Heart Failure: Types and Treatments

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Heart disease and stroke are categorized together as cardiovascular diseases (CVDs). Heart disease includes several types of heart conditions. The most common type of heart disease in the U.S. is coronary heart disease (coronary artery disease or CAD) which describes a physical state in which a person’s blood vessels carrying blood to the heart are narrowed. Having CAD can cause chest pain, a heart attack (blood flow to the heart is blocked and a part of the heart muscle is damaged or dies), an arrhythmia (heart beating too fast, too slow or irregularly), or heart failure, which results in the heart being unable to pump enough blood and oxygen to support the other organs in the body. Heart disease is the number one killer of men and women in the U.S. One in five people will develop heart failure.

Statistics on heart failure in the U.S.

  • Approximately 5.7 million adults have heart failure based on the most recent statistics

  • Heart failure is more common in certain states in the U.S. (especially the southern belt where obesity and diabetes are also quite prevalent)

  • Diseases that damage your heart increase the risk of heart failure. Those include CAD, high blood pressure, obesity, and diabetes.

  • Behaviors including smoking, eating high fat and highly refined foods, and being sedentary raise your risk of developing heart failure.

The heart is a muscle and its pumping action helps to move oxygenated blood from the lungs to the left atrium (one of the four chambers of the heart) to the left ventricle (one of the two lower chambers of the heart). The left ventricle pumps this blood to the rest of the body. The left ventricle tends to be the largest of the four chambers of the heart since it offers the most pumping power.

3 types of heart failure

In left-sided or left ventricular heart failure, the left side of the heart tries to compensate by working harder in order to keep normal blood flow sustained. There are two sub-types of left-sided heart failure:

  1. Systolic failure or “heart failure with reduced ejection fraction:” In this scenario the left ventricle is unable to contract normally due to some muscle injury. This results in the heart’s inability to pump and push sufficient blood into circulation.

  2. Diastolic failure or “heart failure with preserved ejection fraction:” This is also identified as diastolic dysfunction. The left ventricle cannot relax as it normally would between pumping efforts because that part of the muscle has become stiff. This stiffness can lead to high pressures in the heart which can cause shortness of breath. It also prevents the heart from filling properly with blood during the resting periods between each heartbeat which reduces forward blood flow.

The heart’s right-sided pumping power moves used or de-oxygenated blood through the veins in the body, through the right atrium and into the right ventricle. The role of the right ventricle is to pump the blood out of the heart and to the lungs which release oxygen into the blood. In right sided heart failure, the right side of the heart is not able to pump blood adequately to the lungs. It usually happens because of left-sided failure. If the left ventricle is failing then increased fluid pressure basically transfers through the lungs and “back” to the heart’s ride side, damaging it. If the right side of the heart loses its own pumping power, blood inevitably backs up into the body’s venous system. The result is usually swelling/edema or “congestion” in the lower extremities (legs and ankles) or the abdomen, affecting the gastrointestinal tract or the liver (ascites).

The terms congestive heart failure and heart failure are sometimes used interchangeably but the term congestive refers to a condition in which there is fluid build-up in the body. These conditions represents a medical situation that warrants immediate attention. Blood flow from the heart is reduced, while blood flow returning to the heart backs up, which causes fluid build-up or congestion in body tissues. The fluid begins to collect in the legs and ankles, but it can also build up in the lungs, causing shortness of breath, especially when the individual lies down. This back-up of fluids can also limit the kidneys’ ability to get rid of fluids and especially sodium properly. Fluid retention from this scenario causes swelling of the body’s tissues also known as edema.

Warning signs of heart failure

If you experience more than one of the following symptoms, you should seek medical evaluation for heart failure:

  • Shortness of breath (especially if it occurs when you lie down flat)
  • Chronic coughing or wheezing
  • Edema (build-up of fluid)
  • Onset of unexplained fatigue or feeling light-headed
  • Unexplained nausea or lack of appetite
  • Confusion or impaired thinking
  • High heart rate

Diagnosing heart failure

After a full history and a standard physical examination, your doctor may determine that you need to undergo a series of tests to determine if you’ve developed heart failure. Testing can include:

  • Blood tests which may include sodium and potassium levels, albumin, creatinine and certain biomarker levels to detect heart failure and heart muscle damage

  • A chest x-ray to see if there is fluid in the lungs or an enlarged heart

  • An electrocardiogram (EKG or ECG) to see if you had a heart attack or if the left ventricle is enlarged (but it will also catch abnormal heart rhythms)

  • An echocardiogram to examine the heart’s structure, motion, and muscle squeeze

  • Exercise stress test to see how your heart responds to the stress of exercise as well as to evaluate for heart artery blockages

  • Radionuclide Ventriculography or Multiple-Gated Acquisition Scanning (MUGA scan) to see how well the heart chambers are working, how well the blood supply to the heart is and whether the heart has sustained damage from a heart attack.

  • Cardiac catheterization to help to identify (and possibly open) blockages in blood vessels to the heart

  • Magnetic Resonance Imaging (MRI) to see the heart’s structure in great detail and how well blood is flowing through major vessels of the heart and within the heart itself using magnetic imaging

Treating heart failure

Your doctor and a cardiac specialist will help to formulate a treatment program, based on the findings from some of these tests. Those options may include lifestyle modification (diet, exercise, stress reduction, healthier sleep patterns), medications including ACE inhibitors, beta blockers, aldosterone antagonists, diuretics, blood thinners, and cholesterol-lowering drugs, among others. It’s important to understand the purpose of each medication and commit to being compliant with the recommendations. It’s also important to report any adverse side effects to your doctor, so he can modify doses or investigate other medication options.

You may also be a candidate for certain devices or more invasive therapies that can help to correct certain heart issues contributing to the heart failure. Those can include an implantable cardiac defibrillator, cardiac resynchronization therapy, left ventricular assist device (LAVD), angioplasty, coronary artery bypass, valve replacement, or if your condition is very dire, you may need a heart transplant.

Long term prognosis for patients with recent onset of congestive heart failure is discussed in terms of survival rates and have improved over the decades. According to a Mayo Clinic study in 2004, survival rates from the 1980s compared to the late 1990s improved in the range of 5 to 15 percent depending on time frame and gender. One year survival rates range from 79 to 83 percent and five year survival rates 46 to 50 percent. However, a January 2017 study suggests that since 1998, survival rates have not improved. Given these grim statistics, it is crucial to get diagnosed quickly and to commit to changing lifestyle habits and follow your treatment program.

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Treatment Advances for patients with Heart Failure