Treatment of heart failure

Heart failure is a reduction in the heart’s performance and its ability to provide adequate blood circulation throughout the body. As a result, various organs do not receive sufficient amounts of oxygen and nutrients.

In the early stages, heart failure manifests during physical activity — heart rate increases, shortness of breath, dizziness, and fatigue appear. As the disease progresses, symptoms are also observed at rest. Over time, heart failure can lead to impaired function of internal organs and the development of life-threatening conditions. However, with properly selected treatment, the prognosis is favorable. Heart failure can be compensated, allowing a person to maintain a full and active lifestyle.

According to statistical data, more than 25 million people worldwide suffer from heart failure. Most of them are elderly patients, but in recent decades the disease has increasingly been diagnosed in younger individuals as well.

Heart failure is not a separate disease but a syndrome that develops against the background of other pathologies that disrupt the normal function of the heart.

The main causes include:

• cardiac ischemia;

• myocardial infarction;

• hypertension;

• heart defects;

• cardiosclerosis;

• myocarditis;

• arrhythmias;

• diabetes mellitus;

• hyperfunction of the thyroid gland;

• asthma and some other diseases.

Most often, the development of this syndrome is caused by ischemic heart disease. Its cause is atherosclerosis of the coronary arteries — the formation of cholesterol plaques on their walls and, as a result, narrowing of the lumen. This leads to reduced blood supply to the myocardium, and its tissues do not receive sufficient oxygen, macroelements, and microelements.

The second most common cause is hypertension. In 20% of patients with heart failure, it is the only underlying disease. Due to elevated blood pressure, the load on the heart muscle increases, which over time provokes impairment of its function.

During a myocardial infarction, part of the myocardial tissue dies, causing the heart to lose its ability to pump blood effectively. The same result occurs with heart defects — abnormalities of valves, septa, and other structures.

Less commonly, heart failure is triggered by hyperfunction of the thyroid gland, diabetes mellitus, and other systemic diseases.

The syndrome of heart failure is classified according to the clinical course, the nature of the disease, and the degree of the pathological process.

According to the clinical course, the following types are distinguished:

• acute — develops abruptly against the background of a myocardial infarction or another condition requiring urgent medical care;

• chronic — characterized by a gradual decline in the heart’s performance.

By the nature of the disorders, the pathology may be:

• left ventricular — blood congestion develops in the pulmonary circulation;

• right ventricular — blood stagnates in the systemic circulation;

• total — blood congestion occurs in both circulatory systems.

From the lungs, oxygenated blood enters the left ventricle of the heart and is distributed throughout the body. After passing through the systemic circulation, it returns to the right ventricle and then to the lungs.

With the development of left ventricular heart failure, the ability of the left ventricle to pump blood throughout the body decreases. As a result, blood stagnates in the pulmonary circulation (between the heart and the lungs), which can lead to pulmonary edema, persistent shortness of breath, dizziness, and other symptoms.

The right ventricle ensures the return of venous blood with a low oxygen content to the lungs. When its function is impaired, blood congestion occurs in the systemic circulation, venous pressure increases, and swelling of the legs develops.

In some patients, the functions of both ventricles of the heart are impaired simultaneously.

Additionally, the following forms are distinguished:

• systolic — the myocardium pumps a smaller volume of blood through the body due to changes (necrosis) in part of its cells;

• diastolic — the ventricles do not fill with a sufficient amount of blood due to reduced elasticity of their walls.

Four stages of heart failure are distinguished:

• stage 1 — during significant physical exertion, heart rate increases and breathing becomes difficult, but symptoms are absent at rest;

• stage 2 — shortness of breath and increased heart rate appear with mild exertion; pulmonary edema also develops, dry cough occurs, cyanosis of the skin, swelling, and other symptoms appear;

• stage 3 — shortness of breath occurs at rest, swelling of the lungs, legs, and abdomen increases, and other symptoms become more pronounced;

• stage 4 — irreversible changes develop in organs suffering from insufficient blood supply (liver cirrhosis, congestive kidney, etc.), and the patient’s condition significantly worsens.

In some classifications, only three stages are distinguished, with the second stage divided into two forms.

In heart failure, blood circulation and oxygen supply to the entire body are impaired. Therefore, as the disease progresses, the patient’s general well-being worsens and all internal organs are affected. At the fourth stage, irreversible changes may occur in these organs.

The main complications include:

• cardiogenic shock — uncompensated left ventricular failure;
• arrhythmias — heart rhythm disturbances;
• angina pectoris;
• cyanosis — bluish discoloration of the skin;
• ascites — accumulation of fluid in the abdominal cavity;
• pulmonary edema;
• swelling of the legs;
• impaired kidney function;
• liver damage;
• increased blood clotting;
• sleep apnea — temporary pauses in breathing, etc.

For diagnosis, the doctor evaluates the symptoms troubling the patient and reviews the medical history, after which laboratory and instrumental examinations are prescribed.

Typically, the following are performed:

• electrocardiogram (ECG);
• echocardiography (cardiac ultrasound);
• 24-hour Holter ECG monitoring;
• laboratory tests.

If the patient has concomitant diseases or complications, additional examinations may be required:

• chest X-ray or CT scan;
• kidney ultrasound;
• liver ultrasound;
• vascular Doppler ultrasound and other studies.

Most often, heart failure is diagnosed at stages 2 or 3, when pronounced symptoms of the disease appear and prompt the patient to seek medical attention. To detect the pathology earlier, it is necessary to undergo an annual preventive examination by a general practitioner or cardiologist, as well as ECG and other tests. This is especially important for patients with heart diseases or a high risk of their development.

In the acute form, the patient requires intensive therapy. The cause of this condition may be a myocardial infarction. After stabilization of the patient’s condition, diagnostic examinations are performed, and based on the results, further treatment tactics are determined.

The chronic form is treated with medication. Patients are prescribed drugs to normalize heart rhythm and blood pressure, remove excess fluid from the body and reduce edema, as well as other medications that help improve quality of life and reduce the risk of complications. Treatment is always selected individually. Medical prescriptions largely depend on the cause of the pathology and concomitant diseases.

With properly selected therapy, it is possible to stop the progression of heart failure and prevent the development of complications. Many patients are able to lead a full and active life.

In addition to drug therapy, lifestyle modification plays an important role. Patients with edema are advised to limit fluid intake and reduce salt consumption. All patients are also recommended to follow a balanced diet with reduced intake of fatty, fried, and smoked foods, give up harmful habits, and, if their health condition allows, engage in therapeutic physical exercise (the type of exercises and the level of physical activity should be selected by a physician).

In some cases, the patient’s condition can be improved only through surgical treatment. Depending on the underlying disease, patients may undergo coronary artery bypass grafting or stenting, implantation of a pacemaker, and other surgical procedures.

Heart failure develops as a complication of other diseases, most often cardiac and vascular conditions. Therefore, patients with heart diseases or a risk of their development are advised to undergo an ECG and consult a cardiologist at least once a year.

The risk of cardiovascular diseases can also be reduced by:

• healthy nutrition;
• regular physical activity;
• maintaining body weight within the normal range;
• timely treatment of all diseases;
• quitting smoking and alcohol consumption.

To schedule an appointment with a cardiologist at “Oxford Medical,” please call our contact center or write to us via the chat on the website.