Heart Failure

The heart muscle weakened due to heart failure
The heart muscle weakened due to heart failure
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What is Heart Failure?

Heart failure is a condition where the heart cannot pump blood sufficiently to meet the body’s need for oxygen and nutrients. This deterioration in the heart’s pumping function typically occurs due to weakening or stiffening of the heart muscle, or a combination of both. Normally, the heart supports all bodily functions by delivering oxygen and nutrient-rich blood to organs and tissues. However, when heart failure develops, this task cannot be performed as required. This can lead to functional disorders in various systems due to inadequate blood supply to organs.

Heart failure can essentially emerge through two different mechanisms:

  • Systolic Heart Failure: The heart muscle cannot contract strongly enough; therefore, not enough blood is pumped to the body with each contraction. This type of heart failure is generally associated with weakening, enlargement, or thinning of the heart muscle.
  • Diastolic Heart Failure: The heart muscle cannot relax sufficiently and becomes stiff; therefore, heart chambers do not fill with the necessary amount of blood. While the heart maintains its blood pumping ability, the volume of pumped blood decreases due to incomplete chamber filling.

In both cases, the functional insufficiency of the heart leads to inadequate supply of oxygen and nutrients needed by the body. This can cause various symptoms such as shortness of breath, fatigue, and edema, and can lead to complications that seriously affect quality of life.

Heart failure can be a chronic (long-term) problem or develop as an acute condition with sudden and severe symptoms. Early diagnosis and treatment are crucial in slowing the progression of the disease and alleviating symptoms.

Symptoms of Heart Failure

Heart failure is a condition where the heart cannot pump sufficient blood to the body. This disorder can manifest with symptoms like shortness of breath, fatigue, edema, rapid weight gain, and irregular heartbeat, and can progress over time. Symptoms may develop gradually or appear suddenly and severely, especially in acute heart failure.

Heart failure symptoms may include:

  • Shortness of breath (especially during exercise or while lying down)
  • Fatigue and weakness
  • Swelling in ankle, leg, and abdomen (edema)
  • Rapid or irregular heartbeat
  • Decreased ability to exercise
  • Loss of appetite and nausea
  • Cough (especially while lying down)
  • Cough with white or pink-tinged sputum
  • Concentration difficulties
  • Wheezing
  • Rapid weight gain

Causes of Heart Failure, Risk Factors

Heart failure develops due to various diseases that cause deterioration in the structure or function of the heart muscle. The most common causes include coronary artery disease, high blood pressure, heart attack, heart valve diseases, and diabetes.

Causes and risk factors of heart failure may include:

  • Coronary artery disease: Narrowing or blockage of blood vessels that feed the heart leads to insufficient oxygen reaching the heart muscle.
  • Chronic high blood pressure (hypertension): The heart’s constant work against increased pressure can cause muscle weakening and functional loss over time.
  • Previous heart attack: Permanent damage to the heart muscle can negatively affect pumping functions.
  • Heart valve diseases: Narrowing, leakage, or improper functioning of heart valves can disrupt blood flow and strain the heart.
  • Cardiomyopathy: Heart muscle diseases arising from genetic or other causes can weaken the heart’s pumping capacity.
  • Diabetes: Blood sugar uncontrollability can damage the heart muscle and increase other risk factors.
  • Obesity: Excess weight can increase the load on the heart, potentially leading to failure in the long term.
  • Congenital heart defects: Inherent structural abnormalities can affect the heart’s normal functioning. Untreated congenital defects or those leading to complications can increase heart failure risk.
  • Aging: Advanced age can reduce heart muscle elasticity and pumping capacity. Additionally, the frequency of high blood pressure, arterial stiffness, and other cardiovascular diseases increases with age, which can create conditions for heart failure development.
  • Alcohol and drug use: Especially long-term or excessive use can cause direct toxic effects on the heart muscle.
  • Family history: Genetic predisposition to heart disease can increase risk factors.

Since most of these causes are controllable or treatable, adopting a healthy lifestyle and maintaining regular health check-ups play a crucial role in reducing heart failure risk.

Stages of Heart Failure

Heart failure is a progressive disease and its severity can increase over time. There are 4 different stages to assess the severity and progression of the disease:

  • Stage Heart Failure: High-Risk Stage: At this stage, the person does not yet have heart failure symptoms or structural heart problems, but has a high risk of developing heart failure. The treatment approach involves controlling risk factors such as high blood pressure, diabetes, and obesity, and making healthy lifestyle changes (regular exercise, healthy nutrition, quitting smoking).
  • Stage Heart Failure: Structural Heart Disease Present, No Symptoms: At this stage, there are changes in the heart structure, but no heart failure symptoms have appeared yet. The treatment approach includes treating the underlying heart disease, medication, regular check-ups, and monitoring.
  • Stage Heart Failure: Structural Heart Disease and Heart Failure Symptoms Present: At this stage, changes in heart structure have occurred and heart failure symptoms have emerged. The treatment approach includes comprehensive medication, lifestyle changes (salt restriction, fluid intake regulation), device treatments if necessary (such as heart pacemakers), regular check-ups, and close monitoring.
  • Stage Heart Failure: Advanced Heart Failure: This is the most advanced stage of heart failure. The person has serious complaints and does not respond to standard treatments. The treatment approach includes advanced treatment options (such as left ventricular assist devices), heart transplant evaluation.

Patients’ stages can change over time, and with appropriate treatment, they can return to a lower stage. Therefore, regular check-ups and treatment adherence are crucial in disease management. Appropriate intervention and lifestyle changes in early stages can slow or stop the progression of the disease.

