Generality
Heart failure is a serious disease, characterized by the inability of the heart to pump blood effectively and with the right pressure.
The result of this inability consists in the reduced oxygenation of organs and tissues of the human body and in the impairment of the quality of life.
The typical symptoms of heart failure are dyspnea, recurrent fatigue and lower limb edema.
An accurate diagnosis of the problem is important, above all because it allows us to identify the precise causes.
The therapy depends on the causes and can be pharmacological, medical and / or surgical.
Brief anatomical review of the heart
The heart is an unequal organ that is placed in the rib cage, on the left center. Anatomically, it is divisible into two halves, the right half and the left half.
The right half comprises two overlapping cavities, the right atrium, above, and the left ventricle, below.
The left half is very similar to the right half and also includes two overlapping cavities, which are the left atrium, above, and the left ventricle, below.
Central organ of the circulatory system, the heart receives and sends the circulating blood in the human body, through a series of blood vessels:
- The hollow veins, which introduce non-oxygenated blood into the right atrium.
- The pulmonary arteries, which depart from the right ventricle and carry non-oxygenated blood to the lungs.
- Pulmonary veins, which release oxygenated blood into the lungs inside the left atrium.
- The aorta, which departs from the left ventricle and carries oxygenated blood to the various organs and tissues of the human body.
The heart has a particular muscular component - the so-called myocardium - which, thanks to a network of nerve fibers, unique in its kind, has the ability to self-control.
What is heart failure?
Heart failure, or heart failure, is a serious medical condition, which is the inability of the heart to pump blood effectively and with the right pressure.
As a result, the various organs and tissues of the human body receive less oxygen than necessary and this obviously has serious repercussions on the quality of life.
In general, the heart of an individual with heart failure - the so-called " decompensated " - has a weak or too rigid myocardium, which prevents it from functioning properly.
It is opportune to specify, from the beginning, an aspect of heart failure that is often unclear or misunderstood: the presence of heart failure does not mean that the heart is not working, but it means that the heart organ is working badly, in an ineffective way.
Types
Cardiologists classify heart failure in various ways.
According to a fairly common classification, there would be left heart failure and right heart failure .
According to another classification as widespread as the previous one, there would be diastolic heart failure and systolic heart failure .
LEFT HEART RATE AND CARDIAC ROTATE DIFFERENCE
With left heart failure, experts understand the condition that the left ventricle is unable to effectively pump blood into the aorta, which is the main artery of the human body, on which the oxygenation of the entire organism depends.
Thus, the presence of left heart failure implies a reduction in left ventricular activity.
In those suffering from left heart failure, blood tends to flow back to the lungs, causing dyspnea (ie shortness of breath) and pulmonary edema.
With right heart failure, however, experts refer to the medical condition that the right ventricle is unable to properly channel blood into the pulmonary arteries, directed to the lungs. This involves the lack of oxygenation of the blood in the lung and, only secondarily, the lack of oxygenation of organs and tissues of the human body.
Very often, right heart failure is the result of a lung or pulmonary artery disease (pulmonary hypertension)
DIASTOLIC HEART RATE AND SYSTEMIC HEART RATE
Premise: diastole is the phase of expansion and filling (of blood) of the cardiac cavities.
Systole, on the other hand, is the phase of contraction of the cardiac cavities, ie the moment in which the heart pumps blood from the atria to the ventricles and from the ventricles to the blood vessels.
Cardiologists speak of diastolic heart failure when the myocardium is particularly rigid and, due to its rigidity, it is unable to expand to receive blood.
Typically, diastolic heart failure is more common in women.
Experts, on the other hand, speak of systolic heart failure, when the heart loses its ability to contract, because it is weaker than normal or because its cavities have dilated pathologically.
Generally, systolic heart failure affects men.
Please note : diastolic heart failure and systolic heart failure can occur both in the presence of a left heart failure and in the presence of right heart failure.
Causes
The causes of heart failure are numerous.
To simplify consultation, cardiologists have decided to divide them into three broad categories, which are:
- The category of mechanical alterations
- The category of myocardial diseases (or heart muscle diseases )
- The category of electrophysiological dysfunctions (or cardiac rhythm disorders )
Before analyzing the aforementioned categories in detail, it should be pointed out that heart failure is often the result of a set of triggering factors; in fact, it is very rare that it is only a circumstance that affects the proper functioning of the cardiac organ.
MECHANICAL ALTERATIONS
The mechanical alterations that can cause heart failure are:
- Hypertension
- Valvular stenosis, ie the narrowing of one of the four heart valves of the heart. The most common valvular stenoses causing heart failure are: aortic stenosis, mitral stenosis (or mitral valve stenosis) and stenosis of the tricuspid valve.
- Valvular insufficiency, that is the inability of the heart valves to contain and prevent the reflux of blood upstream of the valves themselves. There are 4 different types of insufficiency, one for each heart valve: aortic insufficiency, mitral insufficiency, pulmonary insufficiency and tricuspid insufficiency.
