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Heart Failure

Heart failure or congestive heart failure (CHF) is known as the structural or functional disorder of the heart that impairs its ability to pump a sufficient amount of blood throughout the body. Due to inefficient pumping ability, fluid starts to buildup in the legs, ankles and feet (edema). Coronary artery disease, high blood pressure and diabetes are the primary causes that lead to congestive heart failure. About 5 million people in the United States alone suffer from this condition and each year approximately 300000 people die due to heart failure.

Heart failure increases the pressure in the heart because blood moves through the heart and the body at a slower rate. Thus the heart loses its ability to pump oxygenated blood and nutrients to other parts of the body. During heart failure, the heart does not cease completely but loses the efficiency to pump blood all around the body. Heart failure leads to reduction in muscle contraction and the ability of the heart chambers to fill up with blood is limited, so there is less blood to pump out to tissues in the body. Also when the pumping power of the heart is reduced, it cannot pump out all the blood it receives and as a result the heart chamber fills with more blood.  Congestive heart failure can also be caused due to high blood pressure, diseases of the heart valve, Ischemic heart, congenital heart diseases and even severe anemia.

Heart failure typically affects the left, right or both the ventricles. If the left ventricle fails, then fluid will start to accumulate in the lungs due to clogging of the veins in the lungs and may lead to severe respiratory disorder. Right ventricular failure is a condition in which, right half of the heart fails completely. Due to the increase of pressure in the veins, the fluid slowly starts to buildup in the legs (edema), liver and abdominal organs. When both the sides of the heart i.e. (left ventricle and right ventricle) fail, then the condition gives rise to biventricular failure. When the heart function gets worse over a period of time, the strength of muscle contractions is reduced and the ability of the heart chambers to fill with blood becomes limited resulting in less blood to pump out to tissues in the body.

Congestive heart failure occurs most often in elderly people who are over 70 years and the majority of the patients who die from heart failure are women. According to several studies it has been noticed that men often die due to coronary heart diseases, before it develops in to heart failure. Long term hypertension, drug and alcohol abuse, smoking and high levels of bad cholesterol are often associated with congestive heart failure. Beta blockers can reduce the energy required for the heart to pump the blood all around the body because these blockers block the action of adrenaline hormones in the heart.

Congestive heart failure can also lead to kidney failure as the excess fluid starts to accumulate in the body and the kidneys cannot dispose these fluids due to extra sodium and water composition. Healthy and balanced diet, regular physical activity, normal blood pressure, avoiding smoking and abstaining from illicit drugs are some of the preventive measures which help to avoid complications that lead to heart failure. These defensive steps go a long way in keeping the heart healthy and help to avoid other cardiovascular diseases.

Heart Failure Causes

Coronary artery disease (CAD) or coronary heart disease (CHD)

Coronary artery disease is caused due to accumulation of atheromatous plaque within the walls of arteries that supply fresh oxygenated blood to the heart and it is the root cause of heart failure. If the coronary arteries are blocked, the heart will strive for oxygenated blood and if this request is not met, it may lead to chest pain (Angina pectoris) or a heart attack. This affects the basic pumping ability of the heart and thus leads to congestive heart failure. Coronary heart disease is the most common underlying cause of cardiovascular disability and death. The common risk factors associated with this disease are hypertension, cigarette smoking, elevated blood lipids, a high fat diet, physical inactivity, obesity, diabetes and stress.

High Blood Pressure

Person suffering from long standing high blood pressure is at a greater risk of suffering from heart failure as the heart struggles to pump blood harder. Blood pressure is used to measure the pressure of blood flow inside the arteries. If the blood pressure is higher than normal level then it is called as hypertension and it can lead to a massive heart attack which is also one of the underlying causes of heart failure. The symptoms of hypertension cannot be recognized by some people but consistent high blood pressure levels can prove to be more fatal. High salt intake, smoking, stress, obesity and physical inactivity are some of the reasons responsible for hypertension. People suffering from high blood pressure are always advised to reduce salt intake in their diet, to give up smoking and to engage in some kind of physical activity. Keeping blood pressure at a normal level is beneficial for heart health and prevents heart attacks and other cardiovascular diseases.

Arrhythmia

Prolonged and severe arrhythmia can lead to heart failure. The heart has an internal electrical system that controls the rhythm of the heartbeat. Problems with the electrical system can cause abnormal heart rhythms, called arrhythmias. It one of the major causes that leads to congestive heart failure. In arrhythmia, the heart can beat too fast, too slow or with an irregular rhythm. Tachycardia is a condition in which the heartbeat is too fast and when the beat is too slow it is known as Bradycardia. Due to arrhythmia, heart loses the capability of pumping enough blood to the body and thus causes severe damage to the brain, heart and other organs.

