Heart failure is a condition in which the heart is unable to pump blood effectively to meet the body’s needs for oxygen and nutrients. This can occur because the heart becomes too weak to pump or very stiff, leading to reduced circulation efficiency. Despite its name, heart failure does not mean the heart has stopped working entirely; rather, it struggles to function properly.

Causes

Heart failure can result from various conditions, including:

Cardiomyopathy (disease of the heart muscle)
Coronary artery disease (blockages in the heart arteries)
High blood pressure
Heart attacks
Other conditions, like diabetes, anemia or thyroid disorders.

Symptoms

Common symptoms include:

Shortness of breath (especially during activity or while lying down)
Fatigue and weakness
Swelling in the legs, ankles, or abdomen (edema)
Persistent coughing or wheezing due to fluid buildup in the lungs
Rapid or irregular heartbeat.

Types

Heart failure can be classified into various types depending on the mode of the disease. Most commonly, it is divided into :

Left Heart Failure: The left side of the heart becomes weak(most common), causing fluid buildup in the lungs.
Right Heart Failure: The right side becomes weak, leading to fluid accumulation in the abdomen and lower extremities (legs).
It can be classified as systolic HF(reduced pumping strength) or diastolic HF(stiff heart muscle). It can also be classified as acute HF and chronic HF, depending on its duration of presentation.

Diagnosis

Diagnosing heart failure involves a combination of clinical evaluation, medical history, and various diagnostic tests. Here’s an overview of the process:

Clinical Evaluation

Physical Examination: Healthcare providers assess symptoms such as shortness of breath, fatigue, swelling in the legs or abdomen, and listen for heart murmurs or abnormal sounds using a stethoscope.
Medical History: Patients are asked about their symptoms, medical history, and risk factors like high blood pressure, coronary artery disease or previous heart attack, or diabetes, etc.

Diagnostic Tests

Blood Tests: These can include measurements of B-type natriuretic peptide (BNP) or N-terminal pro-BNP (NT-proBNP), which are elevated in heart failure.
Chest X-ray: Helps evaluate heart size and detect pulmonary congestion.
Electrocardiogram (ECG or EKG): Assesses heart rhythm and can indicate previous heart damage or irregular heartbeats and rhythm.
Echocardiogram: Uses ultrasound waves to create images of the heart, providing information on heart function, size, and valve performance. It measures ejection fraction (EF), which is crucial for diagnosing and classifying heart failure.
Cardiac MRI: Offers detailed images of heart structures and can help identify specific causes of heart failure.
Coronary Angiogram: Used to identify blockages in heart arteries, when CAD is suspected as the cause of heart failure.

Management

While heart failure is a progressive condition that typically cannot be cured, it can often be managed with medications, lifestyle changes, and supportive care.

Lifestyle Modifications

Dietary Changes: Reducing salt intake to manage fluid retention and avoiding caffeine to prevent irregular heartbeats.
Exercise: Participating in cardiac rehabilitation programs to improve heart health.
Smoking Cessation and Alcohol Limits: Essential for improving outcomes.
Weight Management: Monitoring weight daily to detect fluid retention early

Medications

Various medications are central to managing heart failure and are often used in combination e.g. ARNI, diuretics, MRAs, SGLT2 inhibitors, etc. Apart from these treatments, device-based therapy (e.g. ICD, CRT, assist device) and cardiac surgery are also available in suitable cases.

Management may also include treating underlying conditions like anemia, thyroid disorder, irregular heartbeats, sleep apnea, etc. Treatment plans are individualized and often require lifelong adherence to achieve the best outcomes

Citations:
[1] https://www.webmd.com/heart-disease/guide-heart-failure
[2] https://www.heart.org/en/health-topics/heart-failure/what-is-heart-failure
[3] https://www.healthline.com/health/heart-failure
[4] https://www.nhs.uk/conditions/heart-failure/
[5] https://www.mayoclinic.org/diseases-conditions/heart-failure/symptoms-causes/syc-20373142
[6] https://www.hopkinsmedicine.org/health/conditions-and-diseases/heart-failure
[7] https://www.heart.org/en/health-topics/heart-failure/warning-signs-of-heart-failure