A patient experiences heart failure when the muscles of the heart do not pump blood as they should. This is often a result of a few conditions like high blood pressure or narrowing of the arteries of the heart. All of these conditions either make your heart weak or stiff, because of which it fails to pump blood effectively. It isn’t possible to reverse every condition that puts you at risk of heart failure. However, you can take measures to improve the symptoms of a healthy and longer life. A few changes in lifestyle might also help improve the quality of life. One of the most effective ways to reduce the risk of heart failure is to control and prevent conditions that lead to heart failures, such as diabetes, high BP, coronary artery, or obesity.

Symptoms

Heart failure can be both acute and chronic. Some common symptoms of heart failure are:

• Breathlessness
• Weakness
• Fatigue
• Constantly wheezing or coughing
• Edema, or swelling in the feet, legs, and ankles
• Inability to exercise
• Irregular or rapid heartbeat
• Urge to urinate at night
• Rapid weight gain
• Nausea
• Loss of appetite
• Swelling in abdomen
• Inability to concentrate
• Reduced alertness
• Chest pain

Causes

Primarily heart failure happens after a series of conditions, which overtime weaken or damage your heart. However, the heart might not necessarily be weak to cause this condition. Sometimes, when the heart becomes too stiff, it can lead to heart failure. In this health issue, the ventricles tend to get stiff and are unable to fill in-between beats. However, in certain cases, the ventricles dilate, and the muscles of the heart are weak and damaged because of which the heart fails to pump blood through the body effectively. When this goes on for some time, the heart is unable to keep up with the day-to-day necessity of pumping the blood to the whole body.

One of the best means to know if the heart is adequately pumping blood is via ejection fraction. It helps in guiding the course of treatment and classifying different heart failures. Usually, in a healthy heart, this fraction is approximately 50%, or even more. It would mean that almost half of the blood that fills up the ventricle is effectively pumped out in every beat.

However, there’s no certainty, and heart failure might also happen to people who have a healthy ejection fraction. It might occur as a result of the stiffness of the heart muscles, which might happen because of high BP.

Medically, heart failure could either involve the left ventricle, or the right ventricle, or even both the ventricles. However, in general, it usually starts in the left ventricle because that is the key pumping chamber.

Types of heart failure

• Left-sided

In this, the fluid retention might happen in the lungs, which might lead to breathlessness.

• Right-sided

In this, the fluid retention might happen in the feet, abdomen, or the legs, leading to swelling.

• Systolic

This might happen when the left side is unable to vigorously contract, which might pose issues in the normal pumping of the blood.

• Diastolic

In this, the left ventricle is unable to fill to its optimal capacity, which could pose a serious problem to individuals.

Heart failure might occur because of some of the following listed conditions. However, this is not an exhaustive list of conditions that can weaken your heart, and there are others that may also lead to that result. Unfortunately, you may have these conditions, but you may not be aware of it.

• High BP

When you have high BP, your heart has to work more, or doubly, to circulate the blood in the body. With time, this exertion can lead to stiffness or weakness of the muscles around the heart.

• Coronary artery
  One of the most common causes of heart failure is a coronary artery. It occurs because of the accumulation of fatty deposits in the arteries. As a result of this, the blood flow is restricted, and this might lead to a heart attack.
• Myocarditis
  This is a condition in which there is certain inflammation in the muscles around the heart. This might happen because of a virus, like COVID-19, and can cause a failure in the left-side.
• Cardiomyopathy
  The damage of the heart muscles is called cardiomyopathy. It could be caused by a slew of reasons, such as alcohol abuse, some diseases, drug-abuse, and infections. Genes, too, might be responsible for this.
• Arrhythmias
  Arrhythmias is a condition in which the rhythms of the heart are abnormal. It means that the heart beats faster or slower than usual. When the heart beats faster, it has more work to do. On the other hand, a slower heartbeat, too, could be problematic.
• Congenital defects
  Sometimes the chambers or the valves of the heart aren’t properly formed. This would force the healthy parts to work extra hard to pump blood. As a result, there’s an increased chance of heart failure.
• Faulty valves
  Valves play an important role in the blood flowing in the right direction. If the valve is damaged, it can weaken the heart.
• Other diseases
  Diseases such as HIV, hypothyroidism, diabetes, and the build-up of protein or iron can also put you at risk of heart failure. Allergic reactions, viruses attacking the heart, clots in the lungs, infections, an illness that has an impact on the whole body, or certain medications can also put you at risk of this heart condition.