Congenital Heart disease

Congenital heart disease (CHD) is a birth defect which is caused due to abnormal heart structure and functions and it is the major cause of heart failure among children. According to recent survey, at least 8 out of every 1000 babies born each year have a congenital heart defect. This disease may be caused due to genetic disorder or it can pass through family having history of CHD. Women who smoke during pregnancy have an increased risk of having a baby with congenital heart disease. CHD does not cause pain in the chest but common symptoms associated with this disease are poor blood circulation, fatigue, cyanosis and rapid breathing. Due to abnormal structural and functional defects of the heart, the risk of heart failure arrest among children increases.

Heart Attack

People who have had heart attack in some point of their life may be at a greater risk of having a heart failure. Heart attack is a condition which is caused due to breaking of atherosclerosis plaque or when it is dislodged from the wall of a vessel supplying blood to the heart and is suddenly obstructed. A blood clot can also form on the site of plaque of atherosclerosis in a coronary artery, preventing blood reaching the heart. Due to this the heart muscles are no longer oxygenated and they start to die and are replaced by scar tissue. The heart cannot pump blood efficiently if large areas of heart muscle are replaced by scar tissue.

The primary cause for heart attack is atherosclerosis, which is the result of the accumulation of fatty deposits called as plaque inside the arteries which carry fresh oxygenated blood and nutrients to the heart and heart muscles. Atherosclerosis restricts the supply of oxygenated blood to the heart as these fatty deposits make the arteries narrow which obstruct the normal flow of the blood and therefore restrict the supply of oxygen to the heart muscles, making them incapable of pumping blood all around the body.

Heart Failure Risk Factors

 High cholesterol

High cholesterol levels in the blood increases the risk for coronary artery disease because it aids in the buildup of fatty deposits inside the coronary arteries.  When the arteries are blocked due to fatty deposits, supply of oxygenated blood to brain and rest of the body is reduced to a large extent. Cholesterol-rich food increases the level of bad cholesterol or low density lipoprotein (LDL), which is deposited on the artery walls, which leads to atherosclerosis and it is the primary cause of coronary artery disease. These LDL molecules contain more cholesterol and do not aid in the transportation of cholesterol out of the body, instead they deposit cholesterol onto the vessel walls. Low HDL levels can lead to severe cardiovascular disorder. High density lipoprotein (HDL) or good cholesterol plays a vital role in removing cholesterol out of the body by transporting it to the liver.

 Diabetes

Diabetes generally contributes to high cholesterol and triglyceride levels (unhealthy fats) that lead to coronary heart disease. People suffering from diabetes tend to have higher LDL levels than HDL levels. The higher percentage of LDL or bad cholesterol obstruct the normal flow of oxygenated blood to the heart, thus making heart inefficient for pumping blood all around the body. When the glucose level in the body increases, it affects the coronary arteries, making the walls rough and narrow due to the accumulation of fatty deposits that block the flow of the blood. If blood flow to the heart is interrupted, the cardiac muscles become starved for oxygen and die. People suffering from type 2 diabetes are at a much higher risk of a heart attack or a cardiac arrest. Generally in type 1 diabetes, pancreas does not make enough insulin but in the case of type 2 diabetes insulin produced by the pancreas is rejected by the body. If any of these conditions disturbs the blood glucose levels in the body it can lead to heart failure and other cardiovascular diseases.

Cardiomyopathy (Enlarged Heart) 

Cardiomyopathy is the deterioration of the function of myocardium. This cardiovascular disease affects the heart by arresting its normal functional activities. It can also severely affect blood vessel system of the body. It is mainly the disease of the heart muscle.

 Smoking

Smoking is the leading cause of most of the heart diseases. Cigarettes contain harmful chemical compounds and toxic substances which cause irreparable damage not only to the heart but also to the overall health. It contains nicotine which is addictive and helps to increase bad cholesterol levels in the body. Smoking increases the risk of coronary heart disease by 70%. It also increases the risk of sudden death due to coronary heart disease. Carbon monoxide contained in the smoke can clump the platelets in the blood, which makes the blood sticky and thus block coronary arteries. The chances of having a heart failure are seen quite often among habitual smokers. The risk of congenital heart disease increases among pregnant women who are habitual smokers. Smoking causes more than 430,000 deaths in the US each year due to cardiac arrest. It causes immediate increase in heart rate and blood pressure. Passive smoking also poses significant health hazards to women, infants and children.

Drug abuse

Addiction to certain drugs such as heroin, cocaine, hashish and other powerful prescription drugs can cause major cardiovascular complications. Habitual use of these drugs can cause severe stress on the heart which can lead to cardiac arrest, stroke and heart failure. Due to overdose of such drugs a person may even die due to sudden cardiac arrest (SCA). Drug abuse is also associated with complications such as high heart rate, high blood pressure, cardiac seizures, impotence, respiratory failure and coma.

