HEART FAILURE

What’s it?

The heart is a muscle formed by two halves, the right and the left one. When one of these cavities fails to pump, becoming unable to send forward all the blood it receives, we call it heart failure.

Heart failure isn’t a heart disease per se. It’s the inability of the heart to perform its functions in a suitable way as a consequence from other illnesses, the heart itself, and other organs.

How does it develop?

There are the acute heart failure and the congestive heart failure. The former is a sudden catastrophic event that occurs as a result from any situation that makes the heart unable of an effective performance.

Usually, acute heart failure follows a myocardial infarction or severe heart arrhythmia.

There’s also the acute heart failure caused by non-cardiac disorders. An example is severe hemorrhage, severe brain trauma and high-voltage electric shock.

Acute heart failure is a severe condition that demands urgent medical care and is fatal at times, even if treatment is provided.

Congestive heart failure may have an acute onset, but it usually develops gradually, sometimes taking years to develop. Being a chronic condition, it raises the possibility of heart adaptations, which can allow a prolonged life, sometimes with some limitations for sufferers, if properly treated.

The main causes of heart failure are the following:
 

Diseases that can alter the contractibility of the heart. The most common cause is atherosclerotic disease of the heart.
Diseases that require a greater effort by the cardiac muscle. That’s what occurs in arterial hypertension or stenosis (narrowing) of the aortic valve, which, over time, may lead to congestive failure of the left ventricle. Lung diseases such as emphysema can enhance the endurance of the heart’s right part and occasionally lead to congestive failure of the right ventricle.
Diseases that may make a greater amount of blood return to the heart, as hyperthyroidism, severe anemia, and congenital heart diseases. The failure of the valves (when they fail to close properly) may lead a greater amount of blood to reflux into the cavities and the heart may decompensate for being unable to pump the excess input.

Manifestations of congestive heart failure vary according to the nature of the stress to which the heart is subject, to its response, as well as to which ventricle is more involved. The left ventricle usually fails before the right one, but sometimes the two of them fail simultaneously.

What does one experience?

The left ventricle failing, the territory that is congested is the lung. This accounts for the shortness of breath that initially appears at great efforts, subsequently being experienced at medium efforts, and finally evolving to shortness of breath even at rest. With the aggravation, orthopnea (shortness of breath whilst lying flat) appears. The individual may wake up at night due to shortness of breath, which forces them to sit straight in order to get some relief. That’s called paroxysmal nocturnal dyspnea. It can also evolve into a more severe state of left decompensation designated as severe acute lung edema, which results in death, if not treated urgently.

The right ventricle failing, edema, or swelling, occurs, especially in the legs and liver, in addition to other organs, all of this being caused by the accumulation of fluids in these organs.

How does the doctor diagnose it?

The diagnosis is made via clinical exams:
 

heart auscultation (murmurs)
lung auscultation (wheezing)
edema in the legs

Supplementary exams can also be used, such as:

The diagnosis is made via clinical exams:
 

x-ray of the chest (which shows the heart augmentation)
echocardiography (which shows the heart while functioning, heart failure being more thoroughly visualized), among others.

How is it treated?

It’s necessary, if possible, to treat the underlying disease that triggered the congestive heart failure. As an example we have stenosis of the aortic or mitral valve, and arterial hypertension.

The failing heart must also be treated. For this, salt intake is restricted. Losing weight is recommended. Drugs called diuretics are administered in addition to others that act directly on the cardiac muscle or correct existent arrhythmias.

With these measures, the doctor manages to extend for years the life of a patient suffering from congestive heart failure.

A heart transplant may be necessary as an ultimate solution.

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