HEART FAILURE

HEART FAILURE

 Heart failure is a public health problem worldwide. Here in Malaysia, it accounts for 9% of all hospital medical admissions. Statistics from the United States in 1991 established that heart failure was the primary diagnosis in approximately 790,000 hospitalizations . About 5.7 million people in the United States have heart failure, and it results in about 300,000 deaths each year. Both children and adults can have heart failure, although the symptoms and treatments differ. Heart failure is a powerful but imprecise phrase. If  a dozen patients  or clinicians  are asked  to define heart failure then at least a dozen  different answers would be given . One common  theme  would be that heart failure is serious . Everyone understands that the heart is essential  for life,  so to hear it is ‘ failing ’ is , at the very least, worrying for patients and their carers . The phrase is imprecise because it does not explain if the heart is failing completely or partially, imminently  or  in the future,  permanently or temporarily, what the cause is and whether  a  cure is possible.   According to Medical Dictionary, heart failure is defined as the inability of the heart to keep up with the demands on it and, specifically, failure of the heart to pump blood with normal efficiency. When this occurs, the heart is unable to provide adequate blood flow to other organs such as the brain, liver and kidneys. Heart failure may be due to failure of the right or left or both ventricles.                    

There are many symptoms of heart failure .  One of them is breathlessness or shortness of breath ( Dyspnea ).   When the heart begins to fail, blood backs up in the veins attempting to carry oxygenated blood from the lungs to the heart. As fluid pools in the lungs, it interferes with normal breathing. In turn, a person with heart failure  may experience breathlessness during exercise or other activities . As the condition worsens, shortness of breath may occur when at rest or asleep . These periods of breathlessness may leave the person  feeling exhausted and anxious.  Having fatigue is also one of te symptom of heart failure. As heart failure becomes more severe, the heart is unable to pump the amount of blood required to meet all of the body's needs. To compensate, blood is diverted away from less-crucial areas, including the arms and legs, to supply the heart and brain. As a result, people with heart failure often feel weak (especially in their arms and legs), tired and have difficulty performing ordinary activities such as walking, climbing stairs or carrying groceries. 

The other symptom is chronic cough or wheezing . The fluid buildup in the lungs may result in a persistent cough or wheezing, that may produce phlegm (a thick, mucous-like substance) that may be tinged with blood . Other than that, a person having heart failure may also experience rapid or irregular heartbeat . The heart may speed up to compensate for its failing ability to adequately pump blood throughout the body. Patients may feel a fluttering in the heart (palpitations) or a heartbeat that seems irregular or out of rhythm. This often is described as a pounding or racing sensation in the chest . Lack of appetite or nausea is also one of the symptom of heart failure .  When the liver and digestive system become congested they fail to receive a normal supply of blood. This can make a person  feel nauseous or full, even if you haven't eaten . A person with heart failure may also have mental confusion or impaired thinking . Abnormal levels of certain substances, such as sodium, in the blood and reduced blood flow to the brain can cause memory loss or disorientation, which a person may or may not be aware of.  In addition , fluid buildup and swelling is also the symptom of heart  failure . This happen because when blood flow to the kidneys is restricted, the kidneys produce hormones that lead to salt and water retention. This causes swelling, also called edema, that occurs most often in the feet, ankles and legs.

