Even though it may sound like it, heart failure does not necessarily mean that the heart has failed. Heart failure is a serious condition in which the heart is not pumping blood around the body efficiently.
The patient's left side, right side, or even both sides of the body can be affected. Symptoms will depend on which side is affected and how severe the heart failure is - symptoms can be severe.
According to the American Heart Association, the left side of the heart is usually affected first.
We depend on the pumping action of the heart to deliver nutrient- and oxygen-rich blood to every cell in the body. When cells are not nourished adequately, it is not possible for the body to function properly.
If the heart is weakened and cannot supply the cells with sufficient blood, the patient becomes tired and breathless. Everyday activities that were once taken for granted become challenging, such as walking, carrying the shopping or climbing the stairs.
Heart failure is a serious condition for which there is usually no cure. However, with the right treatment, the patient can still lead an enjoyable, meaningful and productive life.
The number of elderly people developing heart failure is increasing in industrial countries, especially in the USA.
Researchers at Drexel University School of Public Health in Philadelphia reported in 2008 that the number of older patients hospitalized for heart failure has more than doubled in the last 27 years in the USA.
The American Heart Association says that Americans with severe heart failure see almost three times as many Medicare providers each year compared to a typical beneficiary.
Heart failure is said to be the leading cause of death in South-East Asia. Researchers reported that a variant of a gene that increases the risk heart failure seven-fold is most common amongst people in South East Asia.
According to the National Heart, Lung and Blood Institute, approximately 5.1 million people in the United States have heart failure.
Heart failure, heart attack, and cardiac arrest
Many lay people confuse the three terms of heart failure, heart attack and cardiac arrest. They are quite different.
Heart failure is different to heart attack and cardiac arrest.
- Heart attack - this consists of death of heart muscle due to an occlusion (blockage) of a coronary artery. Put simply, heart muscle tissue dies. The heart muscle dies because it is starved of oxygen (because blood is not getting to it).
- Heart failure - this means the heart muscle cannot pump blood around the body effectively/properly. It is not a heart attack.
- Cardiac arrest - this means the heartbeat stops, the heart stops, blood circulation stops, there is no pulse.
Causes of heart failure
The following conditions can cause heart failure:
- Diabetes - especially diabetes type 2.
- Obesity - people who are both obese and have diabetes type 2 have double the risk of developing heart failure, according to this study.
- Smoking - people who smoke regularly run a significantly higher risk of developing heart failure compared to lifetime non-smokers and people who gave up.
- Hypertension (high blood pressure).
- Four risk factors - high blood pressure, excessive weight, smoking and diabetes were strongly correlated with greater size of the heart's left ventricle over the short term (four years) and the long term (16 years), according to a study of more than 4,217 people.
- Waist size - A study found that waist size was a predictor of heart failure among middle-aged and older men and women, and was found to be a risk factor even when BMI (body mass index) was in the normal range.
- Heart attack (coronary heart disease).
- Depression among heart disease patients - A US study found that patients with heart disease who were then diagnosed with depression were at greater risk of heart failure.
- Inherited heart disease, such as cardiomyopathy (damage to the heart muscle).
- Congenital heart defects.
- Anemia (a deficiency of red blood cells).
- Sleep disorders - there is a link between increased probability of dying and sleep apnea among heart failure patients, according to this study.
- Hyperthyroidism (overactive thyroid gland).
- Hypothyroidism (underactive thyroid gland).
- Heart failure on the left side of the body can cause heart failure on the right side.
- Faulty heart valves.
- Myocarditis - inflammation of the heart muscle, usually caused by a virus, leading to left-sided heart failure.
- Heart arrhythmias (abnormal heart rhythms) - they may cause the heart to beat too fast, creating more work for the heart. Eventually the heart may weaken, leading to heart failure. If heartbeat is too slow not enough blood may get out from the heart to the body, leading to heart failure.
- Atrial fibrillation - patients with atrial fribrillaiton have a much higher risk of hospitalization due to heart failure, a study found.
- Emphysema (a chronic disease that makes it hard for the patient to breathe).
- Lupus (person's own immune system attacks healthy cells and tissues).
- Hemochromatosis (pathology in which iron accumulates in the tissues).
- Amyloidosis (one or more organ systems in the body accumulate deposits of abnormal proteins).
Symptoms of heart failure
Doctors say that by themselves the signs of heart failure may not mean the patient has heart failure and he/she should not be alarmed. However, people who have not been diagnosed with heart failure and experience more than one of the symptoms below should tell their doctor and ask for an evaluation of their heart. This article by the European Society of Cardiology explains how patients with heart failure and their families can help improve prognosis in acute events if they are taught to recognize the tell-tale signs of worsening condition and seek immediate medical help.
People who have been diagnosed with heart failure should monitor their symptoms carefully and report any sudden changes to their doctor immediately.
We will now go through some of the common symptoms of heart failure.
Extreme fatigue (tiredness)
By far the main symptom is extreme fatigue - tiredness. The patient is not getting enough blood pumped from the heart to his/her muscles. The body diverts blood away from less vital organs - muscles in the limbs - and focuses on supplying the heart and brain.
Other symptoms depend on which side of the body is not getting an adequate supply of blood:
Heart failure on the left side of the body:
- Breathlessness, panting (dyspnea) - this may happen at any time, but will be more noticeable or acute when the patient is active or lying down. Patients at night will often need to sit up in bed or have an urge to get some fresh air.
- Frothy spit (with the cough)
This happens when blood backs up in the pulmonary veins because the heart cannot keep up with the supply, causing fluid to leak into the lungs.
Heart failure on the right side of the body:
- Swollen ankles
- Swollen legs
- Enlarged liver
- Enlarged stomach
This happens because as blood flow out of the heart slows down, blood that returns to the heart through the veins backs up, causing fluid accumulation in the tissues. Kidneys find it harder to dispose of sodium and water, which in turn causes fluid retention in the tissues.
Heart failure on both sides of the body:
- Dizziness and/or confusion - as levels of sodium and other substances in the blood change the patient is much more likely to experience confusion, and also dizziness.
- Loss of appetite - as the digestive system receives less blood the patient experiences problems with digestion and appetite.
On the next page we look at the diagnosis of heart failure, available treatments and prevention of heart failure.