The heart failure is the inability of the heart to pump enough blood to meet the needs of the organization. It is a serious health problem that results, among other things, in breathlessness and tiredness disproportionate to the effort produced.
It usually occurs in individuals whose health has been weakened for several years by heart or respiratory disorders or by hypertension.
The number of cases of heart failure has increased over the last 30 years 11 . Among the reasons for this increase, there is the improvement of the treatment of heart disorders and the prolongation of the life expectancy of those affected. Although recent statistics are not available, heart failure is a major cause of death in the elderly . The survival rate 5 years after diagnosis is approximately 50% .
Causes of Heart failure
The heart failure occurs when the heart no longer has as much force to expel blood in the arteries and it fills less blood because it is stiffened or dilated. Each contraction of the heart is therefore less effective. The blood takes longer to pass through the arteries and tends to stagnate in the veins. It is because of this congestion of blood in the veins that it is called congestive heart failure.
Usually, heart failure reaches either of the 2 ventricles, right or left. In some cases, both ventricles may be affected.
- Left heart failure. This is the most common form. Fluids accumulate in the tissues and are concentrated mainly in the lungs, causing marked breathing difficulties (shortness of breath, wheezing, etc.). Untreated or poorly treated high blood pressure for several years and coronary disorders (heart weakened by attacks of angina pectoris or infarction) are the main culprits;
- Heart failure right. This time, the accumulation of fluids is mainly located in the legs and ankles , causing their swelling . It is often caused by left heart failure, but may also be the result of lung disease, such as chronic bronchitis, emphysema, or pulmonary embolism.
The heart is composed of 4 cavities :
To see how the blood flows in the heart, watch our animation by clicking on the illustration at the beginning of the card.
When the circulation of the blood is less well, the heart compensates by contracting more strongly and accelerating its beats. The heart muscle gets bigger to pump more blood. The kidneys, which also receive less blood, respond by limiting fluid losses through urine. This phenomenon is called water retention . Water retention results in swelling and an increase in blood volume, which in turn helps to tire the heart. Fatigue and shortness of breath set in. Over time, the heart can no longer provide the extra effort.
In the vast majority of cases, heart failure is chronic . The tiredness is often the first symptom to appear. As the disease progresses, shortness of breath appears on exertion and then on rest.
Sometimes the treatment of the cause of heart failure makes it disappear (for example, a cardiac malformation corrected by surgery). In other cases, medications and the adoption of healthy lifestyle habits provide better comfort and help to resume certain neglected activities.
The New York Heart Association defines 4 stages of heart failure progression based on the level of physical activity tolerated.
|Stages of evolution of the disease||Limitation of physical activities||symptoms|
|Class I (light)||No limitation||No abnormal breathlessness at the least effort, or fatigue in everyday life.|
|Class II (light)||Light limitation||No discomfort at rest, but symptoms appears during moderate intensity physical activity.|
|Class III (moderate)||Frank limit||The symptoms appear during physical activities, even light. Comfortable at rest only.|
|Class IV (severe)||Major limitation||The symptoms are manifest even at rest.|
They vary according to the health status of the person, his age, the cause of heart failure and its severity.
Left untreated, heart failure can quickly lead to serious complications. Fluids accumulate in the lungs and make breathing difficult. The risks of arrhythmia and cardiac arrest increase. In addition, if a blood clot forms in the veins, it can obstruct the pulmonary artery ( pulmonary embolism), a life-threatening problem. Finally, in the absence of treatment, heart failure can damage the liver and kidneys, which are vital organs.
Diagnosis of heart failure
The clinical examination that allows the doctor to diagnose heart failure may be supplemented by more in-depth examinations to determine its cause and severity.
- Blood test. The determination of the various constituents of blood (cholesterol, glucose, potassium, creatinine , etc.) provides information on the cause of heart failure and the state of sensitive organs, such as the kidney or liver. Natriuretic peptide type B (BNP) can also be assayed to determine the degree of insufficiency;
- X-ray of the chest. The silhouette of the heart visible on the X-ray informs of its state (of its volume, for example) and also of possible causes of its dysfunction. In addition, this test makes it possible to check the presence of liquid in the lungs;
- Electrocardiogram. This examination consists of measuring the electrical activity of the heart. It is not invasive and does not cause any pain. It can detect arrhythmias and electrical conduction disorders inside the heart. It can be practiced at rest or during an effort;
- Echocardiography. This is an ultrasound of the heart. This visual examination of the heart makes it possible to verify its state: the existence of a malformation, the size of the ventricles, the state of the valves of the heart, the traces of an old infarction, etc.
Symptoms of heart failure
- Constant fatigue;
- Shortness of breath caused by less and less effort;
- A short, wheezing breath. Difficulty in breathing increases when lying down;
- Of pain or “tightness” in the chest ;
- An increase in the frequency of nocturnal urination;
- Weight gain due to water retention (ranging from a few pounds to over 10 pounds);
- Cough in case of accumulation of fluids in the lungs.
Distinctive features of left heart failure
- Severe breathing difficulties, given the accumulation of fluids in the lungs;
Distinctive features of right heart failure
- Swelling of the legs and ankles;
- Swelling of the belly;
- A feeling of heaviness more pronounced;
- Digestive problems and liver damage.
