Heart Failure

The symptoms of heart failure may start suddenly or progress gradually over weeks or months. The most common symptoms of heart failure and their reasons are listed below:

• Breathlessness
• Persistent cough and wheezing
• Tiredness or fatigue
• Swelling of feet, ankles, and legs
• Loss of appetite
• Increased heart rate
• Dizziness
• Confusion

Heart failure occurs when the heart isn’t pumping blood effectively, either due to weak contractions or inadequate filling.

It can affect the right side (reducing blood flow to the lungs) or the left side (limiting oxygen-rich blood to the body), often starting with the left side first.

Several risk factors can increase the risk of heart failure, which are discussed in the next segment.

Risk Factors For Heart Failure

Most people who develop heart failure have (or had) another heart condition first. The most common conditions that can lead to heart failure are:

1. Heart Conditions

• Coronary artery disease: It causes the build-up of plaque (fatty deposits) in the arteries that supply blood to your heart muscle, leading to narrowing of the blood vessels.
• Heart attack (myocardial infarction): It reduces or blocks blood flow to the heart muscle and impacts the heart’s ability to pump blood.
• Cardiomyopathy (heart muscle disease): These diseases of the heart muscle may lead to left ventricle dysfunction, damage the heart muscles, and change the structure of your heart, making it harder for your heart to pump blood.
• Valvular heart disease (disease of heart valves): Rheumatic fever may permanently damage the heart valves, leading to heart failure.
• Hypertension (high blood pressure): When blood pressure is high, your heart has to pump harder than normal to maintain blood circulation.
• Atrial fibrillation (AF): It refers to the irregular and rapid beating of the heart.
• Untreated congenital heart defects: Although rare, this condition occurs when the heart and its chambers may not be formed correctly at birth.

2. Non-modifiable Factors

• Age: Advancing age increases the risk of heart failure as the heart muscles weaken and blood vessels stiffen over time.
• Gender: Women are at a higher risk of heart failure if they have hypertension, while men are greatly impacted if they have coronary artery disease.
• Race/ethnicity: More common in young black-skinned individuals, particularly men, and people of Hispanic origin.
• Genetic predisposition: A family history of heart disease can increase the risk of heart failure due to inherited genetic factors affecting heart function.

3. Modifiable Factors

• Diabetes
• Sleep apnea
• Obesity
• Anemia
• Infections
• Lifestyle factors such as smoking

1. Blood tests
• Serum electrolytes: Detects imbalances that may indicate heart failure severity or medication effects.
• Random blood sugar: Identifies diabetes, a key risk factor for heart failure.
• Serum creatinine: Assesses kidney function, which can be affected by heart failure.
• Serum albumin: Low levels may indicate poor nutrition or fluid buildup due to heart failure.
• BUN (blood urea nitrogen): Evaluates kidney function, which can decline in heart failure.
• Estimated glomerular filtration rate (eGFR): Measures kidney efficiency, which is often impaired in heart failure.
• Thyroid-stimulating hormone (TSH) test: Detects thyroid disorders that can contribute to heart failure.
• NT-pro BNP (B-type natriuretic peptide) test: Confirms heart failure by measuring heart strain and fluid overload.
2. Imaging tests
• Chest X-ray: Shows the accumulation of fluid in the lungs and enlargement of the heart in patients with heart failure.
• Electrocardiography (ECG or EKG): Records the electrical activity in the heart to determine heart failure associated with other heart conditions.
• Echocardiography (Echo): An ultrasound used to determine the volume of blood in the heart, mass, and valve functioning.
• Multigated acquisition scan (MUGA scan): A non-invasive diagnostic test that shows how well the lower chambers of the heart (ventricles) are pumping blood.
• Ejection fraction (EF): Measures how well the heart pumps blood, helping to diagnose heart failure and determine its severity.
• Treadmill test (TMT) or exercise stress test: Assesses how well the heart functions under stress (physical activity) and detects reduced blood flow.

