How Does Heart Failure Affect the Body’s Ability to Function?

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In this concise overview, Dr. Vedala Ramakrishna, an experienced medical professional with qualifications in MBBS, delves into the critical aspects of Heart Failure conditions and its management.

Heart failure is a term used to describe a heart that cannot keep up with its workload. The body may not get enough oxygen, which it needs. The human body depends on the heart’s pumping action to deliver oxygen and nutrient-rich blood to the body’s cells. In fact, when the cells are nourished properly, the body can function normally.

With heart failure, the weakened heart cannot supply the cells with enough blood. This results in fatigue and shortness of breath, and some people experience coughing. Routine activities like walking and climbing may result in difficulties. The normal healthy heart, which is a strong muscular pump a little larger than a fist, pumps blood continuously through the circulatory system.

Heart Failure

Heart failure is a clinical syndrome in which cardiac function is abnormal, low cardiac output, and congestive symptoms being prominent.

Heart failure is a chronic progressive condition in which the heart muscle is unable to pump enough blood to meet the body’s needs for blood and oxygen. Heart cannot keep up with the work load.

Pathophysiology

1. Alteration in heart structure (hypertrophy) or enlarging: – The heart stretches to contract more strongly and keep up with the demand to pump more blood. Over time, this causes the heart to enlarge.
2. Developing more muscle mass: The increase in muscle mass occurs because the heart’s contracting cells get bigger. This lets the heart pump more strongly in the initial phase.
3. Pumping faster: – This helps increase the heart’s output.

Heart failure can involve the heart’s left side, right side, or even both sides, but it is more common on the left side. At times, with increased plasma vasopressin and aldosterone, there is a chance of vasoconstriction, which may lead to fluid retention. There is also alteration of increased peripheral resistance and redistribution of blood flow, which causes sodium retention. Also read about “Knee replacement surgery” at https://journals-times.com/2024/06/29/knee-replacement-an-overview-of-procedures-risks-and-recovery/

Left heart failure, left side failure, or acute heart failure

      The leading causes of this type are: –

1. Myocardial damage like MI, Myocarditis, and cardiomyopathy.
2. Increased load like hypertension, valve diseases, and cardiac arrhythmias.

Clinical features

1. Dyspnoea with pink frothy sputum associated with tachypnoea.
2. Cold skin with low blood pressure is associated with tachycardia.
3. Lung crackle with gallop rhythm associated with raised JVP.

Emergency treatment

1. Monitor ECG and urine output.
2. Insert IV line and consider dopamine (5 to 20μ/ KG/min)
3. Oxygen 5 to 6 liters/ min.
4. Frusemide 40 to 80 Mg IV.
5. Morphine 1 to 2 Mg IV.

Investigations

1. Serum biochemistry, blood count, cardiac enzymes.
2. X-ray chest
3. ECG and 2D ECHO.

Management

It depends on the underlying cause. If there is ischemia, then advice for angioplasty or CABG with supportive therapy along with diuretics, vasodilators like ACE inhibitors, and short-period IV inotropic agents.

Right heart failure or chronic heart failure

     The leading causes of this type are: –

1. Pulmonary hypertension is secondary to LHF, chronic lung disease, and pulmonary embolism.
2. Right ventricular infarction and tricuspid valve disorder are associated with right ventricular cardiomyopathy.

Symptoms

1. Weakness, fatigue, and low urinary output with fluid retention and oedema are symptoms of inadequate blood supply to tissue.
2. Headache, insomnia, cough, dyspnoea, Cheyne stokes respiration, anorexia, and vomiting.
3. Pain at right hypochondrium.
4. Nocturia and oliguria with oedema of feet.

These are due to the inability of the heart to empty properly.

Signs

1. Oedema with raised JVP and tender liver.
2. Cardiomegaly with right ventricular gallop with peripheral cyanosis.
3. Cardiac cachexia.

Investigations

1. ECG, Chest X-ray, 2D ECHO (for ejection fraction, which is more important), and Holter.
2. Blood tests and biochemistry tests, including electrolytes related to hypocalcemia, thyroid, anemia, and iron storage diseases.
3. Coronary angiography 
4. Cardiopulmonary exercise test.

Management

1. Rest
2. Low salt intake (2gm salt per day)
3. No alcohol, no smoking.
4. Control of blood pressure.
5. Important treatment is by usage of vasodilators like hydralazine (200mg TDS) and prazosin (.5 mg TDS), which relax veins and arterioles.
6. Apart from the usage of ACE inhibitors, calcium antagonists, carvedilol, beta-blockers, and dobutamine are indicated.
7. Other measures are the usage of sedatives, aminophylline, antibiotics, oxygen therapy, and passive or active exercises.

Sometimes recommended for heart transplantation, cardiomyopathy, TAH (total artificial heart), VAT (ventricular assist device), and other techniques, including high-risk myocardial revascularization, TMR, and Biventricular pacing.

Epidemiological status

Usually, heart failure is known as CHF or CCF, with the frequency of 40 million persons being suffered with a 35 percent risk of death.

Latest development in CCF

Cardiac Resynchronization Therapy (CRT) is a developing treatment strategy for heart failure, especially benefiting patients with specific heart rhythm disorders. Recent advancements in CRT focus on optimizing the pacing technique to enhance patient outcomes.

New studies, such as the His-Purkinje Conduction System Pacing Optimized Trial of Cardiac Resynchronization Therapy (HOT-CRT), have emphasized the effectiveness of left bundle branch area pacing (LBBAP) as a better alternative to traditional biventricular pacing (BVP). This method has shown significant improvements in left ventricular ejection fraction compared to BVP, suggesting a more effective resynchronization of heartbeats in affected patients.

Watch an animation at https://watchlearnlive.heart.org/index.php?moduleSelect=cardrt

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