heart muscle.

Heart transplant surgery or heart valve surgery.

 

Self-care for heart failure patients

Become familiar with the different symptoms caused by fluid and salt retention, such as weight gain, swelling, fatigue, discomfort when lying down, or having to wake during the night to sit up and catch your breath. If any of these symptoms are experienced, immediately inform the doctor or nurse.

Measure your weight and record it every morning – or at least for two mornings per week – immediately after going using the toilet after you wake up. Write down your weight reading before eating breakfast, as any weight gain of more than one kilogram in 1-2 days (or 2 kilograms in 3 days) indicates fluid and salt retention.

Limit salt intake to 2-3 grams per day, and avoid eating salty food in general, including canned foods, pickled foods, and soy sauce. Also, limit intake of drinking water according to the treatment plan.

Overweight patients should aim to lose weight if possible, as weight gain means the heart must work harder to pump blood to the rest of the body. In cases where the patient experiences loss of appetite, sickness, vomiting, stomach cramps, weight loss of more than 5 kilograms in 6 months, or where the patient's BMI is less than 22 kg/m2, the patient should eat small portions of easily digestible food at regular intervals in order to prevent malnutrition.

Avoid smoking tobacco and drinking alcohol (or have no more than 2 drinks per day), as alcohol adversely affects the heart.

Keep to a suitable exercise regime. Start off with walks on a flat surface, starting with short sessions of 2-5 minutes per day, and then increasing the sessions to 5-10 minutes per day. Joining an exercise-based cardiac rehabilitation program is also an option. However, if fatigue, exhaustion, or feelings of discomfort occur during exercise, stop immediately.

Only engage in sexual activity if you are able to walk up one flight of stairs (of 8-10 steps) without gasping for breath or stopping to rest. This is recommended as symptoms of heart failure may be increased with sex.

Take any medications as instructed. However, if any unusual symptoms occur – which could be side effects of medication – consult your doctor (prior to stopping your medication). If purchasing any additional medication from the pharmacy, consult your doctor regarding the side effects of the medications on your heart and kidneys, as well as interactions with other medications which you are currently taking.

Try to lower stress levels with relaxing activities such as a light exercise or meditation.

Avoid walking long distances, especially if needing to sit for long periods along the way. Heart failure patients should not go out for walks alone; they should be accompanied by a friend or relative. Additionally, avoid flying if your symptoms

worsen.

Get vaccinated for the flu yearly, if possible.

Have regular health check-ups and meet with the doctor as scheduled.

 

 

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Editor : M. Shamsur Rahman

Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

Editor : M. Shamsur Rahman
Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

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