Heart Failure

Heart failure happens when the heart cannot pomp enough blood volume for body metabolism demand. In clinically, there is left and right heart failure but very rare it is happen without involving the other side. Heart failure is almost always a chronic, long-term condition, although it can sometimes develop suddenly.

Heart failure is often classified as either systolic or diastolic.

·          Systolic heart failure means that your heart muscle cannot pump, or eject, the blood out of the heart very well.

·          Diastolic heart failure means that your heart's pumping chamber does not fill up with blood.

The most of etiology of heart failure is heart ischemic disease. It is very important to indicate the cause of heart failure for preventing from losing management of the real problem. 

Other problems that may cause heart failure are:

·          Congenital heart disease

·          Heart valve disease

·          Some types of abnormal heart rhythms (arrhythmias)

·          Hypertension

·          Lung emboli

·          Anemia

·          Thyroids toxicity

·          Myocarditic

·          Infectious Endocarditic

·          Cardiomyophaty

·          Thiamine deficiency  

Diseases such as emphysema, severe anemia, hyperthyroidism, or hypothyroidism, may cause or contribute to heart failure

In left ventricle heart failure we found symptoms: breathe difficulty in activity, orthopne and nocturnal dispne paroxysmal.

In right ventricle heart failure we found symptoms: edema on feet and felling discomfort on upper right quadrant.

The general symptoms are: exhausted and lethargy.

The sigs are: edema on feet and sacrum, increasing of jugular vein pressure, basal crepitating, larger size of liver (hepatomegali) and heard of three and four heart sounds.

The Stages of Heart Failure – NYHA Classification

In order to determine the best course of of therapy, physicians often assess the stage of heart failure according to the New York Heart Association (NYHA) functional classification system. This system relates symptoms to everyday activities and the patient's quality of life.

Class	Patient Symptoms
Class I (Mild)	No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, or dyspnea (shortness of breath).
Class II (Mild)	Slight limitation of physical activity. Comfortable at rest, but ordinary physical activity results in fatigue, palpitation, or dyspnea.
Class III (Moderate)	Marked limitation of physical activity. Comfortable at rest, but less than ordinary activity causes fatigue, palpitation, or dyspnea.
Class IV (Severe)	Unable to carry out any physical activity without discomfort. Symptoms of cardiac insufficiency at rest. If any physical activity is undertaken, discomfort is increased.

Investigation:

1.       Chest X-ray: bigger size of heart (kardiomegali), lung vain stretching, Kerley B line, alveolar edema, and plural effusion.

2.       ECG: hypertrophy of left ventricle, p-mitral in mitral steno tic or evidences of ischemic heart.

3.       Echocardiograph, we can look the heart problem clearly from monitor.

If you have heart failure, your doctor will monitor you closely. You will have follow up appointments at least every 3 to 6 months and tests to check your heart function. For example, an ultrasound of your heart (echocardiogram) will be done once in awhile to see how well your heart pumps blood with each beat.

You will need to carefully monitor yourself and help manage your condition. One important way to do this is to track your weight on a daily basis. Weight gain can be a sign that you are retaining fluid and that your heart failure is worsening. Make sure you weigh yourself at the same time each day and on the same scale, with little to no clothes on.

Other important measures include:

·          Take your medications as directed. Carry a list of medications with you wherever you go.

·          Limit salt intake.

·          Don’t smoke.

·          Stay active. For example, walk or ride a stationary bicycle. Your doctor can provide a safe and effective exercise plan based on your degree of heart failure and how well you do on tests that check the strength and function of your heart. DO NOT exercise on days that your weight has gone up from fluid retention or you are not feeling well.

·          Lose weight if you are overweight.

·          Get enough rest, including after exercise, eating, or other activities. This allows your heart to rest as well. Keep your feet elevated to decrease swelling.

Here are some tips to lower your salt and sodium intake:

·          Look for foods that are labeled “low-sodium,” “sodium-free,” “no salt added,” or “unsalted.” Check the total sodium content on food labels. Be especially careful of canned, packaged, and frozen foods. A nutritionist can teach you how to understand these labels.

·          Don’t cook with salt or add salt to what you are eating. Try pepper, garlic, lemon, or other spices for flavor instead. Be careful of packaged spice blends as these often contain salt or salt products (like monosodium glutamate, MSG).

·          Avoid foods that are naturally high in sodium, like anchovies, meats (particularly cured meats, bacon, hot dogs, sausage, bologna, ham, and salami), nuts, olives, pickles, sauerkraut, soy and Worcestershire sauces, tomato and other vegetable juices, and cheese.

·          Take care when eating out. Stick to steamed, grilled, baked, boiled, and broiled foods with no added salt, sauce, or cheese.

·          Use oil and vinegar, rather than bottled dressings, on salads.

·          Eat fresh fruit or sorbet when having dessert.

Your doctor may consider prescribing the following medications:

·          ACE inhibitors such as captopril, enalapril, lisinopril, and ramipril to open up blood vessels and decrease the work load of the heart

·          Diuretics including hydrochlorothiazide, chlorthalidone, chlorothiazide, furosemide, torsemide, bumetanide, and spironolactone to help rid your body of fluid and salt (sodium)

·          Digitalis glycosides to increase the ability of the heart muscle to contract properly and help treat some heart rhythm disturbances

·          Angiotensin receptor blockers (ARBs) such as losartan and candesartan to reduce the workload of the heart; this class of drug is especially important for those who cannot tolerate ACE inhibitors

·          Beta-blockers such as such as carvedilol and metoprolol, which are particularly useful for those with a history of coronary artery disease

Certain medications may make heart failure worse and should be avoided. These include nonsteroidal anti-inflammatory drugs, thiazolidinediones, metformin, cilostazol, PDE-5 inhibitors (sildenafil, vardenafil), and many drugs that treat abnormal heart rhythms.

Valve replacements or repair coronary bypass surgery (CABG), and angioplasty may help some people with heart failure.

The following devices may be recommended for certain patients:

·          A single or dual chamber pacemaker to help with slow heart rates or certain other heart signaling problems

·          A biventricular pacemaker to help the left and right side of your heart contract at the same time.

·          An implantable cardioverter-defibrillator to correct or prevent severe arrhythmias (abnormal heart rhythms)

Severe heart failure may require the following treatments:

·          Intra-aortic balloon pump (IABP), a temporary device placed into the aorta

·          Left ventricular assist device (LVAD), which takes over the role of the heart by pumping blood from the heart into the aorta; it's most often used by those who are waiting for a heart transplant.

Note: These devices can be life saving, but they are not permanent solutions. Patients who become dependent on circulatory support will need a heart transplant.

Heart failure symptoms may be improved with biventricular pacemaker or cardiac resynchronization therapy. Ask your provider if you are a candidate for this type of treatment.