Prevention of diseases that damage the heart is the best way to keep heart failure at bay. The following pointers can help you understand the preventive measures to avoid or delay heart failure:

• Be active: Exercising can help to improve your general well-being and heart function by maintaining a healthy weight, blood pressure, blood cholesterol, and blood sugar levels.
• Maintain a healthy weight:
  • Lose weight to attain a body mass index (BMI) between 18.5 and 24.9.
  • Pay more attention to losing abdominal or belly fat, as it can increase the risk of heart disease more than fat on any other part of the body.
  • Achieve your weight loss goals with Tata 1mg’s medically supervised weight management program. Book Your Assessment Today
• Say No to smoking:
  • Smoking can damage your arteries, which can cause heart failure.
  • Also, try to stay away from secondhand smoke.
  • Want to quit smoking? Explore our widest range of smoking cessation products that can help you get rid of this deadly habit. Quit Today
• Limit alcohol intake:
  • Do not drink too much alcohol, which can raise your blood pressure.
  • Men should consume no more than 2 drinks per day, and women no more than 1 drink per day.
• Manage your stress:
  • Stress can elevate your blood pressure.
  • Mind-body practices such as Tai Chi, yoga, Qi Gong, and meditation can help in managing stress and thereby preventing heart diseases that lead to heart failure.
• Focus on quality sleep:
  • Make lifestyle changes to get sound sleep, like going to bed and getting up at the same time every night, and keeping electronics out of the bedroom.
  • Sleep problems like sleep apnea can increase the risk of heart failure. If you suffer from it, get treatment at the earliest.
  • Get the restful sleep you deserve! Explore our range of sleep aid products for better nights and brighter days! Shop Now
• Get your annual flu vaccination: The flu shot helps to prevent lung infections which can worsen the symptoms of heart failure. You can now get your vaccination shots from the comfort and safety of your home with Tata 1mg. Book Your Slot Now

Note: For individuals at risk of developing heart failure, screening for natriuretic peptide biomarkers and early intervention may prevent the condition.

The risk of heart failure can be lowered by home-based lifestyle modifications like diet and exercise. Along with these, the treatment of heart failure consists of:

1. Medications

• Diuretics: Also known as water pills, these drugs work by removing extra water and certain electrolytes from the body. This increases the amount of urine produced and aids in controlling hypertension and treating heart failure. Examples include:
  • Furosemide
  • Hydrochlorothiazide
• Angiotensin-converting enzyme (ACE) inhibitors: They work by dilating or widening blood vessels, allowing blood to flow more freely and enabling the heart to pump blood more efficiently. Examples include:
  • Captopril
  • Ramipril
  • Enalapril
  • Lisinopril
• Beta-blockers: They slow down the heart rate and make it easier for the heart to pump blood around the body. They also lower blood pressure and prevent heart attacks while widening blood vessels for better blood flow. Common examples include:
  • Propranolol
  • Metoprolol
  • Atenolol
• Aldosterone antagonists: These inhibit the effects of aldosterone, a hormone that causes sodium and water retention, leading to increased blood volume and blood pressure. These drugs lower blood pressure and reduce fluid around the heart without potassium loss. Common examples include:
  • Spironolactone
  • Eplerenone
• Angiotensin II receptor blockers (ARBs): This class of drugs lowers blood pressure by relaxing blood vessels, improving blood flow, and reducing strain on the heart. Examples include:
  • Telmisartan
  • Losartan
  • Olmesartan

2. Other combination drugs

• Sacubitril + Valsartan: This combination treats heart failure by relaxing blood vessels and making it easier for the heart to pump blood throughout the body. It also helps the body retain less water.
• Ivabradine: It reduces the heart rate and lowers the workload on the heart, thereby decreasing the oxygen requirement and maintaining the pumping efficiency of the heart.
• Isosorbide Dinitrate + Hydralazine: Isosorbide dinitrate relaxes blood vessels to reduce the heart’s oxygen demand, while hydralazine helps maintain this effect.
• Dapagliflozin: Originally used for diabetes, this drug also aids heart failure by lowering blood sugar, reducing heart risks, and improving survival.

3. Surgical procedures

• Angioplasty: This procedure opens up blocked blood vessels that restrict blood supply to the heart muscle, a major cause of heart failure.
• Coronary artery bypass: This procedure redirects blood supply around a blocked artery.
• Valve replacement: A defective or diseased valve can lead to heart failure. In this procedure, a faulty heart valve is replaced with an artificial mechanical valve.
• Heart transplantation: A heart transplant is necessary if heart muscle function continues to deteriorate despite treatment. It is required for individuals with end-stage heart failure and those with congenital heart disease.