Heart Failure Symptoms

Heart failure is a condition in which the heart does not fail completely but loses the ability to pump blood all around the body. The heart muscles do not have enough energy to contract easily which eventually leads to the failure of left, right or both the ventricles. The symptoms generally develop as the fluid starts to accumulate in the body. For some people the condition of heart failure maybe ongoing and in some cases it may occur suddenly. Common symptoms associated with heart failure are chest pain, fatigue, swelling in the legs, arms and ankles, heavy breathing and rapid heartbeat. Immediate medical help should be given to a person suffering from heart failure otherwise it can prove fatal. The symptoms for heart failure can also be classified according to left ventricle failure or right ventricle failure.  

Left ventricle heart failure symptoms

This condition occurs when the left ventricle of the heart fails to work efficiently. Some symptoms include:

  • Physical immobility
  • Shortness of breath (Dyspnea)
  • Fatigue
  • Dizziness
  • Confusion
  • Cardiac asthma

Right ventricle heart failure symptoms

This condition occurs when the right ventricle of the heart fails to work efficiently. Some symptoms include:

  • Swelling of feet and ankles
  • Irregular fast heartbeats
  • Weakness
  • Dizziness
  • Palpitations
  • Anemia
  • Edema
  • Frequent urination during night               
  • Enlarged liver

In severe cases the symptom may also include kidney failure and hyperthyroidism.

Heart Failure Cells

Heart failure cells are macrophage in the lung during left heart failure that carries large amounts of hemosiderin. The main causes are left heart failure and chronic pulmonary edema.

In left heart failure, the left ventricle can not keep pace with the incoming blood from the pulmonary veins causing increased pressure on the alveolar capillaries  resulting in the red blood cells leaking out. Alveolar macrophages ingest the red blood cells and become engorged with brownish hemosiderin.

In pulmonary edema alveolar septa get thick and fibrous increasing pressure on alveolar capillaries and resulting in leakage of red blood cells which undergo phagocytosis by alveolar macrophages.

Heart Failure Prevention

Physical activity

Physical activity not only helps to keep our heart healthy but also helps to improve mental wellbeing. Regular physical activity will help to fight against diabetes, obesity, hypertension, stress, high blood cholesterol which usually triggers many cardiovascular diseases. Meditation and relaxation techniques can calm the mind and soothe the senses. These techniques work well to overcome stress, which is one of the major factors that cause heart attack and can lead to heart failure.

Healthy diet

Taking a balanced and nutritious diet is a key requirement to prevent cardiovascular diseases.

  • Fruits and vegetables rich in vitamins and minerals should be included in the daily dietary intake as they help to protect against heart diseases.
  • The people who are engaged in weight loss should include diet low in calories and fats. Soluble fibers such as cereals, beans, peas, lentils, citrus fruits, strawberries and apples helps to lower bad cholesterol or LDL levels. Insoluble fibers such as whole meal bread, cauliflower, beetroot and prune aids digestion and maintain heart health.
  • People suffering from high blood pressure should follow a low salt diet as increased salt intake pushes blood pressure higher and puts a greater strain on the heart. Magnesium rich food such as potatoes, spinach, and tofu help regulate heart activity.
  • Stay away from foods high in saturated fats such as red meats, cheese, fried foods and butter. Including 2-3 Garlic cloves in the green salad can help to lower cholesterol and triglyceride levels.
  • People suffering from heart disease should also minimize all food containing high amount of refined sugars because as they raise cholesterol and contribute to weight gain.

Antioxidants

Antioxidants fight against free radicals and help reduce the risk of heart attacks and strokes and are widely used in dietary supplements to maintain good health. Antioxidants are also beneficial in preventing diseases such as cancer and coronary heart diseases. Vitamin E, selenium, carotene and gingko biloba prevent oxidation and are useful deterrents against atherosclerosis. Low levels of potassium or magnesium can cause serious heart disorders. Including bananas in the regular diet can prevent these mineral deficiencies, helping maintain a healthy regular heart beat.

Heart Failure Guidelines

Heart Failure is a life threatening condition which is caused due to a weakened heart muscle’s reduced  pumping ability. Living with chronic heart failure can be challenging but following some vital guidelines can help prevent this fatal condition helping you lead a healthy long life.

  • Talk to your doctor - regular check ups and taking the prescribed medication can help you spot the dangers in time.
  • Watch your weight – Regular monitoring of your weight, limited salt intake and controlling the fluid intake are necessary.
  • Alter your lifestyle – No smoking, no caffeine, no alcohol, no aerated drinks and No junk food are a must.
  • Exercise regularly and correctly- Physical activity is a must to keep the heart pumping and pumping well.
  • Watch out for the danger signs – Extra weight gain, accelerated heart beat, shortness of breath, feeling dizzy, unnatural fatigue or tiredness, swollen legs ankles or abdomen, coughing at night are all some of the alarm signals that need to be acted upon immediately.