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Revision as of 11:54, 27 July 2011
For the WikiDoc page for this topic, click here
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Jinhui Wu, MD
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What is heart failure?
Heart failure is a clinical syndrome in which the heart can not pump enough blood throughout the body. It can be caused by many types of cardiovascular diseases, such as coronary artery disease, hypertension, diabetes, valve heart diseases and endocrinic diseases. Usual signs and symptoms include blood and fluid to back up into the lungs, edema in the feet, ankles and legs, tiredness and shortness of breath. Patent's symptoms, echocardiogram and cardiac MRI can be evidence to assess the heart function. Treatments include treating the underlying cause of your heart failure, medicines, percutaneous coronary intervention, left ventricular assist device (LVAD) and heart transplantation. The prognosis of heart failure varies widely. It depends on the cause of heart failure, left ventricular ejection fraction and the duration of the disease.
How do I know if I have heart failure and what are the symptoms of heart failure?
Early heart failure does not have any symptoms. As the disease developes, people may notice one or more of the following symptoms:
- Shortness of breath during physical activity
- Difficulty breathing when lying in a flat position
- Palpitation
- Hemoptysis or pink frothy sputum
- Blood and fluid to back up into the lungs
- Edema in the feet, ankles and legs
- Tiredness
- Swollen neck (jugular) veins
Other health problems may also cause these symptoms. Only a doctor can tell for sure. A person with any of these symptoms should tell the doctor so that the problems can be diagnosed and treated as early as possible.
Who is at risk for heart failure?
Certain factors increase your risk of getting heart disease, then increase your risk of getting heart failure. You are at a higher risk if you are:
- A woman age 55 or older
- A man age 45 or older
- Obesity or overweight
- Smoking
- High cholesterol
- High blood pressure
- Heavy drinking
- Diabetes
- Lack of exercise
How to know you have heart failure?
- BNP(Brain natriuretic peptide)/ NT-proBNP (N-terminal pro b-type natriuretic peptide) test: Either BNP or NT-proBNP may be used to help diagnose heart failure and to grade the severity of that heart failure. Foremore, the levels can help doctors differentiate between heart failure and lung diseases.
- Echocardiogram: This is a painless and no risk test for patients. Cardiac echo can demonstrate both structure and function of the heart. It can tell the doctor the left ventricular ejection fraction and help doctor detect the heart function.
- Chest X-ray: The test can creat the picture of the heart and lungs. When heart failure appears, the picture may show largened heart and pulmonary venous pleonaemia.
- Cardiac MRI (magnetic resonance imaging): Cardiac MRI can create both still and moving pictures of the heart and major blood vessels. It can help doctors analyse the structure and function of the heart and decide the treatment protocols for the patient.
- Cardiac biomarkers: This is a blood test. It needs to be done to identify your basic cardiac diseases such as acute coronary syndrome.
- Electrocardiogram: This is a simple and painless test that records the heart's electrical activity. It is needed to detect your primary cardiac diseases.
- Thoracentesis: In heart failure, the pleural space is filled with more fluid than normal and it can cause patient feels shortness of breath. During the procedure, the doctor inserts a thin needle or plastic tube into the pleural space and draws out the excess fluid to detect the cause of the pleural effusion.
When to seek urgent medical care?
Patients with early heart failure can compensate. With the disease developing, the heart function decompensate and patients demonstrate a series of signs and symptoms. Call your health care provider if symptoms of heart failure develops. If you experience either of the following symptoms, seeking urgent medical care as soon as possible:
- Serious shortness of breath
- Patients can not lie in flat at night, even orthopnea.
- Hemoptysis or congh pink frothy sputum
Treatment options
Patients with heart failure have many treatment options. The selection depends on the condition of the disease. The options are general therapy, medications, percutaneous coronary intervention (PCI) and heart transplantation.
General therapy: Because heart failure is a clinical syndrome of multiple heart diseases, the following measurements are important.
- Treating basic cardiac disease such as controlling blood pressure, improving myocardial perfusion and surgery for impaired heart valves.
- Removing incentives such as treating pneumonia, arrhythmia, hypokalemia.
- Having a good rest, a low-sodium diet and managing stress.
Medications:
- Diuretics: Diuretics can release the symptom of shortness of breath and the sign of edema quickly. There are three kinds of diuretics, loop diuretics, thiazides and potassium-sparing diuretics. The patients should take the medicines under the doctor's direction and check the blood level of electrolyes regularly.
- Angiotensin converting enzyme inhibitor (ACEI): Angiotensin converting enzyme inhibitor (ACEI) is widely used in cardivascular diseases. This includes a large group of drugs, such as Enalapril (Vasotec/Renitec), Ramipril (Altace/Tritace/Ramace/Ramiwin), Quinapril (Accupril), Perindopril (Coversyl/Aceon), Lisinopril (Lisodur/Lopril/Novatec/Prinivil/Zestril) and Benazepril (Lotensin). They can improve symptoms and prognosis of heart failure by several ways. Uasual side effects include dry cough and angioedema. Patients who can not tolerate cough are often switched to angiotensin II receptor antagonist. Patients with renal artery stenosis on both sides or severe renal impairment are not appropriate for angiotensin converting enzyme inhibitor (ACEI).
