Heart Failure

What is Heart Failure?

When the myocardium can't pump effectively enough to meet the body's metabolic needs, heart failure occurs. Pump failure usually occurs in a damaged left ventricle (called left-sided heart failure), but it may happen in the right ventricle (called right-sided heart failure) primarily, or secondary to left-sided heart failure. Usually, though, left-sided and right-sided heart failure develop simultaneously. Heart failure is classified as high-output or low­output, acute or chronic, left-sided or right-sided. and forward or backward.

For many patients, the symptoms of heart failure restrict the ability to perform activities of daily living, severely affecting quality of life. Advances in diagnostic and therapeutic techniques have greatly improved the outlook for these patients, but the prognosis still depends on the underlying cause and its response to treatment.

Causes of Heart Failure

The main causes of heart failure are listed below:

• Diabetes
• High blood pressure (also known as hypertension)
• Thyroid problems
• Heart defects present at birth (congenital heart defects)
• Faulty heart valves
• Toxic substances (such as alcohol abuse)
• Lung disease

Heart failure becomes more common with advancing age. You are also at increased risk for developing heart failure if you are overweight, have diabetes, smoke cigarettes, abuse alcohol, or use cocaine.

Signs & Symptoms of Heart Failure

Some people with heart failure have few problems or symptoms. The following is a list of problems that people with heart failure might have:

• Shortness of breath (perhaps when walking or climbing stairs)
• Shortness of breath when lying down flat in bed
• Waking up in the night, suddenly breathless
• General tiredness or weakness
• Swelling of the legs (usually just the feet or ankles)
• Rapid weight gain (1 or 2 pounds a day for 3 days in a row)
• Chronic cough

Call your doctor if you have any of these symptoms, especially if you've had heart problems before.

Diagnostic Tests

Electrocardiography reflects heart strain or enlargement, or ischemia. It may also reveal atrial enlargement, tachycardia, and extrasystoles.

Chest X-rays show increased pulmonary vascular markings, interstitial edema, or pleural effusion and cardiomegaly.

Pulmonary artery pressure monitoring typically demonstrates elevated pulmonary artery and pul monary artery wedge pressures. left ventricular enddiastolic pressure in left-sided heart failure. and elevated right atrial or central venous pressure in right­sided heart failure.

Treatment

The aim of therapy is to improve pump function by reversing the compensatory mechanisms producing the clinical effects. Heart failure can usually be controlled quickly by treatment consisting of:

• diuresis (with diuretics. such as furosemide. hydrochlorothiazide. ethacrynic acid. bumetanide. spironolactone. or triamterene) to reduce total blood volume and circulatory congestion.
• prolonged bed rest
• oxygen administration to increase oxygen delivery to the myocardium and other vital organ tissues
• inotropic drugs. such as digoxin. to strengthen myocardial contractility; sympathomimetics. such as dopamine and dobutamine. in acute situations; or amrinone. to increase contractility and cause arterial vasodilation.
• vasodilators to increase cardiac output or angiotensinconverting enzyme inhibitors to decrease afterload . anti embolism stockings to prevent venostasis and possible thromboembolism formation.

Treatment of acute pulmonary edema requires morphine; nitroglycerin or nitroprusside as a vasodilator to diminish blood return to the heart; dobutamine. dopamine. or amrinone to increase myocardial contractility and cardiac output; diuretics to reduce fluid volume; supplemental oxygen; and high Fowler's position.

After recovery, the patient usually must continue taking digitalis glycosides, diuretics, and potassium supplements and must remain under medical supervision. If the patient with valve dysfunction has recurrent acute heart failure, surgical replacement may be necessary.

Prevention Tips

• DO NOT smoke
• Avoid alcohol use
• Treat your high blood pressure with diet, exercise, and medication if necessary.
• Reduce salt intake.