Risk factors

• High BP
  If your BP is high, the heart has to work harder than usual.
• Diabetes
  People with diabetes are at an increased risk of coronary artery disease and high BP.
• Coronary artery disease
  Because of this, the arteries narrow down and limit the amount of oxygen in the blood.
• Heart attack
  A heart’s ability to pump blood is likely to be severely hampered post a heart attack.
• Sleep apnea
  It is a condition in which you are unable to breathe properly at night, causing abnormal heartbeats and reduced oxygen levels, either of which can hamper the heart functioning.
• Viruses
  A virus attack, too, can lead to heart failure.
• Diabetes medications
  Medications used in diabetes, such as pioglitazone and rosiglitazone, are known to increase the risk of heart failure.
• Other medications
  Other medications, such as antiarrhythmic medications, NSAIDs, anesthesia medications, or the medications used to cure urological conditions, psychiatric conditions, high BP, neurological conditions, infections, lung conditions, cancer, inflammatory conditions, and blood conditions can put you at risk of heart failure.
• Valvular heart disease
  Those with this disease are at a higher risk of heart failure.
• Congenital heart defects
  Those born with structural heart defects are at risk of heart failure.
• Obesity
  People who are overweight are at a higher risk of heart disease.
• Tobacco usage
  Those who consume tobacco are also at risk of this condition.
• Irregular heartbeats
  Irregular heartbeats can weaken the heart and put you at risk of this condition.

Prevention

To prevent heart failure, you will have to work towards reducing the risk factors. These are issues such as high BP or coronary artery disease, which can be significantly controlled or eliminated. All you need to do is make a few lifestyle changes and take your medications properly.

Some lifestyle changes needed are:

• Quitting smoking
• Not stressing too much
• Maintaining a healthy body weight
• Keeping a check on diabetes and high BP
• Exercising regularly
• Eating a balanced nutritious diet

Diagnosis

For the doctor to diagnose heart failure, he/she will review your symptoms, take a good look at your medical history, and conduct a physical examination. The presence of different risk factors will also be analyzed.

• Physical examination

With the help of a stethoscope, the doctor will try to find out if there are any abnormalities in your heart rate. It could suggest heart failure. This would be followed by an analysis of fluid build-up in legs and abdomen, and examination of the neck veins.

Once the physical examination is done, you might have to undergo a couple of further tests, as given below.

• Blood tests

This is done to check the presence of NT-proBNP chemicals in the blood.

• X-ray

X-ray of the chest is done to determine the condition of your heart and the lungs.

• ECG

ECG is used to diagnose the damage already done to the heart. It also helps study problems with heart rhythm.

• Echocardiogram

This is done to see check abnormalities in the shape or size of the heart.

• Stress test

This test is done to understand how well your heart responds in times of exertion.

• CT-scan and MRI

Both of these give inside images of the chest for a detailed analysis.

• Myocardial biopsy

This is done to diagnose different diseases related to the heart muscle, which might be the cause of failure.

• Coronary angiogram

This is done to check if there’s any visible blockage in the arteries.

Treatment

The treatment technique used for heart failure primarily depends on the severity of the condition. When the treatment starts early, it helps improve symptoms quickly. However, despite it all, your doctor may recommend that you undergo regular testing in a gap of three to six months. The primary goal of heart failure treatment is to increase your lifespan.

Some treatment measures used include:

Medication
Usually, medication is used to treat the early stages of the disease. It can help restrict the condition from getting worse and keeping a check on the symptoms. You’ll be prescribed medications to:

• Reduce heart rate, if required
• Get rid of blood clots
• Enhance the heart’s natural ability to pump blood
• Replenish potassium levels
• Get rid of surplus sodium
• Maintain the cholesterol level

Before stopping or starting a new medicine, you should always consult your doctor.

Surgery

Sometimes people who suffer from heart failure might need a surgery called a coronary bypass. In this, your doctor will open up a new pathway for the blood to flow, instead of it having to use the blocked artery.

Angioplasty might also be recommended. Here, a small balloon along with a catheter is inserted in the narrow or the blocked artery. Once the catheter comes in contact with the blocked artery, the doctor will inflate the balloon. As a result of inflation, the artery opens up. To keep this blocked artery open, a permanent stent might be placed to keep the artery open and restrict its narrowing.

Some people might also need pacemakers, which will help control heartbeats. The pacemaker is placed inside the chest to either increase or slow down the heartbeat. It is mostly used in combination with the medications and bypass surgery.

If there is no other recourse, and the patient is in the final stage of the disease, then he/she might be recommended a heart transplant. As part of this surgery, the doctor will remove either a part or whole of your heart and replace it with a healthier one from a suitable donor.

Diet and heart failure

A few changes in your diet can also prevent the symptom flare-up and keep the condition in check.

Changes needed

• Try to switch to the Mediterranean or a DASH diet
• Eat a diet rich in nutritional values
• Eat more of a plant-based diet that is a mix of whole grains, beans, fruits, vegetables, legumes, seeds, and nuts
• Include low-fat dairy in your diet

Avoid the following food items

• Red meat
• Saturated fats
• High-cholesterol foods
• Sodium- or sugar-rich foods
• Avoid frozen meals, canned soups, cured meats, salad dressings, rice mixes, seasoned pasta, snack foods, crackers, and the like
• Restrict fluid intake and keep a check on the amount of fluid you consume every day
• Stop alcohol consumption

However, before you cut out or add a particular food item in your diet, it is best to speak to your health professional. Sometimes, a particular food item might cause symptoms in one person but might be safe for another. So, try to restrict foods that either aggravate your symptoms or worsen your health.