What is Heart Failure?

This is a common condition because the conditions that cause heart failure, e.g. coronary artery disease, hypertension, diabetes mellitus, cancers are common in Singapore.

Heart failure is the symptomatic manifestation of a weakened heart. A weakened heart without symptoms is known as cardiomyopathy.
Regardless, cardiomyopathy or heart failure is a chronic condition that happens when the heart fails to maintain its proper function to pump enough blood supply to the body’s tissues resulting in improper oxygenation of vital body organs.

Heart failure progresses with time from the “At risk pre symptoms heart failure” Stage A to the advanced “end stage” Stage D. However, there are many options for treatment of heart failure depending on the stage of the disease and its causes.

By understanding heart failure, its causes and treatments early, you can gain insights on how to maintain a healthy lifestyle to prevent or treat heart diseases.

Causes of Heart Failure or Cardiomyopathy

Heart failure is generally a manifestation of another condition or disease affecting the heart first, such as the following:

  • Coronary artery disease (CAD), including heart attack, is a major of cause of heart failure,
  • Abnormal heart valves (valvular heart disease),
  • heart muscle infection or inflammation (myocarditis),
  • Diabetes mellitus,
  • Certain Anti-cancer Chemotherapy drugs used to treat common cancers,
  • Lung diseases as COPD,
  • Thyroid diseases,
  • Severe anemia,
  • Excessive regular alcohol use,
  • Obesity, and
  • Sleep Apnea

These conditions create stress effects on the heart that will lead to the failure of the heart ventricles to pump or fill with adequate blood sufficient to maintain the function of the heart.

Essentially, the ventricles (pumping chambers of the heart) regularly expand and contract in order to receive and then deliver blood throughout the body. However, when the ventricles are unable to normally contract due to the weakening of the heart muscles, this causes systolic dysfunction (systolic heart failure or heart failure with reduced ejection fraction). On the other hand, the ventricles can stiffen (or are unable to relax) due to overload pressure stress on the heart muscles which can lead to diastolic dysfunction (diastolic heart failure or heart failure with preserved ejection fraction).

What Are the Symptoms of Heart Failure?

The symptoms of heart failure can differ from one person to another depending on the severity of the condition. If you only have one of the symptoms listed below, it may not be necessarily related to heart failure. However, should you experience more than one of the following symptoms, it’s recommended that you visit a doctor:

  • Chronic persistent cough. When blood is congested in the pulmonary veins due to heart failure, the fluid can leak into the lungs and can lead to persistent coughing with pink or white blood-tinged sputum.
  • Dyspnea. Shortness of breath caused by pulmonary congestion as discussed above. Initially it begins with exertion. With untreated heart disease progression, it can occur with mild exertion or even at rest.
  • Tachycardia or Arrhythmia. A dysfunctioning heart produces abnormal electrical signals leading to changes in the heart beat rate or rhythm.
  • Peripheral edema. Heart failure can interrupt kidney function by hormonal effects or by abnormal blood perfusion to the kidneys. This leads to salt and water retention in tissues resulting in legs and feet swelling.
  • Limitation of exercise and daily activities. As a consequence of reduced supply to the body organs, the patient can feel fatigue and tiredness all the time, from just performing regular daily activities. This is because with heart failure, the body prioritizes delivery of blood to the brain and heart which results in a low blood supply to the muscles and other less vital parts of the body.

Prevention of Heart Failure

Risk of heart failure can be reduced by reducing the risks of its common causes- coronary artery disease, hypertension, and diabetes mellitus. Steps to reduce risk of cancer and also reduce risk of heart failure.

Treatment of heart failure

There are various treatment options for this condition. The treatment plan will depend on current stage of the heart failure, and pre-existing medical conditions that may be present.

Treatment of heart failure includes treating specific causes of heart failure, non-pharmacological therapy, pharmacological (medication) therapy and surgery.

Treating specific causes of heart failure

The cause of heart of heart failure must be looked for and treated specifically. If coronary artery disease is the cause, it must be treated with medications and revascularization procedures (e.g. PCI or CABG) as needed.

Non pharmacological therapy

Lifestyle changes:

Diet

Minor changes in your daily food intake can have a positive effect on your overall health. Patients who are at high risk of cardiovascular diseases or suffer from heart failure should adopt a low-fat diet to lower blood cholesterol level which is a major risk factor for cardiac diseases. Since heart failure can also lead to edema, it is also recommended to lower your intake of refined carbohydrates (e.g. sugar) and salt. In more severe cases for heart failure with fluid retention, restriction of fluids may be needed.

Smoking

Cardiac patients should avoid smoking cigarette as it is directly linked to heart attacks and heart failure. Recent studies reveal smokers have at least twice the risk of heart failure incidents as compared to non-smokers. Furthermore, in a 2012 study by American Heart Journal of more than 2,000 participants, it is revealed that the risk of heart failure for smokers is high regardless of the number of packs consumed per year.

Regular Physical activity

Daily regular physical activity is the cornerstone of a healthy body. However, for patients with late stage heart failure or myocarditis, they must refer to their doctor for advice about the degree of physical activity that can be safely allowed.

Vaccinations

Vaccines against pneumonia and influenza are important to have because these lung diseases pose a great threat to patients with heart failure condition. Speak to your doctor about the vaccinations you can get to protect your health.

Fluid intake

As the body will retain fluid when you have heart failure, it’s important to check the recommended amount of daily fluid intake with your cardiologist. You may also be prescribed with water pills (diuretics) to aid in removing excess fluid.

Starting and staying compliant with management plan

Patient will need to work out a management plan for their heart condition with their heart failure cardiologist.
They will need support from healthcare professionals and their family and friends to stick to the plan that is mutually agreed upon.

Pharmacological (Medications)

There is definitive medication treatment for heart failure. There is now an array of medications that can improve the probability of heart recovery, and to reduce symptoms. There is no single medication that works for all patients. The use of these medications has to be balanced with symptoms, blood pressure, kidney status, and potential side effects.

These medications for heart failure will help to:

  • Reverse the abnormal pathologies in your heart, and improve your heart’s pump action
  • Decrease excess fluid (edema) accumulated in your body
  • Reduce and even minimize your symptoms from heart failure

Your heart failure cardiologist will tailor your treatment plan based on the severity of your symptoms, existing medical conditions (co-morbidities) if any, and customized it to your circumstances.

You should continue to take your medication even after your symptoms have disappeared.

If any side effect occurs, make sure to inform your doctor so that your treatment plan is properly adjusted.

Surgery

Patients with heart failure may require surgical interventions for treatment.

Surgical options include:

  • Implantable Cardioverter Defibrillator (ICD) is surgically implanted in the heart and corrects any abnormal rhythm.
  • Cardiac resynchronization therapy (CRT) helps ventricles to contract efficiently in a more synchronized manner.
  • Left ventricular assist device (LAD) is usually used in advanced symptomatic heart failure patients prior to heart transplantation (bridge to transplant) or as a heart replacement (destination therapy). It assists the weakened heart to pump blood adequately.
  • Heart Transplantation is a surgical transplant procedure for patients with end-stage heart failure. It involves the replacement of a damaged heart with a healthy one from a donor.

The early detection of cardiomyopathy or heart failure gives you the opportunity to halt progression of the weakened heart early, reducing risk of later stage complication.

Make an appointment at Thomson Cardiology Centre to see our heart failure cardiologist, Dr Gerard Leong Kui Toh, if you are concerned about your risk of heart failure or want a review of your existing heart or heart failure condition.

More information on our Heart Health Screening Packages.
Check out articles about Cardiology here.

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