How is Heart Failure Diagnosed?

Heart failure diagnosis is made through a combination of the patient’s complaints, physical examination findings, and various tests. The diagnostic process typically progresses step by step and may require different tests depending on the patient’s condition.

Methods used for heart failure diagnosis include:

  • Physical examination
  • Blood tests (especially BNP or NT-proBNP tests)
  • Chest X-ray
  • Electrocardiogram (ECG)
  • Echocardiogram
  • Stress test
  • Coronary angiography
  • Cardiac MRI or CT scan

The combination of these tests helps determine the presence, type, cause, and severity of heart failure. The information obtained is critical for creating the most appropriate treatment plan for the patient.

How is Heart Failure Treated?

Heart failure treatment is planned individually based on the cause, severity, and patient’s overall health condition. The primary aim of treatment is to alleviate symptoms, improve quality of life, slow disease progression, and extend life expectancy.

Lifestyle changes and medication take precedence in heart failure treatment. However, as the disease progresses and if treatment response is inadequate, surgical treatments may be introduced. These surgical interventions are typically applied when other treatment methods are insufficient or to correct underlying problems.

Lifestyle Changes

Lifestyle changes are important for reducing the heart’s workload and improving the patient’s overall health. These include:

  • Limiting salt consumption
  • Controlling fluid intake
  • Regular exercise
  • Avoiding harmful habits like smoking and alcohol

Additionally, maintaining an ideal weight through a healthy diet can reduce pressure on the heart. Stress management should also be considered for heart health protection.

Medication Treatment

Medication is used to slow heart failure progression, alleviate symptoms, and improve quality of life. Different medications can be prescribed depending on the type and severity of the disease:

  • ACE inhibitors: Dilate blood vessels, improve blood flow, and reduce the heart’s workload
  • Beta-blockers: Regulate heart rate and enable more efficient heart function
  • Diuretics: Remove excess fluid from the body, alleviating edema and shortness of breath
  • Mineralocorticoid receptor antagonists (MRAs): Can help reduce damage to heart muscle
  • Medications regulating heart rhythm or anticoagulants: May be added in some cases

Both adherence to lifestyle changes and medication treatment are vitally important in heart failure management. Patients should carefully follow doctor’s recommendations and not neglect regular check-ups.

Surgical Treatment Methods

In heart failure treatment, surgical methods can be introduced when lifestyle and medication treatments are insufficient:

  • Coronary Artery Bypass Graft (CABG) Surgery: Increases blood flow to heart muscle by bypassing blockages in blood vessels feeding the heart. Particularly beneficial for patients with heart failure due to coronary artery disease.
  • Heart Valve Repair or Replacement: Applied when heart failure results from improper heart valve function. Damaged valves can be repaired or replaced with artificial valves.
  • Cardiac Pacemakers (ICD and CRT): ICD detects and corrects dangerous heart rhythm disorders and reduces sudden cardiac death risk. CRT improves heart functions by ensuring simultaneous operation of the right and left heart sides.
  • Pericardiectomy: A procedure to surgically remove the pericardium (the membrane surrounding the heart) when its stiffening or adhesions impede heart function.
  • Septal Myectomy: Removal of thickened muscle tissue in the left ventricular outflow tract in cases of hypertrophic cardiomyopathy. This procedure improves blood flow.
  • Left Ventricular Assist Device (LVAD): Used in advanced heart failure patients awaiting heart transplant. LVAD supports the heart’s left ventricle and increases pumping capacity.
  • Heart Transplant: Considered as a final option for advanced heart failure patients where all other treatment options have failed and life expectancy is low.

These surgical methods are selected and applied based on the patient’s condition and needs. Treatment decisions are determined by expert physicians and a multidisciplinary team.

Can Heart Failure Be Prevented?

Preventing heart failure is possible by controlling risk factors and adopting a healthy lifestyle. The fundamental ways to prevent heart failure include:

  • Healthy Nutrition: Implement a diet low in salt, rich in vegetables, fruits, whole grains, and healthy fats. Avoid trans fats, processed foods, and sugar.
  • Regular Exercise: Strengthen your heart muscle and improve blood circulation by exercising at moderate intensity for at least 150 minutes per week.
  • Controlling Blood Pressure and Blood Sugar: Hypertension and diabetes are primary causes of heart failure. Have regular check-ups to keep these diseases under control.
  • Weight Management: Maintaining a healthy body weight reduces the load on your heart and minimizes risks.
  • Avoiding Smoking and Alcohol: Smoking causes vessel blockages that strain the heart. Excessive alcohol consumption can have toxic effects on the heart muscle.
  • Stress Management: Chronic stress can raise blood pressure and create conditions for heart disease. You can reduce stress through methods like meditation, yoga, or developing hobbies.
  • Regular Health Check-ups: If you have risk factors like family history, hypertension, or diabetes, have regular cardiac examinations for early detection.
  • Cholesterol Level Control: High cholesterol narrows vessels and increases heart failure risk. Balance cholesterol levels through healthy nutrition and medication treatment when necessary.

These preventive measures are effective not only in preventing heart failure but also in preventing many heart and vascular diseases. Incorporating healthy habits into your life is the most effective way to protect your heart health.

Conclusion

Heart failure is a serious health problem, but with current treatment methods and approaches, it can be managed effectively. Early diagnosis, creating an appropriate treatment plan, and patient compliance with treatment can positively affect the course of the disease.

Reference: Heart Failure