People at risk for Heart failure
- People with coronary disorders (angina pectoris, myocardial infarction) or cardiac arrhythmia. About 40% of people with myocardial infarction will have heart failure. This risk decreases when the infarction is well treated, early;
- People born with a congenital heart defect that achieves the contractile function of one or other of the ventricles of the heart ;
- People with heart valve problems ;
- People with chronic lung disease .
The most importants
- Severe anemia;
- Untreated hyperthyroidism;
- Sleep apnea;
- Physical inactivity;
- A diet rich in salt;
- Metabolic syndrome;
- Alcohol abuse.
Prevention of heart failure
|Basic preventive measures|
|The first preventive measures to be taken are to reduce the risk factors mentioned above. These risk factors are the same as those that are associated with cardiac disorders secondary to atherosclerosis (angina pectoris and myocardial infarction). They are closely linked to lifestyle habits : a healthy and varied diet, physical exercise, stopping smoking and if necessary, the control of hypertension, cholesterol and diabetes. For more details on prevention, see our cardiac disorders card.
Periodically consult your doctor for a checkup. If in doubt, the doctor may suggest an evaluation of ventricular function by echocardiography.
|Measures to prevent aggravation or complications|
|Consult a doctor as soon as the first symptoms appear. Early diagnosis, good medical follow-up , medication if necessary, but also lifestyle improvements can slow the progression of the disease.
In addition to the factors mentioned in the basic preventive measures, ensure :
In addition, avoid the following factors , which accentuate the symptoms:
Since infections affecting the respiratory tract aggravate symptoms of heart failure, vaccination against influenza and against pneumococcal disease is recommended.
Medical treatment of heart failure
|In case of acute crisis
In case of acute attack , marked by difficulty breathing or severe pain in the lungs, contact the emergency services as soon as possible.
While waiting for help, put the person in a seated position and give him nitroglycerin (previously prescribed). This fast acting medicine dilates the arteries of the heart. Acute attacks occur mostly at night.
When the cause is treatable, one must first tackle it. For example, repairing or replacing a heart valve can put an end to heart failure .
When it is not possible to act directly on the cause, the treatments aim at relieving the symptoms. It is quite possible to regain quality of life and slow down the progression of the disease. With new treatments, it is sometimes even possible to reduce the disease.
Importantly, the sooner the disease is diagnosed, the more effective the treatment. Unfortunately, she is often diagnosed at an advanced stage.
Of clinical heart failure related to hospitals offer therapeutic monitoring and full information. The services of several counselors are available: cardiologist, nurse, pharmacist, dietitian, physiotherapist and social worker.
For the majority of people, it will be necessary to take medication . Often, three or four types of drugs are combined to achieve optimal results. Their action is complementary: some, for example, help to strengthen the heart , others to reduce water retention.
Inhibitors of Angiotensinogen Converting Enzyme (ACEI). Their vasodilator action (which increases the opening of the arteries) has the effect of lowering blood pressure and reducing the effort required in the heart . In addition, they reduce the retention of water and salts by the kidneys. ACE inhibitors prevent the formation of angiotensin II, a vasoconstrictor substance (which reduces the opening of arteries) that increases blood pressure. This type of medicine causes an irritating cough in about 10% of its users. Examples include lisinopril, captopril and enalapril.
Blockers of angiotensin II receptors. These drugs block the vasoconstrictor effect of angiotensin II by preventing it from attaching to its site of action. Their effect is therefore similar to that of ACEIs. Examples include losartan and valsartan.
Beta-blockers. These drugs (for example, carvedilol, bisoprolol and metoprolol) reduce the frequency of heartbeat and allow better contraction of the heart.
Diuretics. Mostly used to treat hypertension, diuretics may also be useful in heart failure . By increasing the volume of urine, they help eliminate excess fluids that accumulate in the lungs or limbs. The most commonly used are furosemide and bumetanide. These diuretics cause the loss of minerals, such as potassium and magnesium. Supplementation is justified in some cases, depending on the results obtained during blood tests.
Antagonists of aldosterone. This type of medicine has a diuretic effect but does not cause loss of potassium (a potassium sparing diuretic). Spironolactone and eplerenone (Inspra) are examples. Aldosterone is a substance produced by the adrenal glands that increases blood pressure. This type of medicine is particularly effective in cases of severe heart failure .
Digoxin. Its tonic effect on the heart makes it possible to obtain more effective cardiac contractions. In addition, it slows and regulates the heart rate . Digoxin is extracted from the foxglove, an herbaceous plant.
Way of life
Improving fitness is also part of the therapeutic approach. It plays a determining role on the symptoms. Anything that reduces cardiac stress has a beneficial effect:
- Weight loss;
- Meals less rich and less salty;
- Less frequent consumption of red meat;
- A walking routine;
- Ways to be less stressed, etc.
The doctor or nurse in the heart failure clinic offers advice on this.
Some surgical procedures may be prescribed to treat the cause of heart failure. Thus, it is possible to restore blood flow in a coronary artery obstructed by atherosclerosis, using coronary angioplasty or coronary artery bypass surgery (for more information, see our card on heart disorders). In the case of certain arrhythmias, an artificial pacemaker or defibrillator may be implanted if there is a high risk of cardiac arrest.
- Valvular surgery. Heart failure can be caused by the failure of a heart valve. Depending on the problem, the doctor may decide to repair the valve (valvuloplasty) or replace it with a prosthesis;
- Heart transplant. Cardiac transplantation is sometimes considered, especially in people under 65 years old because of the scarcity of organ donors.
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