4. Devices for heart failure

• Implantable cardiac defibrillator (ICD): A small battery-powered device placed in the chest to detect and stop abnormal heartbeats, delivering electrical signals to restore normal heart rhythm.
• Cardiac resynchronization therapy (Biventricular Pacing): This treatment is for heart failure in individuals whose ventricles do not contract simultaneously.
• Ventricular assist devices (VADs): These implantable pumps support blood flow in heart failure patients or those awaiting a transplant.

Simple lifestyle changes can help manage heart failure symptoms. Stay active, manage stress, monitor weight and fluid retention, limit alcohol, and quit smoking for a healthier heart. Apart from these, focus on diet.

Consume a heart-friendly diet:

• Eat fruits and vegetables, low-fat dairy products, lean protein such as skinless chicken, and healthy fats like olive oil, walnuts, avocados, and fish such as tuna and salmon.
• Limit saturated fats, trans fats, and cholesterol in your diet.
• Limit salt (sodium) in your diet, as excess salt can cause fluid retention and strain your heart. It also elevates your blood pressure.
• Limit sugar in your diet to lower blood sugar levels, which can help prevent or control diabetes.

Here are some additional actions you can take to maintain heart health:

• Stay physically active: Supervised moderate exercise is an integral part of a healthy heart regimen. It also helps in maintaining a healthy weight, as obesity is a known factor that worsens heart failure. Consult your doctor regarding suitable exercises if you are at risk of heart failure.
• Keep stress at bay: Stress can increase blood pressure, so it is important to manage it effectively. Consider practicing yoga, meditation, or deep breathing exercises for stress relief.
• Monitor daily for symptoms of fluid retention: Keep an eye out for symptoms such as increased shortness of breath or swelling in the ankles, which may indicate fluid retention.

Some of the common health complications of heart failure include:

• Arrhythmia or abnormal heart rhythm: Abnormal heart rhythm conditions such as atrial fibrillation and ventricular arrhythmias are common in heart failure, affecting about one-third of the individuals with this condition.
• Heart valve damage: This can occur as the heart enlarges and works harder to pump blood due to worsening heart damage.
• Thromboembolism: An irregular heartbeat can cause blood to pool, potentially leading to the formation of blood clots. These clots can result in a stroke, peripheral embolism, deep venous thrombosis, or pulmonary embolism.
• Respiratory complications: Pulmonary congestion, respiratory muscle weakness, and, in rare cases, pulmonary hypertension are also associated with heart failure.
• Kidney failure: Heart failure can reduce kidney function, leading to waste buildup, high blood pressure, and exacerbation of heart failure.
• Anemia: Kidney damage from heart failure impairs the production of erythropoietin, which is essential for the synthesis of new red blood cells, resulting in anemia.
• Liver damage: Heart failure can diminish blood supply to the liver. Fluid accumulation exerts excessive pressure on the portal vein that delivers blood to the liver, potentially leading to scarring and liver damage.
• Weight and muscle loss: Heart failure can lead to significant loss of weight and muscle mass.

Here are a few ways in which people suffering from heart failure can improve their quality of life and lead a healthy life.

1. Keep a watch on your fluid intake and weight
   • Limit your fluid intake to 1.5 litres or 6 cups of fluid every day.
   • You can also record or chart the amount of fluid consumption.
   • Keep a check on your weight every day to monitor any signs of fluid retention in the body.
2. Track and manage your symptoms
   • People with heart failure present with a variety of symptoms, most of which are non-specific.
   • If you experience any symptoms of heart failure or worsening of the symptoms, report them to your doctor.
   • Keep a tab of your symptoms to understand how your condition is faring over time.
3. Coordinate with your doctor
   • The progression of heart failure varies from person to person.
   • In some individuals, symptoms can be managed for many years.
   • However, in others, the heart may weaken after a short period. Maintain regular communication with your doctor.
4. Follow a proper medication regimen
   • Develop a medication regimen with your doctor to avoid interactions between different drugs.
   • Include non-prescription medications as well.
   • For example, non-prescription painkillers like diclofenac and ibuprofen are unsuitable for people with heart failure as they can strain the kidneys.
5. Get vaccinated
   • Flu and pneumonia pose a greater risk to individuals with heart failure than to healthy people.
   • Consult your doctor about receiving a yearly influenza (flu) vaccine and a one-time pneumococcal vaccine.

Adults need vaccinations too! Learn more about why and what vaccinations adults require.