Finding out why a patient has heart failure is important . Patients want to know what has caused their condition because it is human nature to try to understand and rationalize . Clear explanations of what heart failure is and how it has come about are , psychologically , often the first steps for patients  in coming to terms with their condition . Sometimes poor explanations or understanding may lead to misapprehension about the causes and this can have an effect on patients’ ability to cope . Occasionally  there is not a clear cause for the heart failure , or perhaps there are a couple of potential causes . One of the potential causes is having coronary artery disease and heart attack.  Coronary artery disease is the most common form of heart disease and the most common cause of heart failure. Over time, arteries that supply blood to heart muscle narrow from a buildup of fatty deposits, a process called atherosclerosis. Blood moves slowly through narrowed arteries, leaving some areas of the heart muscle weak and chronically deprived of oxygen-rich blood. In some cases, the blood flow to the muscle is just enough to keep the muscle alive but not functioning well. A heart attack occurs if plaques formed by the fatty deposits in the arteries rupture. This causes a blood clot to block blood flow to an area of the heart muscle, weakening the heart's pumping ability. Other causes that contribute to heart failure is high blood pressure (hypertension). Blood pressure is the force of blood pumped by  heart through  arteries. If  blood pressure is high, the heart has to work harder than it should to circulate blood throughout the body. Over time, the heart muscle may become thicker to compensate for the extra work it must perform, enlarging the heart. Eventually,  heart muscle may become either too stiff or too weak to effectively pump blood.  Faulty heart valves  also causes heart failure . The valves of  heart keep blood flowing in the proper direction through the heart. A damaged valve, due to a heart defect, coronary artery disease or heart infection, forces the heart to work harder to keep blood flowing as it should. Over time, this extra work can weaken the heart. Faulty heart valves, however, can be fixed if found in time. Other than that, abnormal heart rhythms (heart arrhythmias) is also one of the causes of heart failure .  Abnormal heart rhythms may cause the heart to beat too fast. This creates extra work for heart. Over time, the heart may weaken, leading to heart failure. A slow heartbeat may prevent the patient heart from getting enough blood out to the body and may eventually  lead to heart failure  . Damage to the heart muscle (cardiomyopathy) may also lead to heart failure . Some of the many causes of heart muscle damage,  include infections, alcohol abuse, and the toxic effect of drugs such as cocaine or some drugs used for chemotherapy. In addition, whole-body diseases, such as lupus, or thyroid problems can also  damage heart muscle. Besides, myocarditis also exposed a person to heart failure .  Myocarditis is an inflammation of the heart muscle. It's most commonly caused by a virus and can lead to left-sided heart failure .  Chronic diseases such as diabetes, severe anemia, hyperthyroidism, hypothyroidism, emphysema, lupus, hemochromatosis and buildup of proteins in  muscles (amyloidosis) may also  contribute to heart failure. Causes of acute heart failure include viruses that attack the heart muscle, severe infections, allergic reactions, blood clots in the lungs, the use of certain medications or any illness that affects the whole body.

 A number of conditions can contribute to heart failure. Treatment of these factors may range from surgery or angioplasty to open clogged blood vessels in patients with coronary artery disease to medications prescribed to control high blood pressure, diabetes, anemia or thyroid disease. In addition, it's particularly important to treat abnormal heart rhythms called arrhythmias in patient with heart failure.  Lifestyle changes is one of the most important aspect that should be taken into account  to treat or to reduce the risk and symptoms of heart failure . These modifications often improve or control some of the factors contributing to heart failure. For example, people with heart failure will see an improvement if they eat a heart-healthy diet that is low in sodium and fat .  All patients with heart failure should limit their salt intake to less than 1,500 mg a day, and in severe cases, very stringent salt restriction may be necessary. Patients should not add salt to their cooking and their meals. They should also avoid foods high in sodium. These salty foods include ham, bacon, hot dogs, lunch meats, prepared snack foods, dry cereal, cheese, canned soups, soy sauce, and condiments.

 Some patients may need to reduce the amount of water they consume. People with high cholesterol levels or diabetes require additional dietary precautions. To lower the salt and sodium intake , we have to  look for foods that are labeled “low-sodium,” “sodium-free,” “no salt added,” or “unsalted.”  The total sodium content on food labels must be checked .We have to be  careful of canned, packaged, and frozen foods.  To understand these labels , the patient can ask some advices from nutritionist . In addition, do not cook with salt or add salt to what we are eating. Try pepper, garlic, lemon, or other spices for flavor instead of salt . Be careful of packaged spice blends as these often contain salt or salt products (like monosodium glutamate, MSG).  When eating outside, always stick to steamed, grilled, baked, boiled, and broiled foods with no added salt, sauce, or cheese .  Beside controlling the amount of salt intake , exercise regularly is also one of the way to practice healthy lifestyle .  People with heart failure used to be discouraged from exercising. Now, doctors think that exercise, when performed under medical supervision, is extremely important for stable patients with stable conditions. Studies have reported that patients with stable conditions who engage in regular moderate exercise (three times a week) have a better quality of life and lower mortality rates than those who do not exercise . However , exercise is not appropriate for all patients with heart failure . 

