Heart Failure (Congestive Heart Failure)

Heart failure can be caused by heart disease and other conditions that affect the heart’s ability to pump blood effectively. Common causes include:

• Cardiomyopathy, a disease that causes the muscle to weaken. Coronary heart disease and other heart diseases can lead to cardiomyopathy.
• Coronary heart disease refers to the hardening of the arteries supplying blood to the heart due to the build-up of fatty deposits in the walls of the arteries. This restricts the heart’s ability to pump blood. It is one of the most common causes of heart failure.
• Defects of the heart valves, and congenital heart disease (heart defects present at birth).
• High blood pressure, which causes the heart to work harder to supply blood to the body.

Lifestyle factors such as excessive consumption of alcohol and drug abuse can also contribute to heart failure.

If you are suffering from heart failure, you may experience any of the following symptoms:

• Chest pain (angina)
• Fainting and dizziness due to inadequate blood and oxygen supply delivery to organs and muscles
• Fatigue due to inadequate blood and oxygen supply delivery to organs and muscles
• Shortness of breath resulting from fluid build-up in the lungs
• Sudden death
• Swollen feet, ankles and legs resulting from fluid build-up in the veins and body tissues
• Weight gain due to fluid excess in the body
• Weight loss

Seek immediate medical attention if you experience any of the following symptoms:

• chest pain
• severe weakness
• fainting
• rapid or irregular heartbeat accompanied by shortness of breath, chest pain or fainting
• sudden, severe shortness of breath with coughing up of pink, foamy mucous

Your doctor will conduct a physical examination and ask about your symptoms and medical history. Diagnostic tests will help your doctor to eliminate other possible conditions, which may include one or more of the following:

• Blood test to help identify various biomarkers that may indicate or eliminate certain health conditions as well as the performance of organs such as the kidneys and liver.
• Chest X-ray to check for lung congestion or an enlarged heart.
• Electrocardiogram (ECG) to check your heart rhythm and detect arrhythmias. An ECG can also reveal a thickened left ventricle, enlarged heart chambers, or if you’ve had a heart attack before.
• Echocardiography, an ultrasound scan of your heart, assesses the various structures and functions of the heart. It helps to check how well your heart is able to pump blood, and possible causes of heart failure.
• Stress test to check your heart rate and rhythm, breathing and blood pressure while walking or running on a treadmill. It will reveal your heart’s response to exercise, and whether blood supply in the arteries is sufficient.
• Myocardial perfusion scan, in which radionuclides are injected into your bloodstream to reveal how well the heart’s chambers are working or whether a heart attack has damaged your heart.
• Cardiac catheterisation, in which a dye is injected using a small tube or catheter. This is followed by an X-ray to obtain pictures or angiograms to reveal any blockages in the coronary arteries.
• Magnetic resonance imaging (MRI) to reveal your heart’s structure such as its muscle, valves and chambers, and whether there is scarring (permanent damage) of the weakened heart muscle.

Your doctor may recommend a combination of lifestyle changes and medication to try to treat heart failure.

Lifestyle changes would include:

• Maintain a healthy diet
• Consume less salt to reduce swelling
• Quit smoking
• Reduce or eliminate consumption of alcohol and other harmful drugs
• Get regular exercise, with advice from your doctor on suitable activities

Medication may be prescribed to help manage the symptoms of heart failure such as arrhythmia. These may include:

• Diuretics to help eliminate excess fluid in the tissues
• Vasodilators, Angiotensin-Converting Enzyme (ACE) inhibitors, Angiotensin II Receptor Blockers (ARBs) or beta blockers to lower blood pressure and control heart rate

Surgery may be needed to correct heart abnormalities that are causing heart failure. If you are facing end-stage heart failure, one of these procedures may be recommended:

• Defibrillator (pacemaker-like device) to deliver electrical shock to the heart in the event of a dangerous arrhythmia. A special kind of defibrillator, called a Cardiac Resynchronisation Therapy Defibrillator (CRTD), may be implanted in suitable patients to improve the contractility of the heart.
• Ventricular assist devices (VADs) that serve as a mechanical pump to support a weak heart and may be an alternative for those with severe heart failure who are waiting to undergo a heart transplant, or who are not suitable candidates for heart transplant
• Heart transplant from a suitable donor heart may be an option for individuals who are not responding to other treatment options.

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Complications of heart failure will depend on factors such as your overall health and age. These may include:

• Kidney damage, caused by reduced blood flow to the kidneys
• Kidney failure, which will make dialysis necessary
• Heart valve problems, due to an enlarged heart or high pressure in the heart
• Arrhythmias or irregular heart rhythm
• Liver damage, as heart failure can lead to the build-up of fluids. This places increased pressure on the liver, and the build-up of fluids can also lead to scarring and impair liver function further.
• Death