Heart failure occurs due to conditions that either damage or tire the heart or cardiac muscles.
The three common causes of heart failure are
coronary heart disease (CHD) (blockage in heart blood vessels, angina or heart attack)
hypertension or high blood pressure (140/90 mmHg or above or 130/80 or above if you have chronic kidney disease or diabetes)
diabetes or high blood sugar
Cardiomyopathy or heart muscle disease.
Heart valve disease or valvular heart disease.
Arrhythmias or irregular heartbeats.
Congenital heart defects (birth defect).
Conditions which damage heart muscle:
Cancer treatment (chemotherapy and radiotherapy)
Alcohol or illegal drug abuse
Taking too much vitamin E
Obstructive sleep apnea (sleep disorder)
The signs and symptoms common in all types of heart failure are:
- Shortness of breath, initially with physical work and then at rest
- Fatigue (tiredness), initially with physical work and then at rest
- Confusion (in advanced stages)
Right Side Heart Failure
- Swelling in the ankles, feet, legs, abdomen, and neck veins
- Weight gain due to fluid accumulation
- Increased urine formation
- Enlarged liver
Left Side Heart Failure
- Increase in respiratory rate
- Increase in breathing effort with panting and gasping
- Cough, worse on lying down (usually a sign of fluid build up in lungs or pulmonary edema)
- Pleural effusion (fluid accumulates in the lining of lungs)
- Othropnea or inability to breathe lying down
- Rales and crackles in lung field
- Cyanosis or blue tinge of lips, and tips of fingers and toes
Early diagnosis and treatment improves the life span and quality of life.
The diagnosis is made on the basis of medical and family history, physical examination and certain tests.
Medical and Family History
Your doctor would like to know if you or any family member has a history of heart disease, diabetes or high blood pressure. You will be asked to explain your symptoms in detail, when they started, how they progressed etc. Do your best to answer the questions to the best of your ability.
During the physical examination, your doctor will:
- Listen to your heart and lungs sounds
- Look for swelling in your ankles, feet, legs, abdomen, and neck veins.
There is no single test specific for heart failure. After taking your medical and family history and physical exam, your doctor may ask for one or more of the following tests:
- Electrocardiogram (EKG/ECG): This simple test helps record your heart beat. It tells the doctor about irregular heart beats, fast beats, previous heart attacks, and problem in the conduction of impulses in the heart.
- Chest X Ray: This can show a large heart or fluid in lungs. It can also tell the doctor if you have a lung disease.
- B-type natriuretic peptide (BNP) Blood Test: BNP is a hormone whose level rises during heart failure. The test can also be done to monitor progress of treatment.
- Echocardiography (ECHO): This is like an ultrasound of heart where your doctor can see your moving heart. This test tells your doctor about the size of heart and its chambers, the thickness of the walls of the artery, contraction of heart, mixing of blood, previous heart attack, force of blood flow etc.
- Doppler Ultrasound: This test gives the speed and direction of blood flow.
- Holter Monitor: A machine with leads or electrodes will be attached to your chest to record your heart beat. The recorder can be kept in a pocket or slung over your neck. You have to wear it for 24-48 hours while you go about your normal routine.
- Stress Test: If you are capable of running on a tread mill, your doctor may take you up for this to examine how your heart behaves under stress. The test is often followed up with ECHO and nuclear heart scans.
- Nuclear Heart Scan: This shows the amount of oxygen rich blood reaching your heart muscles and identifies areas which do not receive the blood.
- Coronary Angiography: Your doctor may ask for this test if he suspects a block in the heart arteries. A dye is injected through a tube placed in the blood vessel of your groin or arm and taken up to your heart. The doctor can see the flow of the dye on a screen in front of him.
- Other tests: These may include blood sugar, thyroid, liver and kidney function tests
The treatment of heart failure is aimed at keeping the symptoms in check and preventing worsening of the condition. The treatment includes medication, lifestyle changes, and other treatments.