Therefore , if a person is having heart failure, they have to consult their doctor  before starting an exercise programme . People who are approved for, but not used to, exercise should start with 5 - 15 minutes of easy exercise with frequent breaks. Although the goal is to build up to 30 - 45 minutes of walking, swimming, or low-impact aerobic exercises three to five times every week, even shorter times spent exercising are useful. Studies have also reported some benefits from specific exercises . Progressive strength training may be particularly useful for patients with heart failure since it strengthens muscles, which commonly deteriorate in this disorder. Strength training typically uses light weights, weight machines, or even the body's weight (leg raises or sit-ups, for example). Even performing daily handgrip exercises can improve blood flow through the arteries. Furthermore , patients who exercise regularly using supervised treadmill and stationary-bicycle exercises can increase their exercise capacity. Exercising the legs may help correct problems in heart muscles. Exercise has also been associated with reduced inflammation in blood vessels.  Besides , bed rest is also one of the activity recommended to a person with heart failure . Some people with severe heart failure may need bed rest. To reduce congestion in the lungs, the patient's upper body should be elevated. For most patients, resting in an armchair is better than lying in bed. Relaxing and contracting leg muscles is important to prevent clots. As the patient improves, a doctor will progressively recommend more activity . Patients with heart failure are also advised to practice stress reduction techniques . Stress reduction techniques, such as meditation and relaxation response methods, may have direct physical benefits. Anxiety can cause the heart to work harder and beat faster. Other than practicing healthy lifestyle , medications are also needed to treat heart failure .  A number of medications are prescribed for heart failure, and most patients will take more than one drug. Medications may be prescribed to dilate blood vessels , strengthen the heart’s pumping action, and also to reduce the water and sodium in the body to  lessen the heart's workload . Types of medication include Angiotensive Converting Enzyme (ACE) Inhibitors, which dilate, or widen, the arteries, improving blood flow and making it so that the heart doesn't have to pump as hard. ACE-Inhibitors counteract the action of certain compounds formed by the body to regulate heart failure but which can contribute to disease progression . Another types of medications are Beta-blockers and Spironoachone .  

Beta-blockers can  lower the  blood pressure and decrease and block the effect of harmful hormones that can cause disease progression while Spironoachone is a form of diuretic that preserves potassium and has been shown to reduce hospitalization and prolong life when used to treat advanced heart failure. Other type of medication is Digoxin . Digoxin makes the heart beat stronger and slower, and regulates the rhythm of its contractions . However in  some condition, medications are no more effective to treat heart failure . 

Therefore , surgery is needed .  Surgical options to treat underlying causes of heart failure include Coronary Artery Bypass Graft (CABG or "cabbage") or angioplasty and implantation of pacemakers and other devices such as artificial heart valves . Coronary Artery Bypass Graft (CABG or "cabbage") or angioplasty will be done to patients  to prevent and treat heart failure caused by blocked arteries. During bypass surgery, blood vessels taken from another part of the body  usually the leg  are used to link the open parts of a blocked artery around the blockage . Surgical treatments for heart failure itself  include Heart Transplantation and Left Ventricular Assist Devices ( LVAD ) . Although a heart transplant may be the best option for patients with the most severe types of heart failure, this treatment is available to only a small number of people due to a shortage of donor hearts. Recent advances may make artificial heart transplantation an option in the future . Left Ventricular Assist Devices (LVAD)  may be implanted in the chest to increase heart pumping action. Until recently, LVADs required that the patient be hooked up to a large, hospital-based console while awaiting a transplant. Miniaturized battery-powered LVAD units, however, are allowing many patients to leave the hospital. The devices may be used as a primary treatment or as a bridge to heart transplant in adults. 

In conclusion, heart failure rarely occurs suddenly except after a major heart attack, severe heart valve problem or period of seriously high blood pressure . By the time most people notice and see a doctor about their symptoms, the heart has been "failing," little by little, for a long time .  Therefore , this is a good reason to have regular health checkups. During a routine physical examination, the doctor may detect signs of heart failure long before a person  experience the  symptoms . Even though there is no known cure for heart failure today, much has been learned about the condition and how it progresses. There is hope . A person diagnosed with heart failure  can still  live a full and enjoyable life with the right treatment and active attention to their lifestyle .  The most important thing is that  a person should immediately consult the doctor if they have one or more of the above symptoms of heart failure . The progression of the illness can be slowed. The quality of life experienced can also be improved  along with the quantity.