- Angiotensin II receptor antagonist: These type of drugs can block the activation of angiotensin II AT1 receptors. Blockade of AT1 receptors directly causes vasodilation, reduces secretion of vasopressin, reduces production and secretion of aldosterone. Because angiotensin II receptor antagonists do not inhibit the breakdown of bradykinin or other kinins, and are thus only rarely associated with the persistent dry cough and/or angioedema that limit ACE inhibitor therapy. Usual used drugs in heart failure are Candesartan, Valsartan, Telmisartan, Losartan, Irbesartan, and Olmesartan.
- Beta blockers: Beta blockers can reduce heart rate which will lower the myocardial energy expenditure and then prolong the diastolic filling and lengthen coronary perfusion. It can also improve the ejection fraction of the heart and decrease the toxicity of catecholamine on myocardium. Clinical trials show Bisoprolol, Carvedilol and sustained-release Metoprolol are specifically indicated as adjuncts to standard ACE inhibitor and diuretic therapy in congestive heart failure. Patients with asthma, severe conduction block or severe heart failure are not appropriate for beta blockers. You should take these type of medicines under the doctor's direction.
- Digitalis: Digitalis can strengthen the contractility of the heart. But because the pharmacokinetics of digoxin are complex, and the toxic levels are only slightly higher than therapeutic levels, digoxin dosing must be directed by the cardiologists.
Percutaneous coronary intervention (PCI):
- Coronary artery disease (CAD) is the main cause of heart fsailure. Removing the blockages in coronary artery can improve overall heart function, which may improve or resolve heart failure symptoms. The procedure is usually performed in the cardiac catherization lab. A catheter, a very small tube with a tiny deflated balloon on the end, is inserted through an incision in the groin area and pushed through to the diseased artery. Then the balloon is inflated to push open the artery. The balloon is removed once the artery has been fully opened. A stent may be placed during the procedure to keep the blood vessel open. Clinical trials have demonstrated that percutaneous coronary intervention (PCI) is a very effective and safe procedure to reopen blocked vessels and can improve the patient's condition.
Left ventricular assist device (LVAD)
- The left ventricular assist device (LVAD) is a mechanical pump-type device that can help maintain the pumping ability of a heart unable to effectively work on its own. One typical type of LVAD will have a tube going into the left ventricle that pulls blood from the ventricle into a pump. The pump then sends blood into the aorta. LVADs are typically used for weeks to months.
- Heart transplant may be the only effective treatment option for patients with severe, progressive heart failure that can not be helped by medications and dietary and lifestyle changes. During a transplant procedure, the surgeons connect the patient to a heart-lung machine, which takes over the functions of the heart and lungs. Then the surgeons remove the diseased heart and replace it with the donor heart. Finally, the major blood vessels are reconnected and the new heart is ready to work. The outlook for people with heart transplants is good during the first few years after the transplant. Over 85 percent of patients live for more than a year after their operations.
Diseases with similar symptoms
- Ischemic heart disease
- Idiopathic dilated cardiomyopathy
- Hypertension
- Valvular heart disease
- Familial dilated cardiomyopathy
- Bacterial myocarditis
- Parasitic myocarditis
Where to find medical care for heart failure?
Directions to Hospitals Treating heart failure
Prevention of heart failure
Heart failure is a terminal syndrome of heart diseases. And heart disease is the leading cause of the death and a major cause of disability in the U.S. Cardiologists have verified there are many things you can do reduce your chances of getting heart disease. Keeping track of symptoms and reporting any changes that concern you to your healthcare professonal and working more closely with your healthcare team.
- Monitoring your blood pressure
- Exercise regularly
- Quitting smoking
- Checked for diabetes and if you have it, keep it under control
- Know your cholesterol and triglyceride levels and keep them under control
- Eat a lot of fruits and vegetables
- Maintain a healthy weight
- Managing stress
What to expect (Outook/Prognosis)?
The prognosis of people with heart failure can vary dramatically. The following factors may help the doctor estimate the prognosis.
- The severity of the symptoms: It is well established that patients who have more severe symptoms of heart failure do not survive as long as those who have mild symptoms. For example, patients with class IV heart failure have the poorest prognosis, while patients with class I have the best.
- Heart function: The ejection fraction of left ventricle (LVEF) is an important indicator of the prognosis. The more severely damaged your heart muscle is, the worse your ejection fraction and worse prognosis will be, regardless of your symptoms.
- The causes of heart failure: Heart failure associated with alcohol use or pregnancy may spontaneously recover itself over time. Heart failure can be caused by treatable conditions such as hyperthyroidism or hypothyroidism, anemia, or vitamin deficiency. The prognosis of these conditions are generally excellent. Heart failure as a result of a valve condition may also be reversible if the valve problem is recognized early and fixed before permanent damage happens. People with heart failure caused by severe hypertension may see considerable improvement of their symptoms when they control their hypertension. But the majority of patients have heart failure as a result of coronary artery disease (CAD) have a worse prognosis and a higher death rate than people who have heart failure that is not a result of CAD.
- How long you've had heart failure: There is no specific length of time after which your heart function is unlikely to improve. General speaking, the longer you have had heart failure, the poorer prognosis may be even with appropriate treatment.
- Compensatory factors: "compensatory factors" are various adjustments to correct the effects of heart failure on other organs. When heart failure occurs, various hormone levels including renin, aldosterone, norepinephrine, atrial natriuretic peptide, and prostaglandin, may increase. Increases in these hormonal factors and other compensatory factors often make heart failure worse over time.