Heart failure - symptoms and treatment

Heart failure - symptoms and treatment

Heart Failure Definition

Heart Failure - The inability of the HEART to adequately pump BLOOD. Heart failure may affect the right heart (pulmonary circulation), left heart (body circulation), or total heart. Heart failure, occasionally called by its antiquated name dropsy, is a consequence of longstanding CARDIOVASCULAR DISEASE (CVD) that has damaged the structure of the heart. About 5 million Americans live with heart failure.

CONDITIONS THAT CAN CAUSE HEART FAILURE
ATHEROSCLEROSIS CARDIOMYOPATHY
certain arrhythmias CONGENITAL HEART DISEASE
CORONARY ARTERY DISEASE (CAD) HEART ATTACK
HYPERTENSION (high BLOOD PRESSURE) long-term ALCOHOL abuse
PRIMARY PULMONARY HYPERTENSION VALVULAR HEART DISEASE

Symptoms of Heart Failure and Diagnosis

The key symptoms of heart failure are shortness of breath (DYSPNEA) and fluid retention (edema). Because symptoms come on gradually as the heart failure progresses, many people are unaware of them until they notice fatigue, weakness with exertion, rapid or unexplained weight gain, and frequent URINATION. Right heart failure tends to produce peripheral edema (swelling of the lower legs, ankles, and feet). Left heart failure tends to produce central edema (fluid accumulation in the LUNGS), also known as congestive heart failure. Progressive heart failure generally affects the total heart, though right or left failure may be dominant. The diagnostic path typically includes chest X-RAY, which shows fluid accumulation in the lungs and enlargement of the heart, as well as ELECTROCARDIOGRAM (ECG) to assess the heart’s electrical activity. Heart failure often causes ARRHYTHMIA. ECHOCARDIOGRAM shows the heart’s function and size.

Heart Failure Treatment Options and Outlook

Treatment targets any causative cardiovascular conditions, such as CORONARY ARTERY DISEASE (CAD) and HYPERTENSION. Surgery may correct valve dysfunctions or previously undetected congenital abnormalities such as septal defect. Medications can effectively manage heart failure for many years, allowing people to work and enjoy recreational activities. However, as heart failure progresses, it imposes greater restrictions on physical activity. People who have end-stage heart failure may benefit from a ventricular assist device (VAD), a mechanical pump implanted in the chest cavity that aids the heart in pumping blood. This allows the heart to rest and sometimes to recuperate. The VAD also can serve as a bridge to HEART TRANSPLANTATION, another treatment option for end-stage heart failure.

MEDICATIONS TO TREAT HEART FAILURE
Medication TypeRepresentative MedicationsEffects
angiotensin II receptor inhibitors losartan, valsartan, telmisartan dilate arteries; lower BLOOD PRESSURE
angiotensin-converting enzyme (ACE) inhibitors captopril, enalapril, ramipril, benazepril, monopril dilate arteries; lower blood pressure; slow progression of HEART FAILURE
anticoagulants warfarin, heparin, aspirin reduce blood’s tendency to clot
beta blockers carvedilol, metoprolol, propranolol, sotalol, timolol regulate HEART RATE
calcium channel blockers amlodipine dilate arteries; lower blood pressure
diuretics hydrochlorothiazide, furosemide, bumetanide, metolazone reduce fluid accumulations (edema)
inotropics digoxin, digitoxin strengthen heart MUSCLE; decrease heart’s workload
vasodilators nitroglycerin, isosorbide, hydralazine, minoxidil relax and open blood vessels

Risk Factors and Preventive Measures

Underlying cardiovascular conditions are the most important risk factors for heart failure, particularly those that are undiagnosed or poorly managed (notably hypertension and CAD). Lifestyle measures to prevent cardiovascular disease, such as daily physical exercise and not smoking, reduce the likelihood of heart failure as well. CARDIAC REHABILITATION following heart attack can restore heart function to the extent possible. Other preventive measures include careful management of conditions such as DIABETES and OBESITY (including WEIGHT LOSS AND WEIGHT MANAGEMENT) that can lead to cardiovascular disease.

See also CARDIOVASCULAR DISEASE PREVENTION; MEDICATIONS TO TREAT CARDIOVASCULAR DISEASE; PHYSICAL EXERCISE AND CARDIOVASCULAR HEALTH; VENTRICULAR ASSIST DEVICES (VADS).

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