Heart failure means your heart is not able to pump out sufficient amount of blood into the rest of the body. It does not mean that your heart has stopped to beat which is called “cardiac arrest” (see Heart Attack for more information). Your heart may fail  because your  heart muscles have become weak. This kind of heart failure is called systolic heart failure. Sometimes your heart cannot pump out sufficient blood  because not enough blood came to the heart in the first place.  It is called a diastolic heart failure or also “a stiff heart”. 

Heart failure may affect only the right side or the left side of the heart in the beginning but ultimately both sides will be affected. Although it is a chronic condition, it is possible for you to lead an active life if treatment is initiated on time.

Causes

Heart failure is caused by diseases that damage or weaken the heart. Conditions that may cause heart failure include:

• High blood pressure: The heart must pump hard and thus over a period of time heart muscles get enlarged and get stiff and  do not work properly.
• Coronary heart disease: These diseases cause narrowing of blood vessels, reducing the blood flow to heart muscles and thus making them weak and unable to function well.
• Diseases of heart valve: The valves may be narrowed or leaky interfering the normal blood flow and pressure through the valves. If not corrected, this also makes the heart weak over time.
• Cardiomyopathy: Damage to heart muscles from various causes make the heart weak. Heavy alcohol intake, drugs like cocaine, chemotherapy and acute viral infections can directly affect the heart muscle.
• Congenital heart diseases: a heart that is not developed properly is likely to fail sooner.
• Arrhythmias weakens the heart over time .
• Diseases that cause the lining of the heart (called pericardium) to get too thick and cause a heart failure. TB and cancer can cause constrictive pericarditis.
• Conditions such as thyroid disease, severe anemia, diabetes mellitus can also cause a heart failure.

Symptoms

The symptoms of heart failure are:

• Shortness of breath: most common during  exertion or on lying flat.
• Reduced exercise capacity.
• Swelling of lower limbs and abdomen.
• Chest pain.
• Feeling of own heart beat (palpitation).
• Dizziness.
• Fatigue and tiredness.

Diagnosis

Heart failure is diagnosed based on the presence of symptoms discussed above and an echocardiogram showing either low ejection fraction or a stiff heart. If you experience the above symptoms, you should see your doctor. The doctor will find out the severity as well as the causes of the heart failure through a review of your symptoms and medical history, and a detailed examination. You will also send you for some of these diagnostic tests:

• Electrocardiogram (ECG): This will trace the heart’s activity and may detect conditions, such as an abnormal heart rhythm or a previous heart attack that could cause heart failure.
• Echocardiography: An echocardiogram of your heart can measure the weakness of your heart by measuring something called ejection fraction (EF).  An EF of more than 50% is considered normal. Similarly, echocardiogram can also measure the stiffness of your heart. Hence, echocardiogram is essential to confirm the diagnosis of heart failure.
• Blood tests: Natriuretic peptide is protein measured in the blood that gives  a measure of extra fluid in your body which happens when you have heart failure.
• Imaging: Chest X-ray to detect the size and shape of heart; CT scan, MRI may be needed in some cases.
• Coronary angiogram: often needed to rule out underlying coronary artery disease which is the most common cause of heart failure.
• Other tests: Exercise stress test, urine tests, and other blood tests to rule out other possible disease conditions.

Treatment

Management of heart failure involves relief of symptoms and improvement in quality of life by using long-term medications. Most of the time, it is a chronic condition that you will have to live with. Occasionally, it can be  completely corrected by treating the underlying disease. Below are some of the treatment options:

Lifestyle modification:

• Stop smoking and drink in moderation.
• Decrease salt and water intake (less than 2 litres of fluid in a day in severe cases).
• Maintain a healthy weight.
• Indulge into light activity and safe exercises.

Medicines:

Medicines are given for symptomatic relief according to the cause and severity of the condition. They should be taken on time every day. Some of the medicines used are:

• Angiotensin-converting enzyme inhibitors like enalapril, lisinopril etc: These medicines prevent a buildup of fluid, have a protective effect on the heart, and may slow down the progression of heart failure.
• Beta blockers e.g. metoprolol, atenolol etc : These can slow the heart rate and decrease blood pressure and help prolong life.
• Diuretics: These reduce fluid retention.
• Mineralocorticoids like spironolactone etc: These also reduce fluid retention.
• Other medicines: nitrates, digoxin etc.

Surgery and medical device:

• Surgery such as heart valve surgery or coronary artery bypass graft (CABG) surgery or both can correct the underlying disease and cure heart failure.
• There are medical devices that can help your heart pump efficiently until you get a heart transplant.
• You can also implant a defibrillator in the chest that will start your heart in case it stops.
• Your heart rate can be artificially controlled by pacemakers.

Prevention

Healthy lifestyle, regular health checkup and screening for cardiovascular problems are some of the ways you can prevent a heart failure.