- Cardiac or extracardiac shunts . In medicine, the term shunt indicates a hole or a passage, which allows the transfer of a liquid from one compartment to another.
- Pericarditis, or inflammation of the pericardium.
- Cardiac tamponade . It is the condition whereby the pericardial fluid, contained in the pericardial cavity, increases in volume and compresses the heart, hindering the latter in its action of pumping blood.
- The ventricular aneurysm . It is a pathological dilation of the ventricle, usually the left one.
DISEASES OF MYOCARDIUM
The myocardial diseases that can cause heart failure are:
- Cardiomyopathies . A cardiomyopathy is an anatomical alteration of the myocardium, which has a negative effect on the functional level.
There are various types of cardiomyopathies. The most common are: dilated cardiomyopathy, hypertrophic cardiomyopathy and restrictive cardiomyopathy.
- Myocarditis, or inflammation of the myocardium.
- Myocardial infarction (or heart attack ) and, in general, all coronary artery diseases of the heart (or coronary artery disease ). The main cause of these conditions is atherosclerosis.
- Alterations in muscle tissue of metabolic origin . The causes of these alterations include, for example, hypothyroidism, hyperthyroidism and diabetes.
- Intake of certain drugs, including chemotherapy drugs .
ELECTROPHYSIOLOGICAL DYSFUNCTIONS
The electrophysiological dysfunctions that can induce heart failure are:
- Asystole . Asystole is the medical term for the absence of cardiac systole. The presence of asystole is consequent to a deficit of the electrical activity of the heart.
- Ventricular fibrillation . It is a serious arrhythmia, which affects the ventricles. Without adequate treatment, it can be fatal.
- Ventricular tachycardia . It is a cardiac arrhythmia, characterized by an increase in ventricular heart rate.
- Atrial fibrillation . It is an alteration of the heart rhythm that originates from the atrial level.
RISK FACTORS
Important risk factors of heart failure: cigarette smoking, persistent hypertension, atherosclerosis, the presence of high levels of cholesterol in the blood (hypercholesterolemia), the presence of some congenital heart defect, suffering from hypothyroidism, hyperthyroidism, anemia or pulmonary emphysema, overweight, obesity and, finally, a sedentary lifestyle combined with an incorrect lifestyle (diet rich in salt, cigarette smoking, alcohol abuse, etc.).
Symptoms and Complications
To learn more: Symptoms of heart failure
The characteristic symptoms of heart failure are: dyspnea (or shortness of breath ), sense of recurrent tiredness and edema of the lower limbs, with particular involvement of the ankles.
Moreover, very often, in addition to these disorders, the decompensated also manifests:
- Persistent cough
- Appetite decline
- Weight loss due to decreased appetite
- Tachycardia or palpitations
- Irregular pulse
- More or less marked protrusion of the neck veins
In other words, the clinical manifestations of heart failure are very similar to those of other heart conditions or those of different lung diseases.
CHARACTERISTICS OF THE DISPNEA
In an individual with heart failure, dyspnea tends to worsen during a physical activity or lying down.
The tendency of dyspnea to worsen in a lying position is a cause of disturbances during sleep at night: the decompensated patient, in fact, wakes up several times during the night, because he is struggling to breathe and needs to stand up to feel better.
CHARACTERISTICS OF THE LOWER LIMB EDEMA
Edema in the lower limbs - in particular the ankle edema - has the peculiarity of being less severe in the morning, just after the alarm, and worsening during the day.
In the evening, the swelling resulting from the edema is very marked.
WHEN TO REFER TO THE DOCTOR?
They should contact the doctor or go to the nearest hospital center for all those who experience heart failure symptoms and who are aware of being in one of the possible risk categories mentioned above.
COMPLICATIONS
Without adequate treatment, heart failure has the tendency to gradually worsen.
Advanced heart failure strongly affects the quality of life and has a good chance of leading to death.
Diagnosis
When an individual complains of a symptomatology that suggests heart failure, the doctors begin their diagnostic investigations with an accurate physical examination and a careful medical history (clinical history); therefore, they continue their investigation with blood tests and a series of respiratory function tests ; finally, they conclude their observations with an electrocardiogram, an echocardiogram and a chest x-ray .
In some particular situations, they could also prescribe a nuclear magnetic resonance and / or a coronarography .
The diagnosis of heart failure is also important for identifying the triggers.
The knowledge of the causes of the disorder allows to plan the best therapy, case by case.
BLOOD ANALYSIS
Through blood tests, the doctor investigates whether the patient under test suffers from anemia, hypothyroidism, hyperthyroidism, diabetes, hypercholesterolemia, etc., all conditions potentially associated with heart failure.
Moreover, again thanks to blood tests, it is possible to trace the amount of the so-called natriuretic peptide, a substance that the myocardium secretes in the blood only in the presence of a stress condition for the heart.
Generally, high blood levels of natriuretic peptide are a sign of severe heart failure, while low blood levels of natriuretic peptide indicate mild / moderate heart failure.
ELECTROCARDIOGRAM
The electrocardiogram is an instrumental type test, which records and reports the rhythm and electrical activity of the heart.
It allows to understand if heart failure is due to an electrophysiological dysfunction of the heart (asystole, ventricular fibrillation, etc.).
ECHOCARDIOGRAM
An echocardiogram is, in fact, an ultrasound of the heart in real time. Through an ultrasound probe, in fact, this diagnostic test allows to see the main structures of the cardiac organ, during their operation.
In this case, he is able to grasp:
- Health status and functional status of heart valves;
- The state of health of the myocardium in general;
- The systolic function of the heart;
- The diastolic function of the heart;
- If there are holes in the septum that separates the atrium and the right ventricle from the atrium and the left ventricle.
Treatment
The treatment of heart failure depends, to a large extent, on the severity of heart failure itself.
During the therapeutic phase, periodic monitoring of heart health conditions is very important: in general, doctors recommend to undergo check-ups every 3-6 months.
With regards to adoptable therapies, decompensated patients can count on a series of drugs, on the implantation of some electronic devices for the normalization of rhythm and cardiac contraction and, finally, on different surgical interventions, including also heart transplant .
PHARMACOLOGICAL THERAPY
Drug therapy, adopted in case of heart failure, varies from patient to patient, primarily depending on the causes.
Prescribable drugs include:
- ACE inhibitors
- Angiotensin receptor antagonists
- Beta blockers
- Aldosterone antagonists
- Diuretics
- ivabradine
- Digoxin
- Anticoagulants
- Antiplatelet (or antiplatelet agents)
- Hydralazine with nitrates
- Statins
For a cardiologist, the most difficult problem in planning drug therapy is to find the dose of drugs best suited to the patient being treated.
To explain this difficulty is the fact that every individual with heart failure is a case in itself, which requires a therapy calibrated on his cardiac health conditions.
The main effects sought with drug therapy are:
- Improve cardiac blood pumping action (eg: ACE inhibitors, beta-blockers and angiotensin receptor antagonists).
- Fluidize the blood, so as to reduce the risk of formation of blood clots (eg: anticoagulants and antiplatelet agents).
- Reduce heart rate when the heart beats at a faster rate than normal (eg ivabradine).
- Remove excess sodium and replenish potassium levels (eg: diuretics, aldosterone antagonists).
- Reduce cholesterol levels (eg, statins).
- Reduce blood pressure when it is too high (eg: ACE inhibitors, beta-blockers and angiotensin receptor antagonists).
ELECTRONIC DEVICES FOR HEART RATE
The electronic devices that can help patients with heart failure are: the pacemaker, the so-called cardiac resynchronization therapy device and the implantable cardioverter defibrillator (or implantable cardiac defibrillator ).
The use of the aforementioned devices involves a short-term surgery, during which the operating cardio-surgeon connects the heart to a generator of electrical impulses, through two or three leads.
SURGICAL THERAPY
The surgical treatments for heart failure include:
- Valve repair or replacement . These two procedures are indicated in the presence of severe valvular stenosis or severe valve insufficiency.
- Coronary angioplasty or coronary bypass . They are two types of surgery that find application in the presence of narrowing or occlusion of the coronary arteries (coronary artery disease and myocardial infarction).
- Insertion of a ventricular assist device . Also known as VAD, the ventricular assist device is a sort of implantable mechanical pump, capable of replacing the heart.
It is usually a temporary remedy, which cardiologists use to wait for a real heart to be transplanted.
- Heart transplantation . It is a very complex surgical operation, which consists in replacing a heart that is irretrievably damaged with a healthy heart, coming from a donor who died recently.
If the heart transplantation is successful (there is no rejection of the organ, the operation takes place appropriately, etc.), there is a complete restoration of cardiac function.
Prognosis
In general, heart failure has a negative prognosis, as it is an irreversible condition.
In fact, a decompensated heart is a heart that cannot function effectively again, as before "getting sick".
However, there is no doubt that the treatments available at the present time are very effective both in reducing the symptoms and in slowing down the inexorable progression of heart failure.
A therapeutic solution that can make the prognosis of heart failure positive is heart transplantation. As stated, however, this operation is very delicate, it is difficult to put into practice due to scarcity of donors and has several possible complications.
Prevention
Do not smoke or stop smoking, avoid behaviors that can induce hypertension and / or increase blood cholesterol levels, maintain body weight as normal, adopt a healthy diet (avoiding too salty foods, fatty foods, etc.), exercise regularly and not to abuse alcohol are the main preventive measures that doctors recommend to reduce the risk of heart failure.
