Understanding Heart Failure: Symptoms, Causes, and Treatment

The heart pumps blood throughout the body, delivering oxygen and nutrients to vital organs. A healthy heart typically beats between 60 and 100 times per minute, efficiently circulating approximately 5 litres of blood per minute. This volume increases significantly during physical activity to meet the body’s increased oxygen demands. However, when the heart’s pumping ability is compromised, heart failure develops. It is a serious condition that should not be ignored.

What Is Heart Failure?

Heart failure, sometimes known as congestive heart failure, is a condition where the heart muscle fails to pump enough blood to meet the body’s needs for oxygen and nutrients. It does not mean the heart has stopped working. Rather, it is not functioning properly. As a result, the heart cannot circulate blood throughout the body. Poor blood circulation due to heart failure often leads to the buildup of fluid in some organs or parts of the body, such as the lungs, legs, and feet.

What Are the Different Types of Heart Failure?

There are several ways of classifying heart failure, including:

Left-Sided Heart Failure

Left-sided heart failure occurs when the left ventricle cannot pump blood efficiently, leading to insufficient oxygen-rich blood supply to the body. This type of heart failure is divided into two main forms:

• Systolic Failure: This occurs when the left ventricle weakens and cannot pump blood efficiently.
• Diastolic Failure: This occurs when the left ventricle stiffens and loses its ability to relax normally.

Right-Sided Heart Failure

Right-sided heart failure often results from left ventricular dysfunction. Increased pressure from the left side strains the right ventricle, which struggles to pump blood to the lungs. This causes blood to back up in the veins, leading to congestion and swelling.

High-Output Heart Failure

This is a less common type of heart failure where the heart works harder than normal but still fails to meet the body's increased demand for blood. Unlike other types, this condition occurs when the heart is strong but the body requires more blood than it can supply. Causes include hyperthyroidism, severe anaemia, or arteriovenous fistulas.

What Are the Four Stages of Heart Failure?

To help categorise the progression and severity of heart failure, it is classified into four stages:

• Stage A: This stage indicates a high risk of developing heart failure without currently having heart disease or experiencing any symptoms.
• Stage B: Individuals in this stage have structural heart disease but do not present any symptoms of heart failure.
• Stage C: Patients at this stage have structural heart disease and they also show signs or symptoms of heart failure.
• Stage D: This most advanced stage of heart failure involves severe symptoms that limit daily activities.

What Are the Symptoms of Heart Failure?

Heart failure can manifest in various ways and the severity of symptoms often depends on the stage of the condition. Common symptoms include:

• Shortness of breath
• Fatigue and weakness
• Swelling in the legs, ankles, and feet
• Rapid or irregular heartbeat
• Reduced ability to exercise

If you experience any of these symptoms, it is crucial to seek prompt medical attention. Early diagnosis and treatment can improve these symptoms and prevent further complications.

What Causes Heart Failure?

Heart failure is often caused by underlying heart conditions that damage or overwork the heart muscle. Some common causes include:

• Coronary Artery Disease (CAD): CAD gradually narrows heart arteries with plaque buildup, reducing blood flow, which can lead to heart attacks and heart failure.
• High Blood Pressure: Chronic high blood pressure overworks the heart, causing it to thicken and weaken, increasing the risk of heart failure.
• Heart Valve Disease: When heart valves malfunction, it forces the heart to work harder to pump blood effectively. Over time, this can weaken the heart and lead to heart failure.
• Myocarditis: This is an inflammation of the heart muscle, often caused by viruses, which can damage the heart muscle and weaken its pumping ability, potentially leading to heart failure.
• Congenital Heart Defect: Heart abnormalities that are present at birth can interfere with normal blood flow through the heart. It can increase the risk of heart failure later in life.
• Arrhythmias: Arrhythmias are irregular heartbeats that can strain the heart and lead to heart failure.

What Are the Risk Factors for Heart Failure?

Beyond having underlying heart conditions, there are several other factors that can increase the risk of developing heart failure, including:

• Being older than 65: As people age, their heart's ability to pump blood efficiently starts to decline.
• Smoking: The harmful chemicals of cigarettes increase the risk of developing various heart conditions which can lead to heart failure over time.
• Lack of physical activity: An inactive lifestyle increases the risk of obesity, diabetes, and high cholesterol, all of which are major risk factors for heart disease and heart failure.
• Eating an unhealthy diet: A diet high in saturated and trans fats, sodium, and cholesterol can contribute to heart disease and increase the risk of heart failure.
• Family history of heart failure: Having a family member with heart failure increases an individual’s likelihood of developing the condition.

How Is Heart Failure Diagnosed?

After a physical examination, several tests may be used to diagnose heart failure and assess its severity, including:

• Blood Tests: These tests can diagnose heart problems which can be associated with heart failure.
• Exercise Stress Tests: These assess how well the heart performs during physical activity to determine the severity of heart failure.
• Chest X-ray: This imaging test can show signs of heart failure such as heart enlargement and fluid buildup in the lungs.
• Electrocardiogram (ECG or EKG): This records the electrical activity of the heart, helping detect abnormalities that can potentially lead to heart failure.
• Echocardiogram: This ultrasound of the heart helps assess the heart's pumping ability and identifies any damage.
• Coronary Angiogram: This imaging test helps detect blockages or narrowing in the coronary arteries that could lead to or worsen heart failure.
• Cardiac MRI: This non-invasive test offers highly detailed images of the heart to evaluate the heart muscle for damage, assess cardiac function, and identify underlying causes of heart failure.

What Are the Treatment Options for Heart Failure?

Heart failure treatment aims to manage symptoms, slow down the disease’s progression, improve heart function and prevent complications. The best treatment depends on the cause and severity of the condition. Some common treatments include:

Medications can help:

• Lower blood pressure and heart rate: Medicines like ACE inhibitors, ARBs, beta-blockers, and vasodilators can help relax blood vessels and reduce strain on the heart.
• Reduce fluid buildup: Diuretics help your body get rid of extra fluid.

Surgery might be needed in some cases:

• Defibrillator: This pacemaker-like device delivers an electrical shock to the heart if dangerous arrhythmias are detected.
• Heart Valve Repair or Replacement: In cases where heart failure is caused by a heart valve, surgical repair or replacement may be necessary to restore normal blood flow.
• Ventricular Assist Device (VAD): This is a mechanical pump implanted in the chest to assist the heart in pumping blood.
• Heart Transplant: In more severe cases, a failing heart will be replaced with a donor heart.

What Are the Potential Complications of Heart Failure?

Prompt treatment is crucial to prevent potentially serious complications. Complications arising from heart failure include:

• Arrhythmias: Irregular heartbeats increase the risk of stroke or sudden cardiac arrest.
• Fluid Buildup: This can lead to fluid in the lungs and swelling in the legs and ankles.
• Kidney Damage: Reduced blood flow to the kidneys can impair their function and lead to kidney failure.
• Liver Damage: Chronic fluid buildup in the liver can cause scarring which makes it more difficult for the liver to work properly.
• Sudden Cardiac Arrest: It is a life-threatening situation where the heart suddenly stops beating due to irregular heart rhythm.

Heart failure is a serious condition that requires comprehensive care to maintain heart health. By understanding the disease and seeking early diagnosis and treatment, patients can eventually improve their condition.

If you suspect you or a loved one may be at risk for heart failure, visit our heart clinic in Singapore. Our cardiologist, Dr Ang Teck Kee, is dedicated to providing the best possible heart care to improve patient’s quality of life through thorough evaluation and personalised advice. Contact us at 9155 2942 